Common errors made in attempt to contract the pelvic floor muscles in women early after delivery: A prospective observational study

Neels, Hedwig; Wachter, Stefan De; Wyndaele, Jean‐Jacques; Aggelpoel, Tinne Van; Vermandel, Alexandra

doi:10.1016/j.ejogrb.2017.11.019

Cited by 24 publications

(19 citation statements)

References 18 publications

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“…During a clinical examination for PFDs, patients are often asked to perform exercises, such as Valsalva, cough or to “squeeze”. Differences in patients’ ability to comprehend or execute the desired activity lead to variability in response . Some may not correctly activate their pelvic floor muscles, whereas others may recruit different muscle groups without engaging their pelvic floor muscles, thereby increasing their IAP.…”

Section: Discussionmentioning

confidence: 99%

“…Differences in patients' ability to comprehend or execute the desired activity lead to variability in response. 6,23,24 Some may not correctly activate their pelvic floor muscles, whereas others may recruit different muscle groups without engaging their pelvic floor muscles, thereby increasing their IAP. A simple intravaginal pressure measurement will record the total effect of all pressure increases rather than those specific to the pelvic floor musculature.…”

Section: Advantages Of Probe Expansionmentioning

confidence: 99%

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A fiber‐optic sensor‐based device for the measurement of vaginal integrity in women

Parkinson

Rosamilia

Mukherjee

et al. 2019

Neurourology and Urodynamics

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Aims Pelvic floor disorders (PFDs) in women are a major public health concern. Current clinical methods for assessing PFDs are either subjective or confounded by interference from intra‐abdominal pressure (IAP). This study introduces an intravaginal probe that can determine distributed vaginal pressure during voluntary exercises and measures the degree of vaginal tissue support independent of IAP fluctuations. Methods An intravaginal probe was fabricated with 18 independent fiber‐optic pressure transducers positioned along its upper and lower blades. Continuous pressure measurement along the anterior and posterior vaginal walls during the automated expansion of the probe enabled the resistance of the tissue to be evaluated as a function of displacement, in a manner reflecting the elastic modulus of the tissue. After validation in a simulated vaginal phantom, in vivo measurements were conducted in the relaxed state and during a series of voluntary exercises to gauge the utility of the device in women. Results The probe reliably detected variations in the composition of sub‐surface material in the vaginal phantom. During in‐vivo measurements the probe detected distributed tissue elasticity in the absence of IAP change. In addition, the distribution of pressure along both anterior and posterior vaginal walls during cough, Valsalva and pelvic floor contraction was clearly resolved with a large variation observed between subjects. Conclusions Our data highlight the potential for the probe to assess the integrity of the vagina wall and support structures as an integrated functional unit. Further in vivo trials are needed to correlate data with clinical findings to assist in the assessment of PFDs.

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Section: Discussionmentioning

confidence: 99%

Section: Advantages Of Probe Expansionmentioning

confidence: 99%

A fiber‐optic sensor‐based device for the measurement of vaginal integrity in women

Parkinson

Rosamilia

Mukherjee

et al. 2019

Neurourology and Urodynamics

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“…Women in the vaginal palpation group had statistically significant best improvement in symptoms of UI, assessed by the ICIQ‐UI‐SF . Neels et al (2018) found that 57% of women 2 days after vaginal delivery contracted muscles other than the PFM when trying to contract the PFM . In a cohort study following 300 first time mothers from gestational week 21 till 12 months postpartum, only 4% were not able to contract after thorough instruction and use of manual techniques at gestational week 21 .…”

Section: Discussionmentioning

confidence: 99%

“…In addition, Neels et al (2018) found that contracting muscles other than the PFM reduced the ability to contract the PFM postpartum. However, they also found that co‐contraction of outer pelvic muscles could be easily unlearned by visual observation and verbal feedback …”

Section: Discussionmentioning

confidence: 99%

Can you train the pelvic floor muscles by contracting other related muscles?

Kruger

Budgett

Goodman

et al. 2018

Neurourology and Urodynamics

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Aims The aim of this study is to assess whether contraction of muscles other than the pelvic floor muscles (PFM) would be of sufficient magnitude to provide a “training” effect for the pelvic floor. Methods Women were recruited via advertisement from a convenience sample of pelvic floor physiotherapists. A thin flexible array of pressure sensors (FemFit) was self‐inserted into the vagina. Participants performed three maximum pelvic floor contractions and completed a randomized exercise protocol. Maximum pressures were determined for each sensor, for each exercise. Wilcoxon paired tests were used to ascertain the difference in pelvic floor muscle pressure between exercises, and between the pressures from the pelvic floor muscles sensors and those measuring abdominal pressure. Bonferroni correction α 0.005. Results Data was obtained from nineteen participants. Mean age 43 ± 11 years, BMI 22.4 ± 3.2 kg m−2. Mean PFM pressure for pelvic floor muscle contractions was 16.3 ± 12.2 mmHg. Pressure in the region of the pelvic floor was significantly higher during a targeted contraction compared to that for all other exercises, except for cough and curl‐ups (P = 0.009, P = 0.013 respectively). PFM pressure was significantly higher than abdominal for PFMC, internal rotators and gluteals (P < 0.001). Conclusion Targeted PFM contractions develop higher pressures compared to abdominal pressure than any exercise tested in this study. The Femfit device was able to distinguish between abdominal and pelvic floor muscle pressures simultaneously. Exercising accessory muscles in an attempt to activate the pelvic floor sufficiently to illicit a training effect is not recommended.

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“…To evaluate PFM function, the following assessment schedule and interpretations of assessment have been described in the "Royal Dutch Society for Physiotherapy (KNGF) practice guidelines for patients with stress urinary incontinence" (Fig. 2) PFMs in relation to the ability to isolate a PFM contraction with only appropriate rather than excessive co-activation of the abdominal muscles [31]. & Quantify the strength, endurance, and explosive strength of the PFMs using manual muscle tests, such as vaginal or anal palpation [29] or using manometry [32] or dynamometry [33].…”

Section: Pelvic Examination and Vaginal Assessmentmentioning

confidence: 99%

Physiotherapy assessment for female urinary incontinence

2020

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Introduction and hypothesis As noted in the 6th International Consultation on Incontinence (ICI) chapter "Initial Management of Urinary Incontinence in Women" recommendations call for including physiotherapy as a first-line therapy. Methods Building on this, checking available scientific evidence and using the International Classification of Functioning, Disabilities and Health, the following represents a holistic physiotherapist approach for initial evaluation of the health problem of urinary incontinence. Results This paper proposes a teaching module for every relevant health care professional dealing with the assessment of adult female urinary incontinence, focusing on optimal patient selection and appropriate treatment choice. Conclusion The assessment stage involves the explicit decision as to whether "physiotherapy" is the treatment indicated for the patient, based on the findings of the physiotherapy assessment and supplemented by any medical information that accompanied the referral and evaluation.

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Common errors made in attempt to contract the pelvic floor muscles in women early after delivery: A prospective observational study

Cited by 24 publications

References 18 publications

A fiber‐optic sensor‐based device for the measurement of vaginal integrity in women

A fiber‐optic sensor‐based device for the measurement of vaginal integrity in women

Can you train the pelvic floor muscles by contracting other related muscles?

Physiotherapy assessment for female urinary incontinence

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