Abstract
Purpose
Cross-sectional and interventional study to assess pelvic floor muscle (PFM) function in healthy young nulliparous women and to determine the effects of a 3-month PFM training program with emphasis on co-contraction of PFM and anterolateral abdominal muscles and on correctly performed coughing patterns.
Methods
PFM function was assessed by digital vaginal palpation in 40 volunteers and graded according to the 6-point Oxford grading scale. The PFM training program was comprised theoretical instruction, as well as verbal feedback during hands-on instruction and repeated training sessions focussing on strengthening PFM and anterolateral abdominal muscle co-contraction during forced expiration and coughing.
Results
At baseline, 30 women (75%) were able to perform normal PFM contractions at rest (Oxford scale score ≥3); only 4 of them (10%) presented additional involuntary PFM contractions before and during coughing. The remaining 10 women (25%) were unable to perform voluntary or involuntary PFM contractions. Mean Oxford scale score in the whole group was 3.3 ± 1.7. After completing the PFM training program, 29 women (72.5%) performed cough-related PFM contractions and group mean Oxford scale score increased significantly to 4.2 ± 1.0.
Conclusions
The study shows that PFM dysfunction may be detected even in healthy young women. Multidimensional training, however, may significantly improve PFM function.
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Abbreviations
- BMI:
-
Body mass index
- FPFQ:
-
Female pelvic floor questionnaire for clinicians and researchers
- IAP:
-
Intra-abdominal pressure
- PFM:
-
Pelvic floor muscles
References
Messelink B, Benson T, Berghmans B, Bo K, Corcos J, Fowler C et al (2005) Standardisation of terminology of pelvic floor muscle function and dysfunction: report from the pelvic floor clinical assessment group of the international continence society. Neurourol Urodyn 24:374–380
Bump R, Hurt WG, Fantl JA, Wymann JF (1991) Assessment of Kegel pelvic muscle exercise performance after brief verbal instruction. Am J Obstet Gynecol 165:322–329
Dietz HP, Steensma AB, Vancaillie TG (2003) Levator function in nulliparous women. Int Urogynecol J 14:24–26
Thompson JA, O’Sullivan PB, Briffa NK, Neumann P (2006) Assessment of voluntary pelvic floor muscle contraction in continent and incontinent women using transperineal ultrasound, manual muscle testing and vaginal squeeze pressure measurements. Int Urogynecol J 17:624–630
Talasz H, Himmer-Perschak G, Marth E, Fischer-Colbrie J, Hoefner E, Lechleitner M (2008) Evaluation of pelvic floor muscle function in a random group of adult women in Austria. Int Urogynecol J 19:131–135
Spiteri M, Khullar V (2008) Epidemiology of urinary incontinence. In: Haslam J, Laycock J (eds) Therapeutic management of incontinence and pelvic pain, 2nd edn. Springer, London, pp 21–26
Dumoulin C, Hay-Smith J (2010) Pelvic floor muscle training versus no treatment, or inactive control treatments, for urinary incontinence in women. Cochrane Database Syst Rev (1) (Art. No.: CD005654)
Bo K (2004) Pelvic floor muscle training is effective in treatment of female stress urinary incontinence, but how does it work? Int Urogynecol J 2:76–84
Miller JM, Perucchini D, Carchidi LT, DeLancey JOL, Ashton-Miller J (2001) Pelvic floor muscle contraction during a cough and decreased vesical neck mobility. Obstet Gynecol 97:255–260
Sapsford RR, Hodges PW, Richardson CA, Cooper DH, Markwell SJ, Jull GA (2001) Co-activation of the abdominal and pelvic floor muscle during voluntary exercises. Neurourol Urodyn 20:31–42
Neumann P, Gill V (2001) Pelvic floor and abdominal muscles interaction: EMG activity and intra-abdominal pressure. Int Urogynecol J 13:125–132
Sapsford R (2004) Rehabilitation of pelvic floor muscles utilizing trunk stabilization. Man Ther 9:3–12
Hodges PW, Sapsford RR, Pegel LHM (2007) Postural and respiratory functions of the pelvic floor muscles. Neurourol Urodyn 26:362–371
Junginger B, Baessler K, Sapsford R, Hodges PW (2010) Effect of abdominal and pelvic floor tasks on muscle activity, abdominal pressure and bladder neck. Int Urogynecol J 21:69–77
Talasz H, Kremser C, Kofler M, Kalchschmid E, Lechleitner M, Rudisch A (2011) Phase-locked parallel movement of diaphragm and pelvic floor during breathing and coughing—a dynamic MRI investigation in healthy females. Int Urogynecol J Pelvic Floor Dysfunct 22:61–68
Cresswell AG, Grundström H, Thorstensson A (1992) Observations on intra-abdominal pressure and patterns of abdominal intra-muscular activity in man. Acta Physiol Scand 144:409–418
Laycock J (2009) Concept of neuromuscular rehabilitation and pelvic floor muscle training. In: Baesler K, Schüssler B, Burgio KL, Moore KH, Norton PA, Stanton SL (eds) Pelvic floor re-education. Springer, London, pp 179–180
Rock CM (2006) Action of the transversus abdominis muscle when posture is physiological. In: Carriere B, Feldt CM (eds) The pelvic floor, 2nd edn. Thieme, New York, pp 101–107
Bo K, Morkved S, Frawley H, Sherburn M (2009) Evidence for benefit of transversus abdominis training alone or in combination with pelvic floor muscle training to treat female urinary incontinence: a systematic review. Neurourol Urodyn 28(5):368–373
Baessler K, O’Neill SM, Maher CF, Battistutta D (2010) A validated female pelvic floor questionnaire for clinicians and researchers. Int Urogynecol J Pelvic Floor Dysfunct 21:163–172
Laycock J, Whelan MM, Dumoulin C (2008) Patient assessment. In: Haslam J, Laycock J (eds) Therapeutic management of incontinence and pelvic pain. Springer, London, pp 57–66
Hay-Smith EJC, Bø K, Berghmans LCM, Hendriks HJM, de Bie RA, van van Waalwijk Doorn ESC (2001) Pelvic floor muscle training for urinary incontinence in women. Cochrane Database Syst Rev (1) doi:10.1002/14651858.CD001407 (Art. No.: CD001407)
Chiarelli P (2009) Postpartum management of the pelvic floor. In: Baessler K, Schüssler B, Burgio KL, Moore KH, Norton PA, Stanton SL (eds) Pelvic floor re-education. Springer, London, p 240
Miller JM, Ashton-Miller JA, DeLancey JO (1998) A pelvic muscle pre-contraction can reduce cough-related urine loss in selected women with mild SUI. J Am Geriatr Soc 46:870–874
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The authors declare that they have no financial interest or any other conflict of interest that might affect this article.
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Talasz, H., Kalchschmid, E., Kofler, M. et al. Effects of multidimensional pelvic floor muscle training in healthy young women. Arch Gynecol Obstet 285, 709–715 (2012). https://doi.org/10.1007/s00404-011-2039-y
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DOI: https://doi.org/10.1007/s00404-011-2039-y