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.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
References
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)
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)
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)
Athanasiou, S., Khullar, V., et al.: Imaging the urethral sphincter with three-dimensional ultrasound. Obstet. Gynecol. 94(2), 295–301 (1999)
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)
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)
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)
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)
Bo, K., Sherburn, M.: Evaluation of female pelvic-floor muscle function and strength. Phys. Ther. 85(3), 269–282 (2005)
Buchsbaum, G.M., Duecy, E.E., et al.: Urinary incontinence in nulliparous women and their parous sisters. Obstet. Gynecol. 106(6), 1253–1258 (2005)
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
Christensen, L.L., Djurhuus, J.C., et al.: Imaging of pelvic floor contractions using MRI. Neurourol. Urodyn. 14(3): 209–216 (1995)
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)
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)
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)
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)
Constantinou, C.E.: Dynamics of the Female Pelvic Floor. Int. J. Comput. Vision Biomech. (1), 69–81 (2007)
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)
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)
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)
Constantinou, C.E.: Dynamics of female pelvic floor function using urodynamics, ultrasound and magnetic resonance imaging. Eur. J. Obstet. Gynecol. 144S, 159–165 (2009)
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)
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)
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)
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)
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
Dietz, H.P.: Ultrasound imaging of the pelvic floor. Part II: three-dimensional or volume imaging. Ultrasound. Obstet. Gynecol. 23(6), 615–625 (2004)
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
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)
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)
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)
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)
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)
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)
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)
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)
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)
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)
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)
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)
Laycock, J., Brown, J., et al.: Pelvic floor reeducation for stress incontinence: comparing three methods. Br. J. Community. Nurs. 6(5), 230–237 (2001)
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)
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)
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)
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)
Norton, C., Chelvanayagam, S., et al.: Randomized controlled trial of biofeedback for fecal incontinence. Gastroenterology 125(5), 1320–1329 (2003)
Nygaard, I.: Physiologic outcome measures for urinary incontinence. Gastroenterology 126(1 Suppl 1), S99–105 (2004)
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)
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)
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)
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)
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)
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)
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)
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)
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)
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)
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)
Stoker, J., Halligan, S., et al.: Pelvic floor imaging. Radiology 218(3), 621–641 (2001)
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)
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)
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
Corresponding author
Editor information
Editors and Affiliations
Rights 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)