Are visual inspection and digital palpation reliable methods to assess ability to perform a pelvic floor muscle contraction? An intra‐rater study

Pena, Caroline Caetano; Bø, Kari; Ossa, Aura M P de la; Fernandes, Ana Carolina Nociti Lopes; Aleixo, Devechio N; Oliveira, Flávia M F de; Ferreira, Carmen V.

doi:10.1002/nau.24609

Cited by 5 publications

(7 citation statements)

References 25 publications

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“…We identified differences in muscle function by thorough pelvic floor musculature assessment that prevented undesirable activity in other muscles, with the same well‐experienced pelvic floor physical therapist performing all assessments. 24 As such, inter‐rater reliability issues were not present, but intra‐rater reliability might limit the outcomes of our study. We are unaware of previous studies on the inter‐rater and intrarater reliability in male pelvic floor assessment, reflecting a lack of studies on the male pelvic floor.…”

Section: Discussionmentioning

confidence: 91%

“…Furthermore, we included men of all ages with and without PFS, and we used validated questionnaires with clear cut‐off values. We identified differences in muscle function by thorough pelvic floor musculature assessment that prevented undesirable activity in other muscles, with the same well‐experienced pelvic floor physical therapist performing all assessments 24 . As such, inter‐rater reliability issues were not present, but intra‐rater reliability might limit the outcomes of our study.…”

Section: Discussionmentioning

confidence: 99%

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Exploring pelvic floor muscle function in men with and without pelvic floor symptoms: A population‐based study

Notenboom‐Nas

Vries

Beijer

et al. 2022

Neurourology and Urodynamics

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Background: Pelvic floor symptoms (PFS), such as lower urinary tract symptoms, defecation disorders, sexual problems, and genital-pelvic pain, are prevalent in men. Thorough physical assessments of the external anal sphincter (EAS) and the puborectal muscle (PRM) are the keys to unraveling the role of muscle dysfunction. Objectives: To explore associations within and between the EAS and PRM and between muscle (dys-) function and the number of male PFS. Methods: This cross-sectional study purposively enrolled men aged ≥21 years with 0-4 symptoms from a larger study. After extensive external and internal digital pelvic floor assessment, we explored (1) agreement between muscle function of the EAS versus PRM (using cross tabulation), (2) associations within and between the EAS and PRM (using heatmaps), and (3) associations between muscle function and number of PFS (using a visual presentation [heatmaps] and χ 2 tests). Results: Overall, 42 out of 199 men (21%) had completely normal muscle function. Sixty-six (33.2%) had no symptoms, of which 53 (80%) had some degree of muscle dysfunction. No clear dose-response relationship existed between muscle (dys-) function and the number of symptoms. The PRM showed both more dysfunction and severer dysfunction than the EAS. Conclusions: No clear association exists between muscle dysfunction and the number of symptoms, and the absence of PFS does not indicate normal muscle function for all men. Dysfunction levels are highest for the PRM. Further pelvic floor muscle research is warranted in men with PFS.

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Section: Discussionmentioning

confidence: 91%

Section: Discussionmentioning

confidence: 99%

Exploring pelvic floor muscle function in men with and without pelvic floor symptoms: A population‐based study

Notenboom‐Nas

Vries

Beijer

et al. 2022

Neurourology and Urodynamics

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“…Third, the unequal distribution of PFS between sexes might have influenced our results by the over‐representation of certain groups. Fourth, although the same experienced female pelvic floor physical therapist performed all assessments in this study to prevent interobserver variation, we acknowledge the lack of previous studies on inter‐rater and intrarater reliability in male PFM assessment 24 . While our reliance on one assessor for PFM assessments might have introduced systematic errors, it will also have prevented differences in outcomes of PFM function due to different assessors.…”

Section: Discussionmentioning

confidence: 99%

“…Fourth, although the same experienced female pelvic floor physical therapist performed all assessments in this study to prevent interobserver variation, we acknowledge the lack of previous studies on inter-rater and intrarater reliability in male PFM assessment. 24 While our reliance on one assessor for PFM assessments might have introduced systematic errors, it will also have prevented differences in outcomes of PFM function due to different assessors. Fifth, bias may have resulted from enquiring about PFM function and by virtue of participants having complaints.…”

Section: Prm (Table 2)mentioning

confidence: 99%

Comparing male and female pelvic floor muscle function by the number and type of pelvic floor symptoms

Notenboom‐Nas

Vries

Dekker

et al. 2023

Neurourology and Urodynamics

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Pelvic floor symptoms (PFS), including lower urinary tract symptoms, defecation problems, sexual dysfunction, and pelvic pain, are common in males and females. Comparing pelvic floor musculature (PFM) function between sexes may reveal important differences relevant to clinical care. This study aimed to compare male and female PFM function and to assess the function of both sexes with the number and type of PFS.Methods: We purposively enrolled males and females aged ≥ 21 years with 0-4 PFS based on questionnaire responses in an observational cohort study.Participants then underwent PFM assessment, and muscle function in the external anal sphincter (EAS) and puborectal muscle (PRM) were compared between sexes. The relationships between muscle function and the number and type of PFS were explored. Results: Of the invited 400 males and 608 females, 199 and 187 underwent PFM assessment, respectively. Compared with females, males more often showed increased EAS and PRM tone during assessments. Compared with males, females more often showed weaker maximum voluntary contraction (MVC) of the EAS and dysfunctional endurance of both muscles; additionally, those with zero or one PFS, sexual dysfunction, and pelvic pain more often showed a weak MVC of the PRM. Conclusions: Despite a few similarities between males and, females we found differences in muscle tone, MVC, and endurance between male and female PFM function. These findings provide useful insights into the differences in PFM function between males and females.

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“…The ability to contract the PFM will be considered present when there is occlusion and/or occlusion and elevation of the PFM towards the pubic symphysis and absent when there is no perceived internal movement. Additionally, muscle contraction will be graded according to the Modified Oxford Grading Scale (MOGS) [ 15 , 16 ]. Contractions of muscles such as gluteus, adductor, and abdominal will be discouraged by the examiner.…”

Section: Methodsmentioning

confidence: 99%

Effect of pelvic floor muscle training on reports of urinary incontinence in obese women undergoing a low-calorie diet before bariatric surgery — protocol of a randomized controlled trial

Mendes,

Fretta,

Camargo

et al. 2023

Trials

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Background Obesity represents a growing threat to health with multiple negative impacts including urinary incontinence. Pelvic floor muscle training (PFMT) is the first line of treatment for urinary incontinence. Both surgical and conservative weight loss results in improvement of urinary incontinence reports in obese women and we hypothesize that a low-calorie diet in combination with PFMT would result in additional beneficial effects to urinary symptoms in women with UI compared would with weight loss alone. Objective To assess the effect of a low-calorie diet plus PFMT protocol in obese women’s urinary incontinence reports. Methods This is a protocol for a randomized controlled trial that will include obese women reporting UI and being able to contract their pelvic floor muscles. The participants will be randomly allocated in two groups: group 1 will participate in a 12-week protocol of low-calorie diet delivered by a multi-professional team at a tertiary hospital; group II will receive the same low-calorie diet protocol during 12 weeks and will additionally participate in 6 group sessions of supervised PFMT delivered by a physiotherapist. The primary outcome of the study is self-reported UI, and severity and impact of UI on women’s quality of life will be assessed by the ICIQ-SF score. The secondary outcomes will be adherence to the protocols assessed using a home diary, pelvic floor muscle function assessed by bidigital vaginal palpation and the modified Oxford grading scale, and women’s self-perception of their PFM contraction using a questionnaire. Satisfaction with treatments will be assessed using a visual analog scale. The statistical analysis will be performed by intention to treat and multivariate analysis of mixed effects will be used to compare outcomes. The complier average causal effects (CACE) method will be used to assess adherence. There is an urgent need for a high-quality RCT to investigate if the association of a low-calorie diet and PFMT can provide a larger effect in the improvement of urinary incontinence reports in women with obesity. Trial registration Clinical Trials NCT04159467. Registered on 08/28/2021.

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Are visual inspection and digital palpation reliable methods to assess ability to perform a pelvic floor muscle contraction? An intra‐rater study

Cited by 5 publications

References 25 publications

Exploring pelvic floor muscle function in men with and without pelvic floor symptoms: A population‐based study

Exploring pelvic floor muscle function in men with and without pelvic floor symptoms: A population‐based study

Comparing male and female pelvic floor muscle function by the number and type of pelvic floor symptoms

Effect of pelvic floor muscle training on reports of urinary incontinence in obese women undergoing a low-calorie diet before bariatric surgery — protocol of a randomized controlled trial

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