Assessment of voluntary pelvic floor muscle contraction in continent and incontinent women using transperineal ultrasound, manual muscle testing and vaginal squeeze pressure measurements

Abstract

The aims of the study were: (1) to assess women performing voluntary pelvic floor muscle (PFM) contractions, on initial instruction without biofeedback teaching, using transperineal ultrasound, manual muscle testing, and perineometry and (2) to assess for associations between the different measurements of PFM function. Sixty continent (30 nulliparous and 30 parous) and 60 incontinent (30 stress urinary incontinence (SUI) and 30 urge urinary incontinence (UUI)) women were assessed. Bladder neck depression during attempts to perform an elevating pelvic floor muscle (PFM) contraction occurred in 17% of continent and 30% of incontinent women. The UUI group had the highest proportion of women who depressed the bladder neck (40%), although this was not statistically significant (p=0.060). The continent women were stronger on manual muscle testing (p=0.001) and perineometry (p=0.019) and had greater PFM endurance (p<0.001) than the incontinent women. There was a strong tendency for the continent women to have a greater degree of bladder neck elevation than the incontinent women (p=0.051). There was a moderate correlation between bladder neck movement during PFM contraction measured by ultrasound and PFM strength assessed by manual muscle testing (r=0.58, p=0.01) and perineometry (r=0.43, p=0.01). The observation that many women were performing PFM exercises incorrectly reinforces the need for individual PFM assessment with a skilled practitioner. The significant correlation between the measurements of bladder neck elevation during PFM contraction and PFM strength measured using MMT and perineometry supports the use of ultrasound in the assessment of PFM function; however, the correlation was only moderate and, therefore, indicates that the different measurement tools assess different aspects of PFM function. It is recommended that physiotherapists use a combination of assessment tools to evaluate the different aspects of PFM function that are important for continence. Ultrasound is useful to determine the direction of pelvic floor movement in the clinical assessment of pelvic floor muscle function in a mixed subject population.

Força muscular do assoalho pélvico entre mulheres continentes jovens e climatéricas

“…Alguns estudos relatam que muitas mulheres apresentam dificuldades em realizar uma contração correta dos MAP na primeira avaliação, e isso sugere que a elevação do assoalho pélvico não é uma resposta automática à solicitação de "contrair e sustentar" o assoalho pélvico O'SULLIVAN, 2003;TALASZ et al, 2005;THOMPSON et al, 2006b). Thompson et al (2006a) observaram que, durante a avaliação da contração do assoalho pélvico ocorre manobra de valsalva em 25% a 43% das mulheres com incontinência urinária e prolapso.…”

“…Thompson et al (2006a) observaram que, durante a avaliação da contração do assoalho pélvico ocorre manobra de valsalva em 25% a 43% das mulheres com incontinência urinária e prolapso. Em outros estudos Thompson et al (2006b) …”

Evaluation of pelvic floor muscle anatomy and function in women: modern techniques

“…Dno miednicy nie jest organem odizolowanym -kurcząc się, koaktywuje mięśnie brzucha i przeponę, aby wygenerować i utrzymać ciśnienie wewnątrzbrzuszne [2][3][4]. Dlatego w jakiejkolwiek ocenie prawidłowego uniesienia mięśni dna miednicy podczas skurczu należy brać pod uwagę aktywność innych mięśni w obrębie jamy brzusznej czy miednicy.…”

“…skali Oxford (r zawiera się w przedziale 0,703-0,814) [32] oraz skali Brink (r = 0,68) [28]. Korelacja była dobra (ICC = 0,72), gdy porównywano maksymalne ciśnienie do ruchu podstawy pęcherza moczowego ocenianego w USG TA [33], lub korelacja była umiarkowana, gdy porów-nywano maksymalne ciśnienie do ruchu szyi pęcherza moczowego ocenianego w USG TP (r = 0,43) [4]. Prawdziwość i wiarygodność pomiarów jest także wspierana przez badania wykazujące zmiany tych samych wartości przed leczeniem i po leczeniu [34], czy różnice mię-dzy grupami, np.…”

“…Prawdziwość i wiarygodność pomiarów jest także wspierana przez badania wykazujące zmiany tych samych wartości przed leczeniem i po leczeniu [34], czy różnice mię-dzy grupami, np. u kobiet trzymających mocz w porów-naniu z pacjentkami z nietrzymaniem moczu [4].…”