Pelvic floor and abdominal muscle cocontraction in women with and without pelvic floor dysfunction: a systematic review and meta-analysis

Abstract

There is an ongoing discussion regarding abdominal muscle (AbM) and pelvic floor muscle (PFM) synergism. Therefore, this study aimed to investigate the cocontraction between AbMs and PFMs in women with or without pelvic floor dysfunction (PFD). The following databases were searched up to December 21, 2018: MEDLINE, EMBASE, LILACS, PEDro and CENTRAL. We included any study that assessed the cocontraction between PFMs and AbMs in women with and without PFD. Two reviewers independently screened eligible articles and extracted data. The outcomes were extracted and analyzed as continuous variables with random effect models. Twenty studies were included. A meta-analysis did not show differences in women with and without PFD. However, a sensitivity analysis suggested cocontraction of the transversus abdominis (TrA) during PFM contraction in healthy women (standardized mean difference (SMD) –1.02 [95% confidence interval (CI) −1.90 to −0.14], P=0.02; I2= not applicable; very low quality of evidence). Women with PFD during contraction of PFMs showed cocontraction of the obliquus internus (OI) (SMD 1.10 [95% CI 0.27 to 1.94], P=0.01; I2= not applicable; very low quality of evidence), and obliquus externus (OE) (SMD 2.08 [95% CI 1.10 to 3.06], P<0.0001; I2 = not applicable; very low quality of evidence). Increased cocontraction of the TrA may be associated with maximal contraction of PFMs in women without PFD. On the other hand, there is likely an increased cocontraction with the OI and OE in women with PFD.

Ultrasound imaging of abdominal muscles activity among women with stress urinary incontinence: case-control study in Poland

“…In each theory, an important role was played by the increase in intra-abdominal pressure generated by the abdominal muscles in certain situations, such as coughing, sneezing, and physical activity [5]. For this reason, the interactions between the abdominal and pelvic floor muscles have been the focus of studies by various specialists [6][7][8][9][10]. Among the available literature, the majority of studies concern the activity of the musculus transversus abdominis in the population of healthy women [11][12][13].…”

Comparison of urinary incontinence, based on pelvic floor and abdominal muscle strength, between nulliparous female athletes and non‐athletes: A secondary analysis

“…All of the muscles surrounding the abdominopelvic cavity can alter intra‐abdominal pressure (IAP) and have a potential influence on pelvic floor muscle (PFM) activity 6 . Studies have shown that the transverse abdominal and the internal oblique muscles are closely linked to changes in the IAP 7,8 .…”

“…5 All of the muscles surrounding the abdominopelvic cavity can alter intra-abdominal pressure (IAP) and have a potential influence on pelvic floor muscle (PFM) activity. 6 Studies have shown that the transverse abdominal and the internal oblique muscles are closely linked to changes in the IAP. 7,8 Moreover, one small study involving seven healthy, continent women showed that the voluntary activation of the abdominal muscles is associated with increased PFM activity and urethral pressure.…”

Alterations in the structural characteristics of rectus abdominis muscles caused by diabetes and pregnancy: A comparative study of the rat model and women

“…This stretching is hypothesized to be a result of an overload of hypertrophy, contributing to muscle tone and endurance [23]. There is growing scientific and clinical attention on the role of the abdominal muscles in the normal functioning of the pelvic floor muscle in women [24]. Changes in the structure of these muscles may jeopardize their support and continence [25].…”