Pelvic floor muscle displacement during voluntary and involuntary activation
in continent and incontinent women: A systematic review
Monika Leitner
1
1,2,
Helene Moser 1, Jan Taeymans 1, Annette Kuhn 3, Lorenz Radlinger
1
Bern University of Applied Sciences, Health Division, Discipline of Physiotherapy, Bern, Switzerland, 2 University of Bern, Graduate School for Health Sciences, Switzerland
3 Bern University Hospital, Gynecology, Bern, Switzerland
Table 1: Causes for heterogeneity
Introduction
Enhanced comprehension
(PFM-D) and muscle action
(SUI) is of uppermost
development of new and
and SUI rehabilitation [4].
(a)
(b)
of pelvic floor muscle displacement
related to stress urinary incontinence
clinical relevance [1,2,3] for the
specific approaches in PFM training
Purpose
To summarise the current evidence for PFM-D during voluntary
and involuntary activation. Up to now it is unclear whether reflex
activation during daily life activities (e.g. running, jumping,
stair-climbing) has been investigated.
Methods
MEDLINE, EMBASE, Cochrane and SPORTDiscus databases were
searched using selected terminology reflecting the PICO
approach (Figure 1). Articles 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.
The high degree of heterogeneity (Table 1) in the extracted data
restricted the analysis to a systematic review.
Conclusion and Implication
Figure 2: MR images in mid-sagittal plane during Valsalva (a) and during
straining (b). PRM is indicated by the white arrow. [5]
(RDC: right diaphragmatic cupola; PCL: pubococcygeal line; PRM:
puborectalis muscle; S: pubic symphysis; LP: levator plate)
Results
Figure 1: PRISMA flow diagram
Forty-two predominantly observational studies fulfilled the
inclusion criteria. A wide variety of measurement methods and
calculations of displacement was presented. Ultrasound was
used in 31 studies, whereas MR imaging was performed in 15
studies. The bladder neck was the most assessed structure,
whose displacement reflected a PFM motion indirectly. MR
imaging was able to directly measure muscle displacement
(Figure 2). Test positions and test activities varied among the
studies. Most subjects had been assessed in supine position and
standing. The test activities included voluntary PFM contraction,
Valsalva, straining manoeuvres and coughing. The sample was
heterogeneous concerning age, parity and continence status.
Quantification of the observed displacement had been reported
in metric units, angles, compliance or muscle strain.
Comparison of data between continent and incontinent women
became evident.
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The elevating character of voluntary PFM contraction, as well as
the descent of muscle and organs respectively during impact
loads has generally been confirmed. Continent women display
greater displacement during elevation while incontinent women
perform more downward displacement during coughing and
Valsalva manoeuvres. The magnitude of displacement alone
does not allow conclusions on the PFM function as displacement
is influenced by multiple factors (e.g. task, diagnostic
instrument, test position, continence status, bladder filling,
age). The body of research on PFM-D summarised the
knowledge of SUI pathophysiology. However there is lacking
comprehension of involuntary, reflexive activation during
functional activities.
We therefore propose that future investigations focus on
involuntary reflexive contractions during functional activities
(e.g. running, jumping) in order to elucidate PFM dynamics and
muscle action during fast and stressful impact manoeuvers
References
[1]
[2]
[3]
[4]
[5]
Daneshgari & Moore, Bju Int, 98 (2006) 8-14.
Constantinou, European Journal of Obstetrics & Gynecology , 144 (2009) 159-165.
Fozzatti et al., International urogynecology journal, 23 (2012) 1687-1691.
Dumoulin et al., Neurourology and urodynamics, 30 (2011) 746-753.
Talasz et al., European Journal of Obstetrics & Gynecology 164 (2):227-233
Keywords:
Activities of daily living, diagnostics, stress urinary incontinence