Top

International Urogynecology Journal

Published in:

01-11-2015 | Review Article

Pelvic floor muscle displacement during voluntary and involuntary activation in continent and incontinent women: a systematic review

Authors: Monika Leitner, Helene Moser, Jan Taeymans, Annette Kuhn, Lorenz Radlinger

Published in: International Urogynecology Journal | Issue 11/2015

Abstract

Introduction

Investigations of the dynamic function of female pelvic floor muscles (PFM) help us to understand the pathophysiology of stress urinary incontinence (SUI). Displacement measurements of PFM give insight into muscle activation and thus help to improve rehabilitation strategies. This systematic review (PROSPERO 2013: CRD42013006409) was performed to summarise the current evidence for PFM displacement during voluntary and involuntary activation in continent and incontinent women.

Methods

MEDLINE, EMBASE, Cochrane and SPORTDiscus databases were searched using selected terminology reflecting the PICO approach. Screening of Google Scholar and congress abstracts added to further information. Original articles investigating PFM displacement were included if they reported on at least one of the aims of the review, e.g., method, test position, test activity, direction and quantification of displacement, as well as the comparison between continent and incontinent women. Titles and abstracts were screened by two reviewers. The papers included were reviewed by two individuals to ascertain whether they fulfilled the inclusion criteria and data were extracted on outcome parameters.

Results

Forty-two predominantly observational studies fulfilled the inclusion criteria. A variety of measurement methods and calculations of displacement was presented. The sample was heterogeneous concerning age, parity and continence status. Test positions and test activities varied among the studies.

Conclusions

The findings summarise the present knowledge of PFM displacement, but still lack deeper comprehension of the SUI pathomechanism of involuntary, reflexive activation during functional activities. We therefore propose that future investigations focus on PFM dynamics during fast and stressful impact tasks.

Available only for authorised users

Monz B, Pons ME, Hampel C, Hunskaar S, Quail D, Samsioe G, Sykes D, Wagg A, Papanicolaou S (2005) Patient-reported impact of urinary incontinence—results from treatment seeking women in 14 European countries. Maturitas 52 [Suppl 2]:S24–S34. doi:10.1016/j.maturitas.2005.09.005 CrossRefPubMed

Krause C, Wells T, Hughes S, Brink C, Mayer R (2003) Incontinence in women: effect of expectancy to regain control and severity of symptoms on treatment outcomes. Urol Nurs 23(1):54PubMed

Papanicolaou S, Hunskaar S, Lose G, Sykes D (2005) Assessment of bothersomeness and impact on quality of life of urinary incontinence in women in France, Germany, Spain and the UK. BJU Int 96(6):831–838CrossRefPubMed

Bo K (2004) Urinary incontinence, pelvic floor dysfunction, exercise and sport. Sports Med (Auckland, NZ) 34(7):451–464CrossRef

Nygaard I, DeLancey JO, Arnsdorf L, Murphy E (1990) Exercise and incontinence. Obstet Gynecol 75(5):848–851PubMed

Luginbuehl H, Baeyens JP, Taeymans J, Maeder IM, Kuhn A, Radlinger L (2014) Pelvic floor muscle activation and strength components influencing female urinary continence and stress incontinence: A systematic review. Neurourol Urodyn doi: 10.1002/nau.22612 PubMed

Verelst M, Leivseth G (2007) Force and stiffness of the pelvic floor as function of muscle length: a comparison between women with and without stress urinary incontinence. Neurourol Urodyn 26(6):852–857CrossRefPubMed

Shishido K, Peng Q, Jones R, Omata S, Constantinou CE (2008) Influence of pelvic floor muscle contraction on the profile of vaginal closure pressure in continent and stress urinary incontinent women. J Urol 179(5):1917–1922. doi:10.1016/j.juro.2008.01.020 CrossRefPubMed

Deffieux X, Hubeaux K, Porcher R, Ismael SS, Raibaut P, Amarenco G (2008) Abnormal pelvic response to cough in women with stress urinary incontinence. Neurourol Urodyn 27(4):291–296. doi:10.1002/nau.20506 CrossRefPubMed

10.

Morin M, Bourbonnais D, Gravel D, Dumoulin C, Lemieux MC (2004) Pelvic floor muscle function in continent and stress urinary incontinent women using dynamometric measurements. Neurourol Urodyn 23(7):668–674. doi:10.1002/nau.20069 CrossRefPubMed

11.

Morin M, Dumoulin C, Gravel D, Bourbonnais D, Lemieux MC (2007) Reliability of speed of contraction and endurance dynamometric measurements of the pelvic floor musculature in stress incontinent parous women. Neurourol Urodyn 26(3):397–403CrossRefPubMed

12.

Constantinou CE (2009) Dynamics of female pelvic floor function using urodynamics, ultrasound and magnetic resonance imaging (MRI). Eur J Obstet Gynecol Reprod Biol 144:S159–S165PubMedCentralCrossRefPubMed

13.

Komi PV (2003) Strength and power in sport, 2nd edn. Blackwell Scientific Publications, OxfordCrossRef

14.

Komi PV (2000) Stretch-shortening cycle: a powerful model to study normal and fatigued muscle. J Biomech 33(10):1197–1206CrossRefPubMed

15.

Bo K, Lilleas F, Talseth T, Hedland H (2001) Dynamic MRI of the pelvic floor muscles in an upright sitting position. Neurourol Urodyn 20(2):167–174CrossRefPubMed

16.

Jones LR, Peng Q, Humphrey V, Stokes M, Payne C, (2009) Constantinou C Effect of the knack on the pelvic floor: evaluated by 2d real time ultrasound and image processing methods. In: ICS Annual Meeting of the International Continence Society. ICS

17.

Raizada V, Bhargava V, Jung SA, Karstens A, Pretorius D, Krysl P, Mittal RK (2010) Dynamic assessment of the vaginal high-pressure zone using high-definition manometery, 3-dimensional ultrasound, and magnetic resonance imaging of the pelvic floor muscles. Am J Obstet Gynecol 203(2):172.e1–172.e8. doi:10.1016/j.ajog.2010.02.028 CrossRef

18.

Sayers A (2008) Tips and tricks in performing a systematic review. Br J Gen Pract 58(547):136PubMedCentralCrossRefPubMed

19.

Liberati A, Altman DG, Tetzlaff J, Mulrow C, Gøtzsche PC, Ioannidis JP, Clarke M, Devereaux P, Kleijnen J, Moher D (2009) The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration. Ann Intern Med 151(4):W-65–W-94CrossRef

20.

Sampson M, McGowan J, Cogo E, Grimshaw J, Moher D, Lefebvre C (2009) An evidence-based practice guideline for the peer review of electronic search strategies. J Clin Epidemiol 62(9):944–952CrossRefPubMed

21.

Chen R, Song Y, Jiang L, Hong X, Ye P (2011) The assessment of voluntary pelvic floor muscle contraction by three-dimensional transperineal ultrasonography. Arch Gynecol Obstet 284(4):931–936CrossRefPubMed

22.

El Sayed RF, El Mashed S, Farag A, Morsy MM, Abdel Azim MS (2008) Pelvic floor dysfunction: assessment with combined analysis of static and dynamic MR imaging findings. Radiology 248(2):518–530CrossRefPubMed

23.

Strauss C, Lienemann A, Spelsberg F, Bauer M, Jonat W, Strauss A (2012) Biomechanics of the female pelvic floor: a prospective trail of the alteration of force–displacement-vectors in parous and nulliparous women. Arch Gynecol Obstet 285(3):741–747CrossRefPubMed

24.

Kelly M, Tan B, Thompson J, Carroll S, Follington M, Arndt A, Seet M (2007) Healthy adults can more easily elevate the pelvic floor in standing than in crook-lying: an experimental study. Aust J Physiother 53(3):187–191CrossRefPubMed

25.

Thompson JA, O’Sullivan PB, Briffa NK, Neumann P (2007) Comparison of transperineal and transabdominal ultrasound in the assessment of voluntary pelvic floor muscle contractions and functional manoeuvres in continent and incontinent women. Int Urogynecol J 18(7):779–786CrossRef

26.

Dietz H, Eldridge A, Grace M, Clarke B (2004) Pelvic organ descent in young nulligravid women. Am J Obstet Gynecol 191(1):95–99CrossRefPubMed

27.

Baessler K, Junginger B (2008) Bladder neck elevation with different levels of effort of pelvic floor muscle contraction. In: ICS 2008 Annual Meeting of the International Continence Society (ICS)

28.

Schaer GN, Koechli OR, Schuessler B, Haller U (1995) Perineal ultrasound for evaluating the bladder neck in urinary stress incontinence. Obstet Gynecol 85(2):220–224CrossRefPubMed

29.

Balmforth JR, Mantle J, Bidmead J, Cardozo L (2006) A prospective observational trial of pelvic floor muscle training for female stress urinary incontinence. BJU Int 98(4):811–817CrossRefPubMed

30.

Rahmanian S, Jones R, Peng Q, Constantinou CE (2008) Visualization of biomechanical properties of female pelvic floor function using video motion tracking of ultrasound imaging. Stud Health Technol Inform 132:390–395PubMed

31.

Barbič M, Kralj B, Cör A (2003) Compliance of the bladder neck supporting structures: importance of activity pattern of levator ani muscle and content of elastic fibers of endopelvic fascia. Neurourol Urodyn 22(4):269–276CrossRefPubMed

32.

Talasz H, Kremser C, Kofler M, Kalchschmid E, Lechleitner M, Rudisch A (2012) Proof of concept: differential effects of Valsalva and straining maneuvers on the pelvic floor. Eur J Obstet Gynecol Reprod Biol 164(2):227–233CrossRefPubMed

33.

Talasz H, Kremser C, Kofler M, Kalchschmid E, Lechleitner M, Rudisch A (2011) Phase-locked parallel movement of diaphragm and pelvic floor during breathing and coughing—a dynamic MRI investigation in healthy females. Int Urogynecol J 22(1):61–68CrossRefPubMed

34.

Wise B, Cutner A, Cardozo L, Abbott D, Burton G (1992) The assessment of bladder neck movement in postpartum women using perineal ultrasonography. Ultrasound Obstet Gynecol 2(2):116–120CrossRefPubMed

35.

Peng Q, Jones R, Shishido K, Constantinou CE (2007) Ultrasound evaluation of dynamic responses of female pelvic floor muscles. Ultrasound Med Biol 33(3):342–352PubMedCentralCrossRefPubMed

36.

Lovegrove Jones RC, Peng Q, Stokes M, Humphrey VF, Payne C, Constantinou CE (2010) Mechanisms of pelvic floor muscle function and the effect on the urethra during a cough. Eur Urol 57(6):1101–1110PubMedCentralCrossRefPubMed

37.

Chehrehrazi M, Arab AM, Karimi N, Zargham M (2009) Assessment of pelvic floor muscle contraction in stress urinary incontinent women: comparison between transabdominal ultrasound and perineometry. Int Urogynecol J 20(12):1491–1496CrossRef

38.

Sherburn M, Murphy CA, Carroll S, Allen TJ, Galea MP (2005) Investigation of transabdominal real-time ultrasound to visualise the muscles of the pelvic floor. Aust J Physiother 51(3):167–170CrossRefPubMed

39.

Junginger B, Baessler K, Sapsford R, Hodges PW (2010) Effect of abdominal and pelvic floor tasks on muscle activity, abdominal pressure and bladder neck. Int Urogynecol J 21(1):69–77CrossRefPubMed

40.

Reddy AP, DeLancey JO, Zwica LM, Ashton-Miller JA (2001) On-screen vector-based ultrasound assessment of vesical neck movement. Am J Obstet Gynecol 185(1):65–70CrossRefPubMed

41.

McLean L, Varette K, Gentilcore-Saulnier E, Harvey MA, Baker K, Sauerbrei E (2013) Pelvic floor muscle training in women with stress urinary incontinence causes hypertrophy of the urethral sphincters and reduces bladder neck mobility during coughing. Neurourol Urodyn 32(8):1096–1102. doi:10.1002/nau.22343 CrossRefPubMed

42.

Peschers U, Gingelmaier A, Jundt K, Leib B, Dimpfl T (2001) Evaluation of pelvic floor muscle strength using four different techniques. Int Urogynecol J 12(1):27–30CrossRef

43.

McLean L, Gentilcore-Saulnier E, Baker K, Harvey M-A, Sauerbrei E (2011) Pelvic floor muscle training reduces bladder neck mobility during coughing in women with stress urinary incontinence. In: 2011 International World Physical Therapy Congress 2011

44.

Hung H-C, Hsiao S-M, Chih S-Y, Lin H-H, Tsauo J-Y (2011) Effect of pelvic-floor muscle strengthening on bladder neck mobility: a clinical trial. Phys Ther 91(7):1030–1038CrossRefPubMed

45.

Da Roza T, Mascarenhas T, De Araujo M, Parente M, Duarte S, Loureiro J, Natal Jorge R (2011) Displacement of the levator ani muscle in continent and incontinent female athlete. In: ICS 2011 Annual Meeting of the International Continence Society (ICS)

46.

Delmas V, Ami O, Iba-Zizen M-T (2010) Examen dynamique du muscle élévateur de l'anus de la femme par modélisation vectorielle 3D IRM: étude préliminaire. Bull Acad Natl Med 194(6):969–980PubMed

47.

Fielding JR, Griffiths D, Versi E, Mulkern R, Lee M, Jolesz F (1998) MR imaging of pelvic floor continence mechanisms in the supine and sitting positions. AJR Am J Roentgenol 171(6):1607–1610CrossRefPubMed

48.

Pregazzi R, Sartore A, Bortoli P, Grimaldi E, Troiano L, Guaschino S (2002) Perineal ultrasound evaluation of urethral angle and bladder neck mobility in women with stress urinary incontinence. BJOG: Int J Obstet Gynaecol 109(7):821–827CrossRef

49.

Hol M, Bolhuis CV, Vierhout M (1995) Vaginal ultrasound studies of bladder neck mobility. BJOG: Int J Obstet Gynaecol 102(1):47–53CrossRef

50.

Hu L, Song Y (2009) Three-dimensional Virtual-reality reconstruction of pelvic floor structure for patients with female stress Urinary incontinence. In: ICS 2009 Annual Meeting of the International Continence Society (ICS)

51.

Howard D, Miller JM, Delancey JO, Ashton-Miller JA (2000) Differential effects of cough, Valsalva, and continence status on vesical neck movement. Obstet Gynecol 95(4):535PubMedCentralCrossRefPubMed

52.

Miller JM, Perucchini D, Carchidi LT, DeLancey JO, Ashton-Miller J (2001) Pelvic floor muscle contraction during a cough and decreased vesical neck mobility. Obstet Gynecol 97(2):255–260PubMedCentralCrossRefPubMed

53.

Constantinou C, Hvistendahl G, Ryhammer A, Nagel LL, Djurhuus J (2002) Determining the displacement of the pelvic floor and pelvic organs during voluntary contractions using magnetic resonance imaging in younger and older women. BJU Int 90(4):408–414CrossRefPubMed

54.

Rizk DE, Czechowski J, Ekelund L (2004) Dynamic assessment of pelvic floor and bony pelvis morphologic condition with the use of magnetic resonance imaging in a multiethnic, nulliparous, and healthy female population. Am J Obstet Gynecol 191(1):83–89. doi:10.1016/j.ajog.2003.12.041 CrossRefPubMed

55.

Dietz HP (2011) Pelvic floor ultrasound in incontinence: what’s in it for the surgeon? Int Urogynecol J 22(9):1085–1097CrossRefPubMed

56.

Arab AM, Behbahani RB, Lorestani L, Azari A (2009) Correlation of digital palpation and transabdominal ultrasound for assessment of pelvic floor muscle contraction. J Man Manip Ther 17(3):75E–79ECrossRef

57.

Thompson JA, O’Sullivan PB, Briffa K, Neumann P (2005) Assessment of pelvic floor movement using transabdominal and transperineal ultrasound. Int Urogynecol J 16(4):285–292CrossRef

58.

Whittaker JL, Thompson JA, Teyhen DS, Hodges P (2007) Rehabilitative ultrasound imaging of pelvic floor muscle function. J Orthop Sports Phys Ther 37(8):487–498CrossRefPubMed

59.

Christensen L, Djurhuus J, Constantinou C (1995) Imaging of pelvic floor contractions using MRI. Neurourol Urodyn 14(3):209–216CrossRefPubMed

60.

Peng Q, Jones RC, Constantinou CE (2006) 2D Ultrasound image processing in identifying responses of urogenital structures to pelvic floor muscle activity. Ann Biomed Eng 34(3):477–493CrossRefPubMed

61.

Örnö A-K, Dietz H (2007) Levator co‐activation is a significant confounder of pelvic organ descent on Valsalva maneuver. Ultrasound Obstet Gynecol 30(3):346–350CrossRefPubMed

62.

Thompson JA, O'Sullivan PB, Briffa NK, Neumann P (2006) Differences in muscle activation patterns during pelvic floor muscle contraction and Valsalva maneuver. Neurourol Urodyn 25(2):148–155CrossRefPubMed

63.

Sapsford R, Hodges P, Richardson C, Cooper D, Markwell S, Jull G (2001) Co‐activation of the abdominal and pelvic floor muscles during voluntary exercises. Neurourol Urodyn 20(1):31–42CrossRefPubMed

64.

Bo K, Sherburn M (2005) Evaluation of female pelvic-floor muscle function and strength. Phys Ther 85(3):269–282PubMed

65.

Yang J-M, Yang S-H, Yang S-Y, Yang E, Huang W-C (2009) Reliability of real-time ultrasound to detect pelvic floor muscle contraction in urinary incontinent women. J Urol 182(5):2392–2396CrossRefPubMed

66.

Thyer I, Shek C, Dietz H (2008) New imaging method for assessing pelvic floor biomechanics. Ultrasound Obstet Gynecol 31(2):201–205CrossRefPubMed

67.

Messelink B, Benson T, Berghmans B, Bo K, Corcos J, Fowler C, Laycock J, Lim P, van Lunsen R, Nijeholt G (2005) Standardization of terminology of pelvic floor muscle function and dysfunction: report from the pelvic floor clinical assessment group of the International Continence Society. Neurourol Urodyn 24(4):374CrossRefPubMed

Title: Pelvic floor muscle displacement during voluntary and involuntary activation in continent and incontinent women: a systematic review
Authors: Monika Leitner
Helene Moser
Jan Taeymans
Annette Kuhn
Lorenz Radlinger
Publication date: 01-11-2015
Publisher: Springer London
Published in: International Urogynecology Journal / Issue 11/2015
Print ISSN: 0937-3462
Electronic ISSN: 1433-3023
DOI: https://doi.org/10.1007/s00192-015-2700-2

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Pelvic floor muscle displacement during voluntary and involuntary activation in continent and incontinent women: a systematic review

Abstract

Introduction

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Introduction

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 11/2015

Are women with advanced pelvic organ prolapse treated by open mesh sacrocolpopexy at risk of secondary incisional hernia?

Selected abstracts from the annual research meeting of the British Society of Urogynaecology 2014

Clinical symptoms related to anal sphincter defects and atrophy on external phased-array MR imaging

Practice pattern variation in surgical management of pelvic organ prolapse and urinary incontinence in The Netherlands

Virtual reality: a proposal for pelvic floor muscle training

Validation of a Mandarin Chinese version of the pelvic organ prolapse/urinary incontinence sexual questionnaire IUGA–revised (PISQ-IR)