Skip to main content

Visualization of the Dynamics of the Female Pelvic Floor Reflex and Steady State Function

  • Chapter
  • First Online:
Computational Vision and Medical Image Processing

Part of the book series: Computational Methods in Applied Sciences ((COMPUTMETHODS,volume 19))

Abstract

Female urinary incontinence has been recently termed a “silent epidemic”, requiring systematic attention and a multidisciplinary approach towards economically ameliorating its impact. In this paper we examine the role of the pelvic floor (PF) in maintaining urinary continence by evaluating the dynamics produced during its voluntary and reflex activation. Analytical methods for the acquisition and subsequent ultrasound analysis of movement of PF structures during maneuvers that are associated with exercises are presented to enable the development of criteria and unique new parameters that define the kinematics of PF function. Principal among these parameters, are displacement, velocity, acceleration and the trajectory of pelvic floor landmarks facilitating functional and anatomical visualization. Different methods of movement detection, including motion tracking algorithms and segmentation algorithms were developed to acquire new dynamic parameters of Pelvic structures during different maneuvers. 2D animation was applied to enhance the ultrasound imaging and highlight the timing of the movement and deformation to fast and stressful maneuvers, which are important for understanding the neuromuscular control mechanisms in urinary continence. Parameters were derived using image processing of non-invasive trans-perineal scanning and probe measurements from asymptomatic volunteers as well as patients presenting with relevant pathology. In each case the results are visualized using a graphic interface deigned to illustrate the significant factors separating the continent from the incontinent subjects.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 84.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 109.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 109.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Abitbol, M.M.: Evolution of the ischial spine and of the pelvic floor in the Hominoidea. Am. J. Phys. Anthropol. 75(1), 53–67 (1998)

    Article  Google Scholar 

  2. Acton, P.D., Newberg, A.: Artificial neural network classifier for the diagnosis of Parkinson’s disease using [(99m)Tc]TRODAT-1 and SPECT. Phys. Med. Biol. 51(12), 3057–3066 (2006)

    Article  Google Scholar 

  3. Artibani, W., Andersen, Ostergaard, D.R., Constantinou, C.E., Gajewski, J., Nitti, V., Klaskov, P., Tubaro, A.: Imaging and other investigations. In: Abrahms (ed.) Incontinence, pp. 401–445. WHO/UICC (1999)

    Google Scholar 

  4. Athanasiou, S., Khullar, V., et al.: Imaging the urethral sphincter with three-dimensional ultrasound. Obstet. Gynecol. 94(2), 295–301 (1999)

    Article  Google Scholar 

  5. Barbic, M., Kralj, B., et al.: 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), 269–276 (2003)

    Article  Google Scholar 

  6. Berghmans, L.C., Hendriks, H.J., et al.: Conservative treatment of stress urinary incontinence in women: a systematic review of randomized clinical trials. Br. J. Urol. 82(2), 181–191 (1998)

    Google Scholar 

  7. Bhatikar, S.R., DeGroff, C., et al.: A classifier based on the artificial neural network approach for cardiologic auscultation in pediatrics. Artif. Intell. Med. 33(3), 251–260 (2005)

    Article  Google Scholar 

  8. Bo, K., Lilleas, F., et al.: Dynamic MRI of the pelvic floor muscles in an upright sitting position. Neurourol. Urodyn. 20(2), 167–174 (2001)

    Article  Google Scholar 

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

    Google Scholar 

  10. Buchsbaum, G.M., Duecy, E.E., et al.: Urinary incontinence in nulliparous women and their parous sisters. Obstet. Gynecol. 106(6), 1253–1258 (2005)

    Article  Google Scholar 

  11. Bump, R.C., Hurt, W.G., et al.: Assessment of Kegel pelvic muscle exercise performance after brief verbal instruction. Am. J. Obstet. Gynecol. 165(2), 322–327 (1991), discussion 327–329

    Google Scholar 

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

    Article  Google Scholar 

  13. Comiter, C.V., Vasavada, S.P., et al.: Grading pelvic prolapse and pelvic floor relaxation using dynamic magnetic resonance imaging. Urology 54(3), 454–457 (1999)

    Article  Google Scholar 

  14. Constantinou, C.E.: Contribution of magnetic resonance imaging in the evaluation of pelvic floor function. In: Bourcier, McGuire (eds.) Pelvic Floor Disorders, pp. 176–182. Abrams Elsevier (2004)

    Google Scholar 

  15. Constantinou, C.E., Omata, S.: Direction sensitive sensor probe for the evaluation of voluntary and reflex pelvic floor contractions. Neurourol. Urodyn. 26(3), 386–391 (2007)

    Article  Google Scholar 

  16. Constantinou, C.E., Omata, S., Yoshimura, Y., Peng, Q.: Evaluation of the dynamic responses of female pelvic floor using a novel vaginal probe. Ann. NY. Acad. Sci. 1101, 297–315 (2007)

    Article  Google Scholar 

  17. Constantinou, C.E.: Dynamics of the Female Pelvic Floor. Int. J. Comput. Vision Biomech. (1), 69–81 (2007)

    Google Scholar 

  18. Constantinou, C.E., Govan, D.E.: Spatial distribution and timing of transmitted and reflexly generated urethral pressures in healthy women. J. Urol. 127(5), 964–969 (1982)

    Google Scholar 

  19. Constantinou, C.E., Hvistendahl, G., et al.: 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), 408–414 (2002)

    Article  Google Scholar 

  20. Constantinou, C.E., Omata, S.: Direction sensitive sensor probe for the evaluation of voluntary and reflex pelvic floor contractions. Neurourol. Urodyn. 26(3), 386–391 (2007)

    Article  Google Scholar 

  21. Constantinou, C.E.: Dynamics of female pelvic floor function using urodynamics, ultrasound and magnetic resonance imaging. Eur. J. Obstet. Gynecol. 144S, 159–165 (2009)

    Article  Google Scholar 

  22. Costantini, S., Esposito, F., et al.: Ultrasound imaging of the female perineum: the effect of vaginal delivery on pelvic floor dynamics. Ultrasound. Obstet. Gynecol. 27(2), 183–187 (2006)

    Article  Google Scholar 

  23. Deindl, F.M., Vodusek, D.B., et al.: Activity patterns of pubococcygeal muscles in nulliparous continent women. Br. J. Urol. 72(1), 46–51 (1993)

    Article  Google Scholar 

  24. Deindl, F.M., Vodusek, D.B., et al.: Pelvic floor activity patterns: comparison of nulliparous continent and parous urinary stress incontinent women. A kinesiological EMG study. Br. J. Urol. 73(4), 413–417 (1994)

    Article  Google Scholar 

  25. DeLancey, J.O.: The hidden epidemic of pelvic floor dysfunction: achievable goals for improved prevention and treatment. Am. J. Obstet. Gynecol. 192(5), 1488–1495 (2005)

    Article  Google Scholar 

  26. DeLancey, J.O., Strohbehn, K., et al.: Comparison of ureteral and cervical descents during vaginal hysterectomy for uterine prolapse. Am. J. Obstet. Gynecol. 179(6 Pt 1), 1405–1408 (1998); discussion 1409–1410

    Google Scholar 

  27. Dietz, H.P.: Ultrasound imaging of the pelvic floor. Part II: three-dimensional or volume imaging. Ultrasound. Obstet. Gynecol. 23(6), 615–625 (2004)

    MathSciNet  Google Scholar 

  28. Dietz HP, Jarvis SK, et al. (2002). The assessment of levator muscle strength: a validation of three ultrasound techniques. Int Urogynecol J Pelvic Floor Dysfunct 13(3): 156–159; discussion 159

    Google Scholar 

  29. Dumoulin, C., Peng, Q., Stodkilde-Jorgensen, H., Shishido, K., Constantinou, C.E.: Changes in levator ani anatomical configuration following physiotherapy in women with stress urinary incontinence. J. Urol. 178, 970–977 (2007)

    Article  Google Scholar 

  30. Ferreira, P.H., Ferreira, M.L., et al.: Changes in recruitment of the abdominal muscles in people with low back pain: ultrasound measurement of muscle activity. Spine 29(22), 2560–2566 (2004)

    Article  Google Scholar 

  31. Fielding, J.R., Dumanli, H., et al.: MR-based three-dimensional modeling of the normal pelvic floor in women: quantification of muscle mass. AJR. Am. J. Roentgenol. 174(3), 657–660 (2000)

    Google Scholar 

  32. Goh, V., Halligan, S., et al.: Dynamic MR imaging of the pelvic floor in asymptomatic subjects. AJR. Am. J. Roentgenol. 174(3), 661–666 (2000)

    Google Scholar 

  33. Gousse, A.E., Barbaric, Z.L., et al.: Dynamic half Fourier acquisition, single shot turbo spin-echo magnetic resonance imaging for evaluating the female pelvis. J. Urol. 164(5), 1606–1613 (2000)

    Article  Google Scholar 

  34. Higuchi, K., Sato, K., et al.: Automated diagnosis of heart disease in patients with heart murmurs: application of a neural network technique. J. Med. Eng. Technol. 30(2), 61–68 (2006)

    Article  MathSciNet  Google Scholar 

  35. Hodges, P.W., Richardson, C.A.: Altered trunk muscle recruitment in people with low back pain with upper limb movement at different speeds. Arch. Phys. Med. Rehabil. 80(9), 1005–1012 (1999)

    Article  Google Scholar 

  36. Howard, D., Miller, J.M., et al.: Differential effects of cough, valsalva, and continence status on vesical neck movement. Obstet. Gynecol. 95(4), 535–540 (2000)

    Article  Google Scholar 

  37. Jones, R.C., Peng, Q., et al.: Altered co-activation patterns of the pelvic floor muscles (PFM) during abdominal manoeuvres in stress urinary incontinent (SUI) women. 36th Annual Meeting of the International Continence Society (ICS) (2006)

    Google Scholar 

  38. Kara, S., Guven, A., et al.: Utilization of artificial neural networks in the diagnosis of optic nerve diseases. Comput. Biol. Med. 36(4), 428–437 (2006)

    Article  Google Scholar 

  39. Kessler, R., Constantinou, C.E.: Internal urethrotomy in girls and its impact on the urethral intrinsic and extrinsic continence mechanisms. J. Urol. 136(6), 1248–1253 (1986)

    Google Scholar 

  40. Klutke, C., Golomb, J., et al.: The anatomy of stress incontinence: magnetic resonance imaging of the female bladder neck and urethra. J. Urol. 143(3), 563–566 (1990)

    Google Scholar 

  41. Laycock, J., Brown, J., et al.: Pelvic floor reeducation for stress incontinence: comparing three methods. Br. J. Community. Nurs. 6(5), 230–237 (2001)

    Google Scholar 

  42. Miller, J.M., Ashton-Miller, J.A., et al.: A pelvic muscle precontraction can reduce cough-related urine loss in selected women with mild SUI. J. Am. Geriatr. Soc. 46(7), 870–874 (1998)

    Google Scholar 

  43. Miller, J.M., Perucchini, D., et al.: Pelvic floor muscle contraction during a cough and decreased vesical neck mobility. Obstet. Gynecol. 97(2), 255–260 (2001)

    Article  Google Scholar 

  44. Morin, M., Bourbonnais, D., et al.: Pelvic floor muscle function in continent and stress urinary incontinent women using dynamometric measurements. Neurourol. Urodyn. 23(7), 668–674 (2004)

    Article  Google Scholar 

  45. Neumann, P., Gill, V.: Pelvic floor and abdominal muscle interaction: EMG activity and intra-abdominal pressure. Int. Urogynecol. J. Pelvic. Floor. Dysfunct. 13(2), 125–132 (2002)

    Article  Google Scholar 

  46. Norton, C., Chelvanayagam, S., et al.: Randomized controlled trial of biofeedback for fecal incontinence. Gastroenterology 125(5), 1320–1329 (2003)

    Article  Google Scholar 

  47. Nygaard, I.: Physiologic outcome measures for urinary incontinence. Gastroenterology 126(1 Suppl 1), S99–105 (2004)

    Article  Google Scholar 

  48. Peng, Q., Jones, R.C., et al.: Characterization of the mechanical parameters associated with pelvic floor muscles contractions. 36th Annual Meeting of the International Continence Society (ICS) (2006)

    Google Scholar 

  49. Peng, Q., Jones, R.C., et al.: 2D Ultrasound image processing in identifying responses of urogenital structures to pelvic floor muscle activity. Ann. Biomed. Eng. 34(3), 477–493 (2006)

    Article  Google Scholar 

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

    Google Scholar 

  51. Peng, Q., Jones, R.C., Omata, S., Constantinou, C.E.: Spatial distribution of vaginal closure pressures of continent and stress urinary incontinent women. Physiologic. Measure. 28(11), 1429–1450 (2007)

    Article  Google Scholar 

  52. Pregazzi, R., Sartore, A., et al.: Perineal ultrasound evaluation of urethral angle and bladder neck mobility in women with stress urinary incontinence. Bjog 109(7), 821–827 (2002)

    Google Scholar 

  53. Rahmanian, S., Jones, R., Peng, Q., Constantinou, C.E.: Visualization of biomechanical properties of female pelvic floor function using video motion tracking of ultrasound imaging. Technol. Informat. 132, 390–395 (2008)

    Google Scholar 

  54. Reddy, A.P., DeLancey, J.O., et al.: On-screen vector-based ultrasound assessment of vesical neck movement. Am. J. Obstet. Gynecol. 185(1), 65–70 (2001)

    Article  Google Scholar 

  55. Sapsford, R.R., Hodges, P.W., et al.: Co-activation of the abdominal and pelvic floor muscles during voluntary exercises. Neurourol. Urodyn. 20(1), 31–42 (2001)

    Article  Google Scholar 

  56. Schaer, G.N., Perucchini, D., et al.: Sonographic evaluation of the bladder neck in continent and stress-incontinent women. Obstet. Gynecol. 93(3), 412–426 (1999)

    Article  Google Scholar 

  57. Shishido, K., Peng, Q., Jones, R., Omata, S., Constantinou, C.E.: Influence of pelvic floor muscle contraction on the profile of vaginal closure pressures of continent and stress urinary incontinent women. J. Urol. 179(5), 1917–1922 (2008)

    Article  Google Scholar 

  58. Smith, M.D., Russell, A., et al.: Disorders of breathing and continence have a stronger association with back pain than obesity and physical activity. Aust. J. Physiother. 52(1), 11–16 (2006)

    Google Scholar 

  59. Stoker, J., Halligan, S., et al.: Pelvic floor imaging. Radiology 218(3), 621–641 (2001)

    Google Scholar 

  60. Theofrastous, J.P., Wyman, J.F., et al.: Effects of pelvic floor muscle training on strength and predictors of response in the treatment of urinary incontinence. Neurourol. Urodyn. 21(5), 486–490 (2002)

    Article  Google Scholar 

  61. Yang, A., Mostwin, J.L.: Pelvic floor descent in women: dynamic evaluation with fast MR imaging and cinematic display. Radiology 179(1), 25–33 (1991)

    Google Scholar 

Download references

Acknowledgements

This work was funded in part by NIH, grant 1R21 EB 001654 and R01 EB006170. We like to acknowledge the contributions of R. Jones and V. Wolfe for assistance in data collection and the clinical support of Dr. CK Payne

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Christos E. Constantinou .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2011 Springer Science+Business Media B.V.

About this chapter

Cite this chapter

Constantinou, C.E., Peng, Q., Omata, S. (2011). Visualization of the Dynamics of the Female Pelvic Floor Reflex and Steady State Function. In: Tavares, J., Jorge, R. (eds) Computational Vision and Medical Image Processing. Computational Methods in Applied Sciences, vol 19. Springer, Dordrecht. https://doi.org/10.1007/978-94-007-0011-6_3

Download citation

  • DOI: https://doi.org/10.1007/978-94-007-0011-6_3

  • Published:

  • Publisher Name: Springer, Dordrecht

  • Print ISBN: 978-94-007-0010-9

  • Online ISBN: 978-94-007-0011-6

  • eBook Packages: EngineeringEngineering (R0)

Publish with us

Policies and ethics