What improvements in levator ani motor function lead to improvement in stress urinary incontinence signs and symptoms in females?

Antônio, Flávia Ignácio; Rodrigues, Marina Petter; Brooks, Kaylee; Varette, Kevin; McLean, Linda

doi:10.1007/s00192-021-04931-7

Cited by 3 publications

(9 citation statements)

References 48 publications

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“…Previous research has shown that LAM strength does not differ between continent and incontinent women 20 and a recent study found no significant relationship between LAM strength and the extent of urine leakage among women with SUI, nor between improvements in LAM function measured by the PERFECT scheme and the extent of improvement in SUI symptoms after a PFMT intervention. 4 Beyond the PFMs, women with SUI who participated in PFMT have demonstrated increases in urethral cross-sectional area 21 but increased urethral cross-sectional area was not predictive of success with PFMT intervention. 6 Bladder neck position at rest and bladder neck elevation upon PFM contraction have been shown to be associated with SUI severity 4 and the extent of improvement in bladder neck elevation was positively associated with improvement in SUI symptoms.…”

Section: Difference Between Groups (Mean and 95% Ci)mentioning

confidence: 99%

“…The reliability of the UI subscale score has not undergone an in-depth assessment of its measurement properties as a stand-alone assessment, however, it has been used as a measure of SUI symptom severity in recent studies. 4,6,16,17 A 30-MPT was conducted to objectively quantify urine leakage. Typically, short-term pad tests (e.g., 30-MPT) have lower reliability compared to longer-term (e.g., 24 h) pad tests.…”

Section: Outcome Measuresmentioning

confidence: 99%

“…6 Bladder neck position at rest and bladder neck elevation upon PFM contraction have been shown to be associated with SUI severity 4 and the extent of improvement in bladder neck elevation was positively associated with improvement in SUI symptoms. 4 It may be the case that women who perform the knack maneuver only derive benefits if their maneuver is strong enough to stabilize the urethra or elevate the bladder neck. As the "quality" or effectiveness of the knack performed was not evaluated in the current study, this should be investigated further.…”

Section: Difference Between Groups (Mean and 95% Ci)mentioning

confidence: 99%

“…PFMT is effective at reducing or eliminating SUI signs and symptoms in approximately half of women 1 who undertake this approach, 2 and the presumed mechanism is through improved strength and motor control of the PFMs 3 . Yet, there is limited evidence to support these assumptions 4 . Among 74 female participants with SUI who completed a 12‐week PFMT intervention, a recent prospective study found no association between improvements in levator ani muscle strength, power, or endurance and improvements in SUI signs and symptoms 4 .…”

Section: Introductionmentioning

confidence: 99%

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One in four women with stress urinary incontinence who are taught “the knack” maneuver adopt this motor pattern while coughing: A prospective interventional cohort study

Antônio

Yamamoto

Varette

et al. 2023

Neurourology and Urodynamics

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Questions: Do women with stress urinary incontinence (SUI) who receive instruction to perform the knack maneuver as part of a 12-week pelvic floor muscle training (PFMT) program perform it during voluntary coughing without specific instruction to do so, and are subjective and objective outcomes better among those who do than among those who do not demonstrate the knack during voluntary coughing? Design: Secondary analysis of a prospective interventional cohort. Participants: Women with SUI. Intervention: 12-week PFMT intervention including instruction to perform the knack. Outcome measures: Performance of the knack before a voluntary cough as confirmed through ultrasound imaging. SUI severity determined subjectively (International Consultation on Incontinence Modular Questionnaire-Female Lower Urinary Tract Symptoms [ICIQ-FLUTS] overall score, ICIQ-FLUTS UI subscale score, 3-day bladder diary) and objectively (30-min pad test). Results: Outcome data were available from 69 participants. At baseline, no participants performed the knack when asked to cough. At follow-up, more participants performed the knack during a voluntary cough [18/69 (26%), 95% confidence interval [CI] 15%-35%] than at baseline. The extent of improvement in SUI symptoms was not different between participants who did and did not demonstrate the knack during a voluntary cough [FLUTS-UI subscale score (d = 0.31, 95% CI -0.78 to 2.77, n = 69), FLUTS overall score (d = 0.26, 95% CI −1.52-4.23, n = 69), 30-min pad test (d = 0.03, 95% CI −9.35 to 10.32, n = 69), 3-day bladder diary (d = 0.03, 95% CI −4.07 to 3.60, n = 51)]. Conclusion:Approximately one in four women appear to adopt the knack as a motor response to a cough command, however, adopting the knack was not independently associated with greater improvements in SUI.

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Section: Difference Between Groups (Mean and 95% Ci)mentioning

confidence: 99%

Section: Outcome Measuresmentioning

confidence: 99%

Section: Difference Between Groups (Mean and 95% Ci)mentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

One in four women with stress urinary incontinence who are taught “the knack” maneuver adopt this motor pattern while coughing: A prospective interventional cohort study

Antônio

Yamamoto

Varette

et al. 2023

Neurourology and Urodynamics

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“…U održavanju uretralnog pritiska i pružanju potpore organima male karlice važnu ulogu ima m. levator ani. Sastoji se od sporokontrahujućih mišićnih vlakana (tip I) koja omogućavaju održavanje tonusa mišića tokom dužeg perioda i brzokontrahujućih mišićnih vlakana (tip II) koja služe za brzo povećanje tonusa prilikom iznenadnog porasta pritiska u abdomenu usljed kašljanja, kijanja ili fizičkog napora (24). Preporučljivo je da sesija vježbanja primarno obuhvati kontrakcije dužeg trajanja (minimum trajanja kontrakcije pet sekundi) sa ciljem jačanja sporokontrahujućih mišićnih vlakana, a zatim kontrakcije kraćeg trajanja da bi se aktivirala i ojačala brzokontrahujuća mišićna vlakna (25).…”

Section: Diskusijaunclassified

Effects of exercises for strengthening pelvic floor muscles in pregnant women

Ogurlić¹,

Vukićević²,

Stijepović³

2022

Medicinski časopis

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The pelvic floor is a complex network formed by deep and superficial muscle structures, the vaginal wall and fascia that provides support to the pelvic organs and maintains continence. Changes in the urinary and muscular system during pregnancy cause pelvic floor muscle dysfunction and stress urinary incontinence (SUI). By strengthening these muscles, the symptoms of incontinence can be alleviated. The aim of this paper is to prove the effectiveness of pelvic floor muscle strengthening exercises in the prevention and treatment of urinary incontinence in pregnant women through a systematic review of the available literature. Using the keywords "pelvic floor exercises", "urinary incontinence", "pregnancy", "prevention", "prenatal period" and "postnatal period", three independent authors searched database search engines (PubMed, Physiotherapy Evidence Database and Cochrane Library) for relevant articles from October 2021 to April 2022 using the predetermined criteria, and selected potential papers. The search resulted in 75 works. The papers older than five years, not available in full text, or not written in English were excluded. Ten works that met the criteria were included in the research. The selection was made by using the Jovell and Navarro-Rubio classification of study designs. The classified papers have provided evidence of the importance of prenatal exercises in improving pelvic floor muscle contractility. Structured, supervised training increases the strength of these muscles, reduces urinary symptoms and incontinence. The exercises to strengthen the muscles of the pelvic floor prevent incontinence, reduce the intensity of symptoms and improve the quality of life during pregnancy and postpartum. Health experts have a significant contribution in the education of pregnant women. It is a priority to develop standardized educational programs through which these exercises will be effectively applied.

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Assessment of Involuntary PFM Contractions in Comparison with Existing Literature and IUGA/ICS Terminology Reports

de Jong,

Burkhard,

Zwahlen

et al. 2024

Int Urogynecol J

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Introduction and Hypothesis Involuntary pelvic floor muscle (PFM) contractions are thought to occur during an increase in intra-abdominal pressure (IAP). Although no studies have assessed their presence in women with normal pelvic floor (PF) function, existing literature links the absence of involuntary PFM contractions to various PF dysfunctions. This study rectifies this lacuna by evaluating involuntary PFM contractions during IAP in healthy nulliparous women with no PF dysfunction, using visual observation and vaginal palpation. Results were compared with the literature and the IUGA/ICS Terminology Reports. Methods Nulliparous (n=149) women performed three sets of three maximal coughs. Visual observation and vaginal palpation were conducted in the standing and supine positions. The women were not instructed to contract their PFMs. Occurrence rates were calculated for each assessment method and position; differences between positions were analyzed using the Chi-squared test. Results Rates of occurrence of involuntary PFM contraction were low across both assessments and positions (5–17%). Significant differences were found between standing (5%) and supine (15%) positions for visual observation, but not vaginal palpation (15%, 17% respectively). Occurrence rates also differed compared with the literature and terminology reports. Conclusions Contrary to clinical expectations, rates of occurrence of involuntary PFM contraction among our cohort of nulliparous women were extremely low. Digital palpation results showed high agreement with the terminology reports, but only partial agreement was observed for the visual observation results. Our study underscores the need for more research aimed at defining normal involuntary PF functions, a review of our understanding of involuntary PFM contractions, and better standardized guidelines for involuntary PFM assessment methods.

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What improvements in levator ani motor function lead to improvement in stress urinary incontinence signs and symptoms in females?

Cited by 3 publications

References 48 publications

One in four women with stress urinary incontinence who are taught “the knack” maneuver adopt this motor pattern while coughing: A prospective interventional cohort study

One in four women with stress urinary incontinence who are taught “the knack” maneuver adopt this motor pattern while coughing: A prospective interventional cohort study

Effects of exercises for strengthening pelvic floor muscles in pregnant women

Assessment of Involuntary PFM Contractions in Comparison with Existing Literature and IUGA/ICS Terminology Reports

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