Pelvic floor muscle reflex activity during coughing – an exploratory and reliability study

Abstract

PFM activity during reflex latency response time intervals during coughing was significantly higher than at rest, which suggests PFM pre-activity and reflex activity during coughing. Although we standardized coughing, EMG variables for PFM activity showed poor reliability [good to excellent ICC(3,k) and fair to excellent ICC(3,1) but high SEM and MD]. Therefore, coughing is expected to be heterogeneous, with low reliability, in clinical test situations. Potential crosstalk from other muscles involved in coughing could limit the interpretation of our results.

Pelvic floor muscle activity during fast voluntary contractions in continent and incontinent women

“…Physical activity and coughing are known to manifest SUI 41,42 and it was shown that maximal EMG activity of the PFM is reached at about 120 ms after the impact of coughing 43 or running. 28 Taking into account that the FVC in the present study demonstrated the peak activity after about 500 ms, it has to be questioned, whether the strategy/training of FVC can at all contribute to continence.…”

Valsalva versus straining: There is a distinct difference in resulting bladder neck and puborectalis muscle position

“…Voluntary PFM relaxation prevents PFM activation in many women but not in all. The concurrent PF activation might also be dependent on the velocity of the task with the PFM responding to the sudden change in IAP . In addition, some women might simply be afraid to relax the PF because of fear of urinary leakage or wind incontinence.…”

“…The concurrent PF activation might also be dependent on the velocity of the task with the PFM responding to the sudden change in IAP. 8,30 In addition, some women might simply be afraid to relax the PF because of fear of urinary leakage or wind incontinence. Therefore, in 'real life', preceding and concurrent pelvic floor activations appear to be the rule rather than exception which should be taken into account when assessing pelvic floor anatomy and function.…”

ICS Educational Module: Cough stress test in the evaluation of female urinary incontinence: Introducing the ICS‐Uniform Cough Stress Test

“…While standardization of cough effort/force has been attempted using an audiometer as a gauge (to measure audible cough strength), it has been suggested that it is rather difficult to achieve reliable standardization of coughing force/effort and for the purposes of a routine office visit it is impractical. Rather, the recommendation of three coughs “as hard as possible” seems reasonable …”

“…When compared with patientperception questionnaires (eg, ICIQ-FLUTS, King's Health Questionnaire, UDI-6, and UIQ-7), statistically significant associations of higher grades of SUI (based on the 1-3-5 CST) with higher scores of incontinence domains on the questionnaires were noted. Others have speculated that (pelvic) muscular fatigue may have a role in SUI and its diagnosis: by having patients cough repeatedly (up to seven times), a greater than 20% decrease in MUCP was measured in almost a quarter of patients with SUI-S. 31 While standardization of cough effort/force has been attempted using an audiometer as a gauge (to measure audible cough strength), 32 it has been suggested that it is rather difficult to achieve reliable standardization of coughing force/ effort 33 and for the purposes of a routine office visit it is impractical. Rather, the recommendation of three coughs "as hard as possible" seems reasonable.…”