The relationship between urinary incontinence, pelvic floor muscle strength and lower abdominal muscle activation among women with low back pain

Abreu, Douglas Lima de; Rodrigues, Pedro Teixeira Vidinha; Corrêa, Letícia Amaral; Lacombe, Adriana de Carvalho; Andreotti, Dianne; Nogueira, Leandro Alberto Calazans

doi:10.1080/21679169.2018.1435720

Cited by 13 publications

(23 citation statements)

References 46 publications

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“…In general, these studies had small sample sizes, incomplete methodological reporting, and fair (2/4) or poor (2/4) quality. Four studies examined the correlation between pelvic floor function among women with low back pain, or among women with low back pain with or without incontinence . There was a high proportion of pelvic floor dysfunction on physical exam among women with low back pain (however no comparison group was included) and women with low back pain tended to have less pelvic floor strength and control compared to controls .…”

Section: Resultsmentioning

confidence: 99%

“…21 These studies are contrasted by studies that did not show there was a significant difference between pelvic floor strength or ability to activate the abdominals among women with LBP who did or did not have urinary incontinence. 24,26 Among these four studies, the quality was rated as good for 3/4 and poor for 1/4. Overall the quality of these studies in this section was judged as good (3/8), fair (2/8), and poor (3/8), ( Table 2, with further details in the online appendix).…”

Section: Evidence or Interventions That Examine Low Back Pain With mentioning

confidence: 99%

“…21,22 Low back pain with urinary incontinence does not seem to represent a more severe form of pelvic floor dysfunction. 24,26 There are several potential hypotheses that may explain the relationship between back pain and urinary dysfunction. Kinesiology and muscle physiology studies have demonstrated that low back pain may develop due to changes in control of the traditional trunk muscles (transversus abdominis, rectus abdominis, and multifidus); more recent studies have recognized the role of the pelvic floor muscles in spinal stability.…”

Section: Other Relevant Studiesmentioning

confidence: 99%

“…We identified eight studies that included an assessment of pelvic floor function, low back pain and/or urinary incontinence ( Table 2). [20][21][22][23][24][25][26][27] Three were RCTs that examined whether the addition of pelvic floor therapy (with some behavior modifications) improved LBP; two demonstrated no improvement in low back pain or functional disability, 23,25 and another with a longer course of treatment did show a significant improvement in low back pain and functional disability. 20 In all three studies, urinary incontinence did improve.…”

Section: Evidence or Interventions That Examine Low Back Pain With mentioning

confidence: 99%

“…Four studies examined the correlation between pelvic floor function among women with low back pain, 21,22 or among women with low back pain with or without incontinence. 24,26 There was a high proportion of pelvic floor dysfunction on physical exam among women with low back pain (however no comparison group was included) 22 and women with low back pain tended to have less pelvic floor strength and control compared to controls. 21 These studies are contrasted by studies that did not show there was a significant difference between pelvic floor strength or ability to activate the abdominals among women with LBP who did or did not have urinary incontinence.…”

Section: Evidence or Interventions That Examine Low Back Pain With mentioning

confidence: 99%

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Is there a link between back pain and urinary symptoms?

Welk

Baverstock

2020

Neurourology and Urodynamics

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Aims: To identify epidemiological studies of mechanical low back pain and urinary dysfunction, and to identify potential evidence supporting a mechanism for this relationship.Methods: A systematic online search was conducted of EmBASE, Medline, CINAHL, and PEDro databases. We excluded studies where an obvious link between low back pain and urinary dysfunction exists (such as cauda equina syndrome). Two reviewers used inclusion/exclusion criteria to screen the articles. Data were extracted and summarised with a narrative review, and study quality was assessed.Results: We included 22/930 studies. Twelve studies addressed the epidemiological link between low back pain and urinary symptoms. The studies all found a statistically significant association between the diagnosis of urinary incontinence or urinary symptoms and low back pain, (aOR's 1.1 to 3.1).Results were consistent when stratified by sex, age, and when adjusted for confounders. The study quality was good in 4/12. Eight studies reported on an assessment/intervention related to pelvic floor function, urinary symptoms and low back pain. Pelvic floor dysfunction was common in women with low back pain, however randomized studies and pre-post studies reported mixed results for pelvic floor physiotherapy improving low back pain. The study quality was good in 3/8. Conclusions:Low back pain and urinary incontinence are associated in large epidemiological studies, and the presence of one condition seems to predispose the development of the other. There is limited evidence to suggest pelvic floor interventions are useful for low back pain in this patient population, therefore the mechanism for this relationship is still unclear. K E Y W O R D Slow back pain, overactive bladder, stress incontinence, urge incontinence, urinary incontinence

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Section: Resultsmentioning

confidence: 99%

Section: Evidence or Interventions That Examine Low Back Pain With mentioning

confidence: 99%

Section: Other Relevant Studiesmentioning

confidence: 99%

Section: Evidence or Interventions That Examine Low Back Pain With mentioning

confidence: 99%

Section: Evidence or Interventions That Examine Low Back Pain With mentioning

confidence: 99%

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Is there a link between back pain and urinary symptoms?

Welk

Baverstock

2020

Neurourology and Urodynamics

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Relationship between urinary incontinence and back or pelvic girdle pain: a systematic review with meta-analysis

2021

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Ultrasound imaging of core muscles activity in multiparous women with vaginal laxity: a cross-sectional study

Hady,

Mabrouk,

Osman

2024

Sci Rep

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Vaginal laxity (VL) is a common condition among multiparous women, especially those who have delivered vaginally. Since pelvic floor muscles (PFMs) work synergistically with other core muscles, physical therapy protocols that aim to treat VL should train the PFMs in combination with other core muscles. To investigate the activity of core muscles in multiparous women with and without VL, and its relation to sexual function. An observational, cross-sectional study. The study included 100 multiparous women, who were divided into two groups according to their scores on the vaginal laxity questionnaire (VLQ). Women who scored between 1 and 3 on the VLQ were categorized as having VL (n = 48), while those who scored between 5 and 7 were placed in the control group (n = 52). The primary outcomes were PFM displacement, diaphragmatic excursion, transversus abdominis activation ratio, and lumbar multifidus thickness measured by ultrasound imaging. The secondary outcome was sexual functioning, evaluated using the Arabic female sexual function index (ArFSFI). The VL group had significantly lower PFM displacement (mean difference (MD) − 0.42; 95% confidence interval (CI) − 0.49 to − 0.33; p = 0.001), diaphragmatic excursion (MD − 2.75; 95% CI − 2.95 to − 2.55; p = 0.001), lumbar multifidus thickness (MD − 10.08; 95% CI − 14.32 to − 5.82; p = 0.02), and ArFSFI scores (MD − 9.2; 95% CI − 10.59 to − 7.81; p = 0.001) in comparison to the control group (p < 0.05). Nevertheless, the transversus abdominis activation ratio demonstrated no significant difference between the two groups (MD 0.06; 95% CI − 0.05 to 0.17; p = 0.33). Multiparous women with VL had significantly lower PFM displacement, diaphragmatic excursion, lumbar multifidus thickness, and sexual function index scores than women in the control group. The only exception was transversus abdominis activation, which did not differ significantly between the VL and control groups.

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The relationship between urinary incontinence, pelvic floor muscle strength and lower abdominal muscle activation among women with low back pain

Cited by 13 publications

References 46 publications

Is there a link between back pain and urinary symptoms?

Is there a link between back pain and urinary symptoms?

Relationship between urinary incontinence and back or pelvic girdle pain: a systematic review with meta-analysis

Ultrasound imaging of core muscles activity in multiparous women with vaginal laxity: a cross-sectional study

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