Pelvic floor function in elite nulliparous athletes

Kruger, Jennifer; Dietz, Hans Peter; Murphy, BA

doi:10.1002/uog.4027

Cited by 128 publications

(113 citation statements)

References 25 publications

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“…Em ginastas e jogadoras de basquete, a principal explicação para a perda involuntária de urina relaciona-se com o deslocamento do assoalho pélvico durante os saltos e mudanças de direção 28 . Neste caso, seria necessário uma pré-contração muscular durante a atividade física, para neutralizar o deslocamento do assoalho pélvico e impedir a perda de urina.…”

Section: Discussionunclassified

Avaliação Do Assoalho Pélvico De Atletas: Existe Relação Com a Incontinência Urinária?

Araújo

Parmigiano

Negra

et al. 2015

Rev Bras Med Esporte

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RESUMOIntrodução: O assoalho pélvico feminino é formado por um conjunto de músculos, fáscias e ligamentos que sustentam os órgãos pélvicos (bexiga, ânus e vagina). A lesão destas estruturas, devido à idade avançada e parto podem levar à incontinência urinária. Entretanto, ainda não se sabe se o exercício de alta intensidade é capaz de lesar este conjunto músculo-aponevrótico, levando à incontinência urinária. Objetivo: Comparar a capacidade de contração dos músculos do assoalho pélvico entre mulheres sedentárias e atletas de elite, e verificar se existe associação com a ocorrência de incontinência urinária durante a atividade física. Métodos: Estudo caso-controle que incluiu 93 mulheres (49 atletas e 44 sedentárias) convidadas a responder o questionário "International Consultation on Incontinence Questionnaire -Short Form" e realizar avaliação funcional do assoalho pélvico. As atletas (grupo caso) eram praticantes de corrida de longa distância, basquete e ginástica olímpica. As sedentárias (grupo controle) realizavam menos de 150 minutos por semana de atividades moderadas ou vigorosas. A aferição da pressão de contração foi feita por meio de um perineômetro digital de precisão. Resultados: Os grupos foram homogêneos quanto à idade e índice de massa corpórea. As atletas apresentaram maiores valores de pressão vaginal máxima (70,1±2,4 cmH 2 O) quando comparadas às sedentárias (34,3±1,7 cmH 2 O), (p<0,001). As atletas praticantes de basquete tiveram os maiores valores da pressão vaginal máxima (77,2 cmH 2 O) quando comparadas às ginastas (65,5 cmH 2 O) e corredoras (65,4 cmH 2 O). A prevalência de incontinência urinária nas atletas foi de 76% e somente 16% nas sedentárias (p=0,005). Conclusão: Embora a capacidade de contração do assoalho pélvico em atletas de elite seja superior às sedentárias, a prevalência de incontinência urinaria foi elevada neste grupo de praticantes de esporte de alto rendimento e alto impacto.Palavras-chave: incontinência urinária, esportes, diafragma da pelve. ABSTRACT Introduction: The female pelvic floor is formed by a set of muscles, fasciae, and ligaments that sustain pelvic organs (bladder, anus and vagina). Dysfunction of these structures

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Section: Discussionunclassified

Avaliação Do Assoalho Pélvico De Atletas: Existe Relação Com a Incontinência Urinária?

Araújo

Parmigiano

Negra

et al. 2015

Rev Bras Med Esporte

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“…Examiners obtained the following measurements in the axial plane image corresponding to the plane of minimal antero-posterior (AP) diameter of the levator hiatus: the AP diameter of the levator hiatus (LH AP ), the right-left transverse diameter of the levator hiatus (LH T ), and the area of the levator hiatus (LH area ) (see Figure 1) according to the protocol first described by Dietz and colleagues 18 and cited in several subsequent studies. [4][5][6][7][8][9][10][11][12][13][15][16][17][19][20][21][22][23][24][26][27][28][29][30] Examiners measured each of the three volumes acquired during each task (rest, contraction, Valsalva) with each participant and calculated average measurements for each measure according to each task. Statistical analyses were performed using Excel version 12.2.7 (Microsoft Corp., Redmond, WA) and SPSS version 18.0 (SPSS Inc., Chicago, IL).…”

Section: Discussionmentioning

confidence: 99%

Pelvic Floor Ultrasound Imaging: Are Physiotherapists Interchangeable in the Assessment of Levator Hiatal Biometry?

Thibault-Gagnon

Gentilcore-Saulnier

Auchincloss

et al. 2014

Physiotherapy Canada

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Purpose: To evaluate inter-examiner reliability in the ultrasound (US) assessment of levator hiatal dimensions when different physiotherapists perform independent data acquisition and analysis. Methods: In this cross-sectional observational study, 14 asymptomatic nulliparous women were imaged at rest, during pelvic floor muscle contraction, and during Valsalva manoeuvre by two physiotherapists using three-dimensional (3D) and four-dimensional (4D) transperineal US. Examiners each measured the dimensions of the levator hiatus (area and antero-posterior and transverse diameters) from the US volumes they respectively acquired. Inter-examiner reliability was determined using intra-class correlation coefficients (ICCs), and inter-examiner agreement was determined using Bland-Altman analyses. Results: The ICC results demonstrated very good inter-examiner reliability (ICC ¼ 0.84-0.98); Bland-Altman results showed high inter-examiner agreement across all measurements. Conclusions: Trained examiners may be considered interchangeable in the US assessment of levator hiatal biometry. Overall, trained physiotherapists using transperineal US imaging to assess levator hiatal biometry can be confident when comparing their own clinical findings to those of their colleagues and to findings published in the literature.Key Words: pelvic floor; reproducibility of results; three-dimensional imaging; ultrasonography. RÉ SUMÉObjectif : Examiner la fiabilité entre examinateurs de l'é valuation é chographique des dimensions hiatales du muscle releveur de l'anus lorsque des physiothé rapeutes diffé rents procè dent à l'acquisition et à l'analyse indé pendante de donné es. Mé thodes : Au cours de cette é tude par observation transversale, 14 femmes nullipares asymptomatiques ont subi un examen d'imagerie au repos, au cours d'une contraction des muscles du plancher pelvien et durant une manoeuvre de Valsalva, effectué par deux physiothé rapeutes utilisant l'é chographie transpé riné ale tridimensionnelle (3D) et quadridimensionnelle (4D). Chaque examinateur a mesuré les dimensions du hiatus du muscle releveur (superficie et diamè tre anté roposté rieur et transversal) à partir des volumes é chographiques qu'ils ont acquis respectivement. On a dé terminé la fiabilité entre examinateurs à partir des coefficients de corré lation intra-classe (CCI) et dé terminé l'uniformité entre examinateur au moyen des analyses de Bland et d'Altman. Ré sultats : Les ré sultats de l'application des CCI ont ré vé lé une trè s bonne fiabilité entre examinateurs pour toutes les mesures. (CCI ¼ 0.84-0.98); les ré sultats de Bland et Altman ont ré vé lé une grande uniformité entre examinateurs pour toutes les mesures. Conclusions : Les examinateurs qui ont rec¸u une formation peuvent ê tre considé ré s comme interchangeables dans l'é valuation é chographique de la biomé trie hiatale du muscle releveur. Dans l'ensemble, les physiothé rapeutes qui ont suivi une formation et utilisent l'imagerie é chographique transpé riné ale pour é valuer la biomé trie hiat...

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“…Thus, women should be encouraged to perform PFMT during pregnancy to prevent UI [1]. However, there is scant knowledge about the influence of the pelvic floor muscles (PFM) on labor and delivery outcome [2,3].…”

Section: Introductionmentioning

confidence: 99%

“…There has been some concern that a tight and strong pelvic floor might obstruct labor and result in instrumental delivery, perineal trauma and/ or injury of peripheral nerves, connective tissue and muscles [3]. On the other hand, others suggest that stronger PFM may facilitate labor and vaginal childbirths [1].…”

Section: Introductionmentioning

confidence: 99%

Too tight to give birth? Assessment of pelvic floor muscle function in 277 nulliparous pregnant women

et al. 2013

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Introduction and hypothesis: Theoretically, tight or strong pelvic floor muscles may impair the progress of labor and lead to instrumental deliveries. We aimed to investigate whether vaginal resting pressure, pelvic floor muscle strength or endurance at mid-pregnancy affect delivery outcome. Methods: this was a prospective cohort study of women giving birth at a university hospital. Vaginal resting pressure, pelvic floor muscle strength and endurance in 300 nulliparous pregnant women were assessed at mean gestational week 20.8 (±1.4) using a high precision pressure transducer connected to a vaginal balloon. Delivery outcome measures (acute cesarean section, prolonged second stage of labor (> 2 hours), instrumental vaginal delivery (vacuum and forceps), episiotomy and 3 rd and 4 th degree perineal tear) were retrieved from the hospital's electronic birth records. Results: Twenty-three women were lost to follow-up, mostly because they gave birth at another hospital. Women with prolonged second stage had significantly higher resting pressure than women with second stage less than 2 hours; mean difference 4.4 cm H 2 O (95% CI: 1.2-7.6), p<0.01, aOR: 1.049 (95% CI: 1.011-1.089, p=0.012). Vaginal resting pressure did not affect other delivery outcomes. Pelvic floor muscle strength and endurance similarly were not associated with any delivery outcomes. Conclusions: While mid-pregnancy vaginal resting pressure is associated with prolonged second stage of labor, neither vaginal resting pressure nor pelvic floor muscle strength or endurance are associated with operative delivery or perineal tears. Strong pelvic floor muscles are not disadvantageous for vaginal delivery.

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Pelvic floor function in elite nulliparous athletes

Abstract: ABSTRACT

Cited by 128 publications

References 25 publications

Avaliação Do Assoalho Pélvico De Atletas: Existe Relação Com a Incontinência Urinária?

Avaliação Do Assoalho Pélvico De Atletas: Existe Relação Com a Incontinência Urinária?

Pelvic Floor Ultrasound Imaging: Are Physiotherapists Interchangeable in the Assessment of Levator Hiatal Biometry?

Too tight to give birth? Assessment of pelvic floor muscle function in 277 nulliparous pregnant women

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