Research

The impact of the pelvic floor on respiration and singing in adults

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Abstract

I am currently rewriting/updating this research study. This independent study will examine the literature on the function of the pelvic floor muscles during respiration, its connection to the whole body and its role in singing. Particularly, I will focus on all diaphragms within the body and the role, function and anatomy of the pelvic floor, pelvic muscles and the pelvic diaphragm. I will also assess the link between the pelvis and the primary diaphragm. This study will examine the impact of the pelvis in respiration and in singing, and compare and analyse recent research.

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Article
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Objective: To conduct an interdisciplinary literature review on the function of the pelvic floor musculature during respiration and its role in phonation, particularly singing. Study design: This is a literature review. Methods: A literature review was conducted using three electronic databases: PubMed, Scopus, and Google Scholar. An index search was also performed for the NATS Journal/Journal of Singing utilizing the keywords from the original search, as these articles did not appear in the original search. Peer-reviewed articles from 1985 to 2017 were gathered on the respiratory musculature and/or support mechanisms for phonation (anatomy and physiology). Articles that pertained to the muscular function of the respiratory system in breathing and/or phonation were utilized in the review. Eighty-five articles were included in this review. Results: Breathing and support strategies were variable and nonspecific in much of the singing voice literature. The voice science literature was a rich source of articles written about breathing and support for singing. Multiple studies looked at musculature utilized in respiration and breath support and subglottal pressure generation for muscular support. However, little or no mention was made specifically of the pelvic floor. The physical medicine literature includes the pelvic floor musculature as having an important role in respiration, as a key player in the generation of intra-abdominal pressure, and as a primary expiratory muscle. Conclusions: The information gleaned from this literature review suggests that a cross-pollination between areas of science is needed, because quite obviously, the pelvic floor is a topic in physical medicine, but it is not (so much) in the voice literature. Reaching a consensus on how we describe the function of the respiratory musculature and specifically including the role of the pelvic floor in respiration and phonation deserves future attention. Further research looking specifically at the role of the pelvic floor in phonation is also warranted.
Article
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Pain during intercourse (dyspareunia) and involuntary contraction of the outer third of the vagina (vaginismus) affect between 6.5% and 45% of women. The behavioral approach often includes exhaling to the pain or anticipated discomfort. The common instruction is to exhale in anticipation or sensing discomfort, which paradoxically increases pelvic floor tension and discomfort. Thus, clinicians need to instruct patients to practice what seems initially counterintuitive. The appropriate breathing strategy is to teach effortless diaphragmatic (abdominal) breathing in which the pelvic floor relaxes and descends during inhalation and begin the insertion during inhalation. Do not press or insert during exhalation, and continue to breathe until the discomfort has faded out; then insert slightly more during the next inhalation phase. For clinicians, it is important to point out that this process is most successful when the person feels safe and is given enough time to allow the pelvic floor to relax as monitored by lower abdominal electromyography. This concept is illustrated in a case report of a young woman who successfully experienced intercourse after more than two years of marriage.
Article
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Generally, descriptions of the pelvic floor are discordant, since its complex structures and the complexity of pathological disorders of such structures; commonly the descriptions are sectorial, concerning muscles, fascial developments, ligaments and so on. On the contrary to understand completely nature and function of the pelvic floor it is necessary to study it in the most unitary view and in the most global aspect, considering embriology, philogenesy, anthropologic development and its multiple activities others than urological, gynaecological and intestinal ones. Recent acquirements succeeded in clarifying many aspects of pelvic floor activity, whose musculature has been investigated through electromyography, sonography, magnetic resonance, histology, histochemistry, molecular research. Utilizing recent research concerning not only urinary and gynecologic aspects but also those regarding statics and dynamics of pelvis and its floor, it is now possible to study this important body part as a unit; that means to consider it in the whole body economy to which maintaining upright position, walking and behavior or physical conduct do not share less than urinary, genital, and intestinal functions. It is today possible to consider the pelvic floor as a musclefascial unit with synergic and antagonistic activity of muscular bundles, among them more or less interlaced, with multiple functions and not only the function of pelvic cup closure.
Article
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[Purpose] This study determined the effects a new modality of core stabilization exercises based on diaphragmatic breathing on pulmonary function, abdominal fitness, and movement efficiency. [Subjects] Thirtytwo physically active, healthy males were randomly assigned to an experimental group (n = 16) and a control group (n = 16). [Methods] The experimental group combined diaphragmatic breathing exercises with global stretching postures, and the control group performed common abdominal exercises (e.g., crunch, plank, sit-up), both for 15 minutes twice weekly for 6 weeks. Pulmonary function (measured by forced vital capacity, forced expiratory volume in 1 second, and peak expiratory flow) and abdominal fitness (measured with the American College of Sports Medicine curl-up [cadence] test and the Functional Movement Screen™) were evaluated before and after the intervention. [Results] Significant changes in curl-up (cadence) test scores, Functional Movement Screen scores, and all pulmonary parameters were recorded in the experimental group at the posttraining assessment, whereas in the control group, no significant differences over baseline were observed in any parameters. [Conclusion] Compared with traditional abdominal exercises, core stabilization exercises based on breathing and global stretching postures are more effective in improving pulmonary function and abdominal fitness.
Article
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[Purpose] The aim of the present study was to examine the impact of the pelvic floor muscles (PFM) on dynamic ventilation maneuvers. [Subjects and Methods] The subjects were 19 healthy female adults in their 20s who consented to participate in the present study. Electromyography (EMG) was used to examine respiratory muscle activity, and a spirometer was used to examine vital capacity before and during contraction of the PFM. [Results] There were statistically significant differences in the sternocleidomastoid (SCM), rectus abdominis (RA), external oblique (EO), transverse abdominis/internal oblique (TrA/IO), and maximal voluntary ventilation (MVV) when the PFM was contracted. [Conclusion] Contraction of the PFM can be effective in promoting activation of the respiratory muscles and vital capacity. Therefore, the PFM should be considered to improve the effects of respiratory activity.
Article
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The diaphragm muscle should not be seen as a segment but as part of a body system. This muscle is an important crossroads of information for the entire body, from the trigeminal system to the pelvic floor, passing from thoracic diaphragm to the floor of the mouth: the network of breath. Viola Frymann first spoke of the treatment of three diaphragms, and more recently four diaphragms have been discussed. Current scientific knowledge has led to discussion of the manual treatment of five diaphragms. This article highlights the anatomic connections and fascial and neurologic aspects of the diaphragm muscle, with four other structures considered as diaphragms: that is, the five diaphragms. The logic of the manual treatment proposed here is based on a concept and diagnostic work that should be the basis for any area of the body: The patient never just has a localized symptom but rather a system that adapts to a question.
Article
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Synergistic co-activation of the abdominal and pelvic floor muscles (PFM) has been shown in literature. Some studies have assessed the reliability of ultrasound measures of the abdominal muscles. The aim of this study was to determine the reliability of ultrasound measurements of transverses abdominis (TrA) and obliquus internus (OI) muscles during different conditions (PFM contraction, abdominal hollowing manoeuvre (AHM) with and without PFM contraction) in participants with and without chronic low back pain (LBP). 21 participants (9 with LBP, 12 healthy) participated in the study. The reliability of thickness measurements at rest and during each condition and thickness changes and percentage of this changes at different conditions were assessed. The results showed high reliability of the thickness measurement at rest and during each condition of TrA and OI muscles, moderate to substantial reliability for the thickness change and percentage of thickness change of TrA, and fair to moderate reliability of the thickness change and percentage of thickness change of OI in both groups. Ultrasound imaging can be used as a reliable method for assessment of abdominal muscle activity with and without PFM contraction.
Article
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The aim of this cross-sectional study was to determine correlations between pelvic floor muscle (PFM) function and expiratory function in healthy young nulliparous women. In 40 volunteers, PFM function was assessed by vaginal palpation. Forced expiration patterns were evaluated visually and by palpation of the suprapubic insertion region of the anterolateral abdominal muscles. Forced vital capacity (FVC) and forced expiratory flows (FEF) were determined by spirometry. Incremental positive correlation was found between voluntary PFM contraction strength and forced expiratory flow at 25%, 50% and 75% (FEF(25%), FEF(50%), FEF(75%)) of the FVC, respectively. Positive correlation was also found between PFM contraction strength and forced expired volume in 1 s (FEV(1)). No correlation was found between PFM contraction strength and FVC or peak expiratory flow (PEF). Despite some limitations of this study, the observed correlation between PFM contraction strength and forced expiratory flows may serve as theoretical background for a potential role of coordinated abdominal and PFM training in diseases with expiratory flow limitations.
Article
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Pelvic floor muscle exercises prescribed for the treatment of incontinence commonly emphasize concurrent relaxation of the abdominal muscles. The purpose of this study was to investigate the interaction between individual muscles of the abdominal wall and the pelvic floor using surface and intramuscular electromyography, and the effect of their action on intra-abdominal pressure. Four subjects were tested in the supine and standing positions. The results indicated that the transversus abdominis (TA) and the obliquus internus (OI) were recruited during all pelvic floor muscle contractions. It was not possible for these subjects to contract the pelvic floor effectively while maintaining relaxation of the deep abdominal muscles. A mean intra-abdominal pressure rise of 10 mmHg (supine) was recorded during a maximum pelvic floor muscle contraction. These results suggest that advice to keep the abdominal wall relaxed when performing pelvic floor exercises is inappropriate and may adversely affect the performance of such exercises.
Article
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The aims of the study were: (1) to assess women performing voluntary pelvic floor muscle (PFM) contractions, on initial instruction without biofeedback teaching, using transperineal ultrasound, manual muscle testing, and perineometry and (2) to assess for associations between the different measurements of PFM function. Sixty continent (30 nulliparous and 30 parous) and 60 incontinent (30 stress urinary incontinence (SUI) and 30 urge urinary incontinence (UUI)) women were assessed. Bladder neck depression during attempts to perform an elevating pelvic floor muscle (PFM) contraction occurred in 17% of continent and 30% of incontinent women. The UUI group had the highest proportion of women who depressed the bladder neck (40%), although this was not statistically significant (p=0.060). The continent women were stronger on manual muscle testing (p=0.001) and perineometry (p=0.019) and had greater PFM endurance (pp=0.051). There was a moderate correlation between bladder neck movement during PFM contraction measured by ultrasound and PFM strength assessed by manual muscle testing (r=0.58, p=0.01) and perineometry (r=0.43, p=0.01). The observation that many women were performing PFM exercises incorrectly reinforces the need for individual PFM assessment with a skilled practitioner. The significant correlation between the measurements of bladder neck elevation during PFM contraction and PFM strength measured using MMT and perineometry supports the use of ultrasound in the assessment of PFM function; however, the correlation was only moderate and, therefore, indicates that the different measurement tools assess different aspects of PFM function. It is recommended that physiotherapists use a combination of assessment tools to evaluate the different aspects of PFM function that are important for continence. Ultrasound is useful to determine the direction of pelvic floor movement in the clinical assessment of pelvic floor muscle function in a mixed subject population.
Article
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To date several randomized controlled trials (RCT) have shown that pelvic floor muscle (PFM) training is effective in the treatment of female stress (SUI) and mixed urinary incontinence and, therefore, it is recommended as a first-line therapy. While the effectiveness of treatment is established, there are different theoretical rationales for why PFM training is effective. The aims of this article are to discuss the theories behind why PFM training is effective in treating SUI and to discuss each theory in the framework of new knowledge of functional anatomy and examples of results from RCTs. There are three proposed theories to explain the effectiveness of PFM training for SUI: 1) women learn to consciously pre-contract the PFMs before and during increases in abdominal pressure (such as coughing, physical activity) to prevent leakage; 2) strength training builds up long-lasting muscle volume and thus provides structural support; and 3) abdominal muscle training indirectly strengthens the PFM. The first can be placed in a behavioral construct, while the two latter both have the aim of changing neuromuscular function and morphology, thus making the PFM contraction automatic. To date there are RCTs and basic anatomy studies to support the first two concepts only.
Article
Bridging the gap between evidence-based research and clinical practice, Physical Therapy for the Pelvic Floor has become an invaluable resource to practitioners treating patients with disorders of the pelvic floor. The second edition is now presented in a full colour, hardback format, encompassing the wealth of new research in this area which has emerged in recent years. Kari B� and her team focus on the evidence, from basic studies (theories or rationales for treatment) and RCTs (appraisal of effectiveness) to the implications of these for clinical practice, while also covering pelvic floor dysfunction in specific groups, including men, children, elite athletes, the elderly, pregnant women and those with neurological diseases. Crucially, recommendations on how to start, continue and progress treatment are also given with detailed treatment strategies around pelvic floor muscle training, biofeedback and electrical stimulation.
Book
The second edition of Pelvic Floor Re-education provides a comprehensive overview of the subject, along with other aspects of the clinical assessment and management of pelvic floor disorders. Starting with the latest theories on the anatomy, pathophysiology, and possible causes of pelvic floor damage, the importance of pelvic floor evaluation is looked at in order to determine the type of treatment required. Practical techniques of muscle assessment and investigative methodologies are reviewed and up-to-date information on anatomy and physiology is discussed. An algorithmic approach takes the reader through the options for clinical evaluation and treatment. Several re-education techniques are assessed for pelvic floor dysfunction, including isolated muscle exercise, vagina cones, biofeedback control, and electrical stimulation. This practical book is invaluable reading for all healthcare professionals working with incontinent patients, particularly urogynecologists, obstetricians, gynecologists, and physiotherapists. It also provides a comprehensive but readable source for residents and trainees interested in the scientific and clinical fundamentals of pelvic floor re-education.
Article
This randomized controlled study with blinding allocation evaluated pelvic floor knowledge (PFK) and the presence of pelvic floor dysfunction (PFD) in women office workers. The effects of receiving pelvic floor muscle (PFM) health education on PFK and PFD were also evaluated. Of 161 female volunteers, 145 (90.0 %, age range 18-69 years) responded. They were randomly allocated to three groups (group A 48, group B 48, group C 49). Online surveys were completed by all groups on three occasions using validated tools (Prolapse and Incontinence Knowledge Quiz, PFDI-20, PFIQ-7) and PFM exercise items. On completion of the baseline survey, groups A and B received an education intervention (group C was the control). Following this, all participants completed the second survey. Two months later, to allow time for the PFM exercises to have an effect, group A attended a re-education presentation, followed by the final survey administered to all groups. The results were analyzed using analysis of variance and Tukey's test. Participants receiving both PFM exercise education interventions (group A) and those receiving only the first education intervention (group B) showed highly significant improvements in PFK compared with the control group (both p < 0.001). The groups receiving PFM exercise education also showed a highly significant decrease in PFD symptoms (p < 0.001), and a significant increase in quality of life (QoL; p < 0.05). While the results of this study cannot be generalized to all women, low levels of PFK was associated with high a prevalence of PFD, and an increase in knowledge/awareness following education was significantly associated with an increase in QoL and a decrease in PFD symptoms.
Article
This article proposes a framework for conceptualizing developing as a critically reflective teacher. The author posits that critical reflection is the distinguishing attribute of reflective practitioners. The term critical reflection as developed here merges critical inquiry, the conscious consideration of the ethical implications and consequences of teaching practice, with self-reflection, deep examination of personal beliefs, and assumptions about human potential and learning. Essential practices for developing critical reflection are discussed. This article defines processes fundamental to reflective practice. Teacher beliefs are self-generating, and often unchallenged. Unless teachers develop the practice of critical reflection, they stay trapped in unexamined judgments, interpretations, assumptions, and expectations. Approaching teaching as a reflective practitioner involves infusing personal beliefs and values into a professional identity, resulting in developing a deliberate code of conduct.
Article
The response of the abdominal muscles to voluntary contraction of the pelvic floor (PF) muscles was investigated in women with no history of symptoms of stress urinary incontinence to determine whether there is co-activation of the muscles surrounding the abdominal cavity during exercises for the PF muscles. Electromyographic (EMG) activity of each of the abdominal muscles was recorded with fine-wire electrodes in seven parous females. Subjects contracted the PF muscles maximally in three lumbar spine positions while lying supine. In all subjects, the EMG activity of the abdominal muscles was increased above the baseline level during contractions of the PF muscles in at least one of the spinal positions. The amplitude of the increase in EMG activity of obliquus externus abdominis was greatest when the spine was positioned in flexion and the increase in activity of transversus abdominis was greater than that of rectus abdominis and obliquus externus abdominis when the spine was positioned in extension. In an additional pilot experiment, EMG recordings were made from the pubococcygeus and the abdominal muscles with fine-wire electrodes in two subjects during the performance of three different sub-maximal isometric abdominal muscle maneuvers. Both subjects showed an increase in EMG activity of the pubococcygeus with each abdominal muscle contraction. The results of these experiments indicate that abdominal muscle activity is a normal response to PF exercise in subjects with no symptoms of PF muscle dysfunction and provide preliminary evidence that specific abdominal exercises activate the PF muscles. Neurourol. Urodynam. 20:31–42, 2001. © 2001 Wiley-Liss, Inc.
Article
Dysfunction of one or both hemidiaphragms is an underdiagnosed cause of dyspnea. Weakness or paralysis may be seen during mechanical ventilation, after surgery or trauma, with metabolic or inflammatory disorders, and with myopathy, neuropathy, or diseases causing lung hyperinflation.
Article
Cross-sectional and interventional study to assess pelvic floor muscle (PFM) function in healthy young nulliparous women and to determine the effects of a 3-month PFM training program with emphasis on co-contraction of PFM and anterolateral abdominal muscles and on correctly performed coughing patterns. PFM function was assessed by digital vaginal palpation in 40 volunteers and graded according to the 6-point Oxford grading scale. The PFM training program was comprised theoretical instruction, as well as verbal feedback during hands-on instruction and repeated training sessions focussing on strengthening PFM and anterolateral abdominal muscle co-contraction during forced expiration and coughing. At baseline, 30 women (75%) were able to perform normal PFM contractions at rest (Oxford scale score ≥ 3); only 4 of them (10%) presented additional involuntary PFM contractions before and during coughing. The remaining 10 women (25%) were unable to perform voluntary or involuntary PFM contractions. Mean Oxford scale score in the whole group was 3.3 ± 1.7. After completing the PFM training program, 29 women (72.5%) performed cough-related PFM contractions and group mean Oxford scale score increased significantly to 4.2 ± 1.0. The study shows that PFM dysfunction may be detected even in healthy young women. Multidimensional training, however, may significantly improve PFM function.
Article
the aim of this pilot study was to demonstrate physiological movements of the muscular walls surrounding the abdominal cavity during breathing and coughing in healthy nulliparous women by means of real-time dynamic magnetic resonance imaging (MRI). eight volunteers underwent MRI measurements in a 1.5-T whole body MR-scanner. Coronal and sagittal slices were acquired simultaneously to assess respiratory-related cranio-caudal movement of diaphragm and pelvic floor (PF) and concomitant changes in horizontal abdominal diameter. respective mean amplitudes of cranio-caudal movement of the right and left diaphragmatic cupolae were 15 ± 6 and 9 ± 7 mm during quiet breathing; 32 ± 15 and 28 ± 16 mm during forceful breathing; and 32 ± 13 and 28 ± 7 mm during coughing. Both diaphragm and PF moved caudally during inspiration and cranially during expiration. Abdominal diameter decreased in all eight women consistently during the expiration phase of breathing, and in five women during coughing. in healthy women, real-time dynamic MRI demonstrates parallel cranio-caudal movement of the diaphragm and the PF during breathing and coughing and synchronous changes in abdominal wall diameter.
Article
Although the bladder neck is elevated during a pelvic floor muscle (PFM) contraction, it descends during straining. This study aimed to investigate the relationship between bladder neck displacement, electromyography (EMG) activity of the pelvic floor and abdominal muscles and intra-abdominal pressure (IAP) during different pelvic floor and abdominal contractions. Nine women without PFM dysfunction performed maximal, gentle and moderate PFM contractions, maximal and gentle transversus abdominis (TrA) contractions, bracing, Valsalva and head lift. Bladder neck position was assessed with perineal ultrasound. PFM and abdominal muscle activities were recorded with a vaginal probe and fine-wire electrodes, respectively. IAP was recorded with a rectal balloon. Bladder neck elevation only occurred during PFM and TrA contractions. PFM EMG and IAP increased during all tasks from 0.5 (gentle TrA) to 45.7 cmH2O (maximal Valsalva). Bladder neck elevation was only observed when the activity of PFM EMG was high relative to the IAP increase.
Article
The anatomy of the anterior portion of the levator ani muscle in studied in 26 adult human cadavers of both sexes. This portion of the muscle is found to consist of three layers of muscle fibres. The three layers are: 1. The pelvic layer. Its fibres (1) are attached to the capsule of the prostate or adventitia of the lateral wall of vagina, (2) intermingle with and supplement the longitudinal muscle layer of the anal canal, and (3) are continuous with the fibres of the opposite side behind the recto-anal junction. 2. The middle layer. The most anterior fibres are twisted on themselves to form the round free border of the muscle that bounds the levator hiatus. The majority of the muscle fibres of this layer proceed backwards to cover and blend with the deep part of the external anal shincter, partly joining the anococcygeal ligament. 3. The perineal layer. These fibres surround the superficial part of the external anal sphincter. A respectable bundle of muscles fibres unites with that of the opposite side in from of the lower part of the anal canal. Remaining fibres terminate in perianal skin or anococcygeal ligament. The role of the anterior portion of the levator ani in fixation and prevention of prolapse of the pelvic viscera is stressed.
Article
Forty-seven women had urethral pressure profile determinations performed at rest and during a Kegel pelvic muscle contraction, after brief standardized verbal instruction. Twenty-three (49%) had an ideal Kegel effort--a significant increase in the force of urethral closure without an appreciable Valsalva effort. Twelve subjects (25%) displayed a Kegel technique that could potentially promote incontinence. Age, parity, weight, estrogen deprivation, prior continence surgery or hysterectomy, and passive urethral function did not predict a successful effort. We concluded that simple verbal or written instruction does not represent adequate preparation for a patient who is about to start a Kegel exercise program.
Article
The present study was conducted to determine the pattern of activation of the anterolateral abdominal muscles during the cough reflex. Electromyograms (EMGs) of the rectus abdominis, external oblique, internal oblique, transversus abdominis, and parasternal muscles were recorded along with gastric pressure in anesthetized cats. Cough was produced by mechanical stimulation of the lumen of the intrathoracic trachea or larynx. The pattern of EMG activation of these muscles during cough was compared with that during graded expiratory threshold loading (ETL; 1-30 cmH(2)O). ETL elicited differential recruitment of abdominal muscle EMG activity (transversus abdominis > internal oblique > rectus abdominis congruent with external oblique). In contrast, both laryngeal and tracheobronchial cough resulted in simultaneous activation of all four anterolateral abdominal muscles with peak EMG amplitudes 3- to 10-fold greater than those observed during the largest ETL. Gastric pressures during laryngeal and tracheobronchial cough were at least eightfold greater than those produced by the largest ETL. These results suggest that, unlike their behavior during expiratory loading, the anterolateral abdominal muscles act as a unit during cough.
Article
To determine whether voluntary abdominal muscle contraction is associated with pelvic floor muscle activity. Pelvic floor muscle activity was recorded during contractions of the abdominal muscles at 3 different intensities in supine and standing positions. Research laboratory. Six women and 1 man with no histories of lower back pain. Not applicable. Electromyographic activity of the pelvic floor muscles was recorded with surface electrodes inserted into the anus and vagina. These recordings were corroborated by measurements of anal and vaginal pressures. Gastric pressure was recorded in 2 subjects. Pelvic floor muscle electromyography increased with contraction of the abdominal muscles. With strong abdominal contraction, pelvic floor muscle activity did not differ from that recorded during a maximal pelvic floor muscle effort. The pressure recordings confirmed these data. The increase in pressure recorded in the anus and vagina preceded the pressure in the abdomen. In healthy subjects, voluntary activity in the abdominal muscles results in increased pelvic floor muscle activity. The increase in pelvic floor pressure before the increase in the abdomen pressure indicates that this response is preprogrammed. Dysfunction of the pelvic floor muscles can result in urinary and fecal incontinence. Abdominal muscle training to rehabilitate those muscles may be useful in treating these conditions.
Article
Pelvic floor muscle exercises are one of the main conservative options for the treatment of female urinary incontinence. Despite this widespread use, there is very little information on 'normal' pelvic floor function. In a prospective observational study the authors intended to define the spectrum of normality for pelvic floor function in women, assessing 206 nulliparous women recruited early in their first ongoing pregnancy. Levator function was evaluated using translabial ultrasound: cranioventral displacement of the bladder neck was utilized to quantify levator activity. The presence of a reflex contraction of the external perineal muscles and levator on coughing was registered, as was the strongest of at least three contractions. Only 41 of 206 women (20%) had ever been taught pelvic floor exercises by a health professional, and this had been exclusively verbal. Teaching had no influence on levator strength. Spontaneous contractions on request were obtained in 172 women (85%). Advice was necessary in 96 women (47%) in order to obtain an optimal contraction. Reflex muscle activation on coughing was documented in 118 women (57%) and was associated with a stronger contraction (P<0.001). Reported use of the levator muscle on intercourse was strongly associated with increased levator activity (P<0.001). Motivational factors mentioned were boyfriends, mothers, other female relatives and, most commonly, articles in popular magazines, e.g. Cosmospolitan and Cleo.
Article
The pelvic floor muscles (PFM) are part of the trunk stability mechanism. Their function is interdependent with other muscles of this system. They also contribute to continence, elimination, sexual arousal and intra-abdominal pressure. This paper outlines some aspects of function and dysfunction of the PFM complex and describes the contribution of other trunk muscles to these processes. Muscle pathophysiology of stress urinary incontinence (SUI) is described in detail. The innovative rehabilitation programme for SUI presented here utilizes abdominal muscle action to initiate tonic PFM activity. Abdominal muscle activity is then used in PFM strengthening, motor relearning for functional expiratory actions and finally impact training.
Article
This report presents a standardization of terminology of pelvic floor muscle function and dysfunction. No earlier documents contained definitions on this terminology. These definitions are descriptive and do not imply underlying assumptions that may later prove to be incorrect or incomplete. By following this principle the International Continence Society aims to facilitate comparison of results and enable effective communication by investigators performing pelvic floor muscle studies. It is suggested that acknowledgement of these definitions in written publications be indicated by a footnote to the section "Methods and materials" or its equivalent, to read as follows: "Terminology used is conform the definitions recommended by the International Continence Society, except where specifically noted". The pelvic floor is related to more than one organ system. Dysfunction of the pelvic floor therefore influences different functions at the same time. This report is on pelvic floor muscle function and dysfunction and not on pelvic floor disorders. It contains no terminology on pelvic organ prolapse, urinary or faecal incontinence. Other reports refer to these subjects (Abrams et al, 2002, Weber et al, 2001, Bump et al 1996). This report on terminology of the pelvic floor muscles is written for use, in daily clinical practice, by every health care provider working with patients who have pelvic floor muscle problems. It facilitates the communication between different carers in the field of pelvic floor muscle pathology. Because it has been developed by a multidisciplinary group it can be used by different specialties. This document is based on our current knowledge of physiology and pathophysiology of the pelvic floor muscles. The pelvic floor The term pelvic floor relates to the compound structure, which closes the bony pelvic outlet. The term pelvic floor muscles refers to the muscular layer of the pelvic floor. The pelvic floor consists of different layers, the most cranial being the peritoneum of the pelvic viscera and the most caudal being the skin of vulva, scrotum and perineum (DeLancey 1992). The middle layers of the pelvic floor are made up of predominantly muscular tissue. Apart from the pure pelvic floor muscles, fibro-muscular and fibrous elements, like the endo-pelvic fascia, are found in this layer. Different well recognisable muscles together form the muscular layer of the pelvic floor: levator ani, striated urogenital sphincter, external anal sphincter,
Article
Due to their contribution to modulation of intra-abdominal pressure (IAP) and stiffness of the sacroiliac joints, the pelvic floor muscles (PFM) have been argued to provide a contribution to control of the lumbar spine and pelvis. Furthermore, as IAP is modulated during respiration this is likely to be accompanied by changes in PFM activity. In order to evaluate the postural and respiratory function of the PFM, recordings of anal and vaginal electromyographic activity (EMG) were made with surface electrodes during single and repetitive arm movements that challenge the stability of the spine. EMG recordings were also made during respiratory tasks: quiet breathing and breathing with increased dead-space to induce hypercapnoea. EMG activity of the PFM was increased in advance of deltoid muscle activity as a component of the pre-programmed anticipatory postural activity. This activity was independent of the direction of arm movement. During repetitive movements, PFM EMG was tonic with phasic bursts at the frequency of arm movement. This activity was related to the peak acceleration of the arm, and therefore the amplitude of the reactive forces imposed on the spine. Respiratory activity was observed for the anal and vaginal EMG and was primarily expiratory. When subjects moved the arm repetitively while breathing, PFM EMG was primarily modulated in association with arm movement with little respiratory modulation. This study provides evidence that the PFM contribute to both postural and respiratory functions.
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