Inappropriate pelvic floor muscle activation during forced exhalation and coughing in elderly female inpatients with urinary incontinence

Talasz, Helena; Kofler, Markus; Mariacher, Romana; Lechleitner, Monika

doi:10.1016/j.physio.2021.04.003

Cited by 9 publications

(8 citation statements)

References 27 publications

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“…As a result, it increases the urethral pressure and closes the urethra, consistent with strategies for urinary continence [ 20 ]. However, in SUI patients, inadequate contraction of TrA during expiration leads to abdominal wall bulging [ 21 ], and the PFM is forced down, thereby decreasing urethral pressure [ 20 ]. Tajiri et al also noted the importance of TrA muscle, and reported a decrease in its thickness as the predictor of urinary incontinence [ 22 ].…”

Section: Discussionmentioning

confidence: 99%

Lateral abdominal muscle thickness during breathing maneuvers in women with and without stress urinary incontinence

et al. 2023

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Introduction and hypothesis Stress urinary incontinence (SUI) patients predominantly experience involuntary leakage during respiratory functions that induce a rapid increase in intra-abdominal pressure (IAP) such as coughing and sneezing. The abdominal muscles have an important role in the forced expiration and modulation of IAP. We hypothesized that SUI patients have different thickness changes in the abdominal muscles compared to healthy individuals during breathing maneuvers. Methods This case–control study was conducted on 17 adult women with SUI and 20 continent women. Muscle thickness changes were measured by ultrasonography at the end of deep inspiration and expiration, and the expiratory phase of voluntary coughing for external oblique (EO), internal oblique (IO), and transverse abdominis (TrA) muscles. The percent thickness changes of muscles were used and analyzed with a two-way mixed ANOVA test and post-hoc pairwise comparison at a confidence level of 95% ( p < 0.05). Results The percent thickness changes of TrA muscle were significantly lower in SUI patients at deep expiration ( p < 0.001, Cohen's d = 2.055) and coughing ( p < 0.001, Cohen's d=1.691). While, percent thickness changes for EO ( p = 0.004, Cohen's d=0.996) and IO thickness ( p < 0.001, Cohen's d=1.784) were greater at deep expiration and deep inspiration, respectively. Conclusions The percent thickness changes of abdominal muscles differed between women with and without SUI during breathing maneuvers. The present study provided information regarding the altered function of abdominal muscles during breathing maneuvers; therefore, it is important to consider the respiratory role of abdominal muscles for the rehabilitation of SUI patients. Supplementary Information The online version contains supplementary material available at 10.1007/s00192-023-05458-9.

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Section: Discussionmentioning

confidence: 99%

Lateral abdominal muscle thickness during breathing maneuvers in women with and without stress urinary incontinence

et al. 2023

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“…The studies were published from 1990 to 2022. 16,27,33 In relation to study design, nine were short-term experimental studies 7,10,[16][17][18][19][20]33,34 while nine were RCTs. 12,[21][22][23][24][25][26][27]35 3.1 | Short-term experimental studies and used surface electromyography (sEMG), manometer, ultrasound, or magnetic resonance imaging (MRI) to assess response from the PFM during respiration.…”

Section: Resultsmentioning

confidence: 99%

“…Most studies included healthy participants, while two studies were assessing women with SUI or UI. 16,33 Three studies did not use methods to control for correct contraction of the PFM. 10,20,34 Three studies evaluated hypopressive technique (combination of excessive expiration and abdominal contraction).…”

Section: Resultsmentioning

confidence: 99%

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Can you breathe yourself to a better pelvic floor? A systematic review

Bø

Driusso

Ferreira

2023

Neurourology and Urodynamics

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Introduction: Some authors suggest that breathing exercises should be recommended instead of or in combination with pelvic floor muscle training (PFMT) to prevent and treat urinary incontinence (UI) and pelvic organ prolapse (POP). Aims: The primary aim of the present study was to investigate the evidence for breathing as an intervention alone or in addition to PFM contraction in treatment of UI and POP.Materials & Methods: This systematic review included short-term experimental studies and randomize controlled trials (RCTs) indexed on PubMed, EMBASE, and PEDro database. A form was used to extract data that was analyzed qualitatively due to the heterogeneity in interventions and outcome measures of the included studies. The individual methodological quality of RCTs was analyzed using the PEDro scale. Results: A total of 18 studies were included, 374 participants from short-term experimental studies and 765 from nine RCTs. PEDro score varied from 4 to 8.Activation of the PFM during expiration was significantly less than during a PFM contraction. In general, the RCTs showed that training the PFM is significantly more effective to improve PFM variables and UI and POP than breathing exercises, and that adding breathing exercises to PFMT have no additional effect. Conclusion: This systematic review indicates that the evidence for incorporating breathing exercise in clinical practice in addition to or instead of PFMT is scant or non-existing, both based on short-term experimental studies and small RCTs.

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“…Breathing patterns affect intra‐abdominal pressure and continence 25 but breathing disorders and altered breathing patterns are also indirectly related to pain 1 . Hyperventilation is a risk factor for pelvic pain, because it increases sympathetic arousal and alters motor control 26 .…”

Section: Resultsmentioning

confidence: 99%

Nurses' role in the management of persons with chronic urogenital pelvic pain syndromes: A scoping review

Terzoni¹,

Ferrara²,

Parozzi³

et al. 2022

Neurourology and Urodynamics

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Background Pelvic pain has cognitive, behavioral, sexual, and emotional consequences. Nurses involved in pelvic floor rehabilitation clinics have contacts with patients reporting chronic pain and should know the most appropriate service for patient referral, to submit the problem to professionals capable of correctly assessing and managing the condition. Furthermore, in some countries nurses can use conservative methods to treat the painful symptoms inside a multidisciplinary team such as breathing retraining, biofeedback, and noninvasive neuromodulation. This paper aims to provide an overview of the literature regarding the role of rehabilitation nurses in dealing with patients suffering from chronic urogenital pelvic pain or urogenital painful syndromes, inside a multidisciplinary team. Methods Scoping review on Pubmed, CINAHL, Embase, Scopus, Web of Science including trials, reviews, case studies or series, and other descriptive studies regarding the role of nurses inside the multidisciplinary team in the management of males and females presenting chronic pelvic pain (CPP) or chronic pelvic pain syndrome (CPPS). Results The 36 papers included in this review allowed answering research questions in four areas of nursing: collecting basic information, referring the person to appropriate services, evidence‐based nursing interventions for CPP and CPPS, and proper documentation. Clinical history and assessment of breathing pattern, Muscular assessment and research of trigger points are the main points of data collection. Techniques for muscular relaxation and breathing retraining are important aspects of treatment, as well as biofeedback and noninvasive neuromodulation where the law allows nurses to practice such techniques. The McGill pain questionnaire and the pain inventory of the International Pain Society allow systematic data collection and handover. Conclusion Rehabilitation nurses work inside multidisciplinary teams when dealing with persons suffering from pelvic pain; further research is needed as our comprehension of the underlying pathophysiological mechanisms of CPP and CPPS evolve.

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Inappropriate pelvic floor muscle activation during forced exhalation and coughing in elderly female inpatients with urinary incontinence

Cited by 9 publications

References 27 publications

Lateral abdominal muscle thickness during breathing maneuvers in women with and without stress urinary incontinence

Lateral abdominal muscle thickness during breathing maneuvers in women with and without stress urinary incontinence

Can you breathe yourself to a better pelvic floor? A systematic review

Nurses' role in the management of persons with chronic urogenital pelvic pain syndromes: A scoping review

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