Advertisement

Parity: a risk factor for decreased pelvic floor muscle strength and endurance in middle-aged women

  • Ji Young Hwang
  • Bo-in Kim
  • Seung Hun SongEmail author
Original Article
  • 24 Downloads

Abstract

Introduction and hypothesis

The incidence of pelvic floor muscle (PFM) dysfunction increases rapidly with menopause and aging. Despite the raised magnitude and prevalence of pelvic floor disorders in middle-aged women, the risk factors underlying PFM dysfunction still remain to be identified. PFM function can be clinically measured as the maximum strength and endurance using manometry. The aim of this study was to evaluate PFM function in terms of strength and endurance by perineometer and to assess the risk factors that decrease PFM strength and endurance in middle-aged women.

Methods

This was a cross-sectional study. Overall, 125 parous women (age 40–60 years) completed the study. A questionnaire was used to collect information on several demographic and obstetric variables. The Peritron perineometer measured PFM strength and endurance. Multiple linear regression analysis was used to evaluate the effects of sociodemographic variables on PFM function.

Results

Both average strength of PFMs and maximum muscle strength significantly reduced as the number of parity increased. Average and maximum strength of PFMs showed a significant difference between women with parities of two and one (β = −0.435, p < .001; β = −0.441, p < 0.001, respectively). Both were even more influenced in women with parity of three (β = −0.503, p < .001; β = −0.500, p < .001). However, PFM endurance did not decrease with increasing parity number until the parity of two; however, it decreased in women with parity of three (β = −0.302, p < 0.05).

Conclusion

Parity appeared to have a dominant influence on weakness of PFM, and strength was more significantly associated with parity than endurance in middle-aged women.

Keywords

PFM endurance PFM strength Pelvic floor muscle Perineometer 

Notes

Compliance with ethical standards

Conflicts of interest

None.

References

  1. 1.
    Olsen AL, Smith VJ, Bergstrom JO, Colling JC, Clark AL. Epidemiology of surgically managed pelvic organ prolapse and urinary incontinence. Obstet Gynecol. 1997;89(4):501–6.CrossRefGoogle Scholar
  2. 2.
    Wu JM, Matthews CA, Conover MM, Pate V, Jonsson FM. Lifetime risk of stress urinary incontinence or pelvic organ prolapse surgery. Obstet Gynecol. 2014;123(6):1201–6.CrossRefGoogle Scholar
  3. 3.
    Mannella P, Palla G, Bellini M, Simoncini T. The female pelvic floor through midlife and aging. Maturitas. 2013;76(3):230–4.CrossRefGoogle Scholar
  4. 4.
    Rociu E, Stoker J, Eijkemans MJ, Lameris JS. Normal anal sphincter anatomy and age- and sex-related variations at high-spatial-resolution endoanal MR imaging. Radiology. 2000;217(2):395–401.CrossRefGoogle Scholar
  5. 5.
    Peschers UM, Schaer GN, DeLancey JO, Schuessler B. Levator ani function before and after childbirth. Br J Obstet Gynaecol. 1997;104(9):1004–8.CrossRefGoogle Scholar
  6. 6.
    Ashton-Miller JA, DeLancey JO. Functional anatomy of the female pelvic floor. Ann N Y Acad Sci. 2007;1101:266–96.CrossRefGoogle Scholar
  7. 7.
    Staer-Jensen J, Siafarikas F, Hilde G, Benth JS, Bo K, Engh ME. Postpartum recovery of levator hiatus and bladder neck mobility in relation to pregnancy. Obstet Gynecol. 2015;125(3):531–9.CrossRefGoogle Scholar
  8. 8.
    Rahmani N, Mohseni-Bandpei MA. Application of perineometer in the assessment of pelvic floor muscle strength and endurance: a reliability study. J Bodyw Mov Ther. 2011;15(2):209–14.CrossRefGoogle Scholar
  9. 9.
    Bo K, Ellstrom Engh M, Hilde G. Regular exercisers have stronger pelvic floor muscles than nonregular exercisers at midpregnancy. Am J Obstet Gynecol. 2018;218(4):427.e1–5.CrossRefGoogle Scholar
  10. 10.
    Braekken IH, Majida M, Engh ME, Bo K. Are pelvic floor muscle thickness and size of levator hiatus associated with pelvic floor muscle strength, endurance and vaginal resting pressure in women with pelvic organ prolapse stages I-III? A cross sectional 3D ultrasound study. Neurourol Urodyn. 2014;33(1):115–20.CrossRefGoogle Scholar
  11. 11.
    Amaro JL, Moreira EC, De Oliveira Orsi Gameiro M, Padovani CR. Pelvic floor muscle evaluation in incontinent patients. Int Urogynecol J Pelvic Floor Dysfunct. 2005;16(5):352–4.CrossRefGoogle Scholar
  12. 12.
    Kerschan-Schindl K, Uher E, Wiesinger G, Kaider A, Ebenbichler G, Nicolakis P, et al. Reliability of pelvic floor muscle strength measurement in elderly incontinent women. Neurourol Urodyn. 2002;21(1):42–7.CrossRefGoogle Scholar
  13. 13.
    Ozdemir OC, Bakar Y, Ozengin N, Duran B. The effect of parity on pelvic floor muscle strength and quality of life in women with urinary incontinence: a cross sectional study. J Phys Ther Sci. 2015;27(7):2133–7.CrossRefGoogle Scholar
  14. 14.
    Li H, Wu RF, Qi F, Xiao AM, Ma Z, Hu Y, et al. Postpartum pelvic floor function performance after two different modes of delivery. Genet Mol Res. 2015;14(2):2994–3001.CrossRefGoogle Scholar
  15. 15.
    Harvey MA, Johnston SL, Davies GA. Mid-trimester serum relaxin concentrations and post-partum pelvic floor dysfunction. Acta Obstet Gynecol Scand. 2008;87(12):1315–21.CrossRefGoogle Scholar
  16. 16.
    Hilde G, Staer-Jensen J, Siafarikas F, Engh ME, Braekken IH, Bo K. Impact of childbirth and mode of delivery on vaginal resting pressure and on pelvic floor muscle strength and endurance. Am J Obstet Gynecol. 2013;208(1):50 e1–7.CrossRefGoogle Scholar
  17. 17.
    Sigurdardottir T, Steingrimsdottir T, Arnason A, Bo K. Pelvic floor muscle function before and after first childbirth. Int Urogynecol J. 2011;22(12):1497–503.CrossRefGoogle Scholar
  18. 18.
    Elenskaia K, Thakar R, Sultan AH, Scheer I, Beggs A. The effect of pregnancy and childbirth on pelvic floor muscle function. Int Urogynecol J. 2011;22(11):1421–7.CrossRefGoogle Scholar
  19. 19.
    Varella LR, Torres VB, Angelo PH, Eugenia de Oliveira MC, Matias de Barros AC, Viana Ede S, et al. Influence of parity, type of delivery, and physical activity level on pelvic floor muscles in postmenopausal women. J Phys Ther Sci. 2016;28(3):824–30.CrossRefGoogle Scholar
  20. 20.
    Marshall K, Walsh DM, Baxter GD. The effect of a first vaginal delivery on the integrity of the pelvic floor musculature. Clin Rehabil. 2002;16(7):795–9.CrossRefGoogle Scholar
  21. 21.
    Dimpfl T, Jaeger C, Mueller-Felber W, Anthuber C, Hirsch A, Brandmaier R, et al. Myogenic changes of the levator ani muscle in premenopausal women: the impact of vaginal delivery and age. Neurourol Urodyn. 1998;17(3):197–205.CrossRefGoogle Scholar
  22. 22.
    Bukovsky A, Copas P, Caudle MR, Cekanova M, Dassanayake T, Asbury B, et al. Abnormal expression of p27kip1 protein in levator ani muscle of aging women with pelvic floor disorders - a relationship to the cellular differentiation and degeneration. BMC Clin Pathol. 2001;1(1):4.CrossRefGoogle Scholar
  23. 23.
    Tibaek S, Gard G, Jensen R. Pelvic floor muscle training is effective in women with urinary incontinence after stroke: a randomised, controlled and blinded study. Neurourol Urodyn. 2005;24(4):348–57.CrossRefGoogle Scholar
  24. 24.
    Slieker-ten Hove MC, Pool-Goudzwaard AL, Eijkemans MJ, Steegers-Theunissen RP, Burger CW, Vierhout ME. Pelvic floor muscle function in a general female population in relation with age and parity and the relation between voluntary and involuntary contractions of the pelvic floor musculature. Int Urogynecol J Pelvic Floor Dysfunct. 2009;20(12):1497–504.CrossRefGoogle Scholar
  25. 25.
    Quartly E, Hallam T, Kilbreath S, Refshauge K. Strength and endurance of the pelvic floor muscles in continent women: an observational study. Physiotherapy. 2010;96(4):311–6.CrossRefGoogle Scholar

Copyright information

© The International Urogynecological Association 2019

Authors and Affiliations

  1. 1.Department of Obstetrics and Gynecology, Fertility Center of CHA Gangnam Medical CenterCHA UniversityPocheonSouth Korea
  2. 2.Department of Physical TherapyHanmaeum Changwon HospitalChangwonSouth Korea
  3. 3.Comprehensive Gynecologic Cancer Center, Department of Obstetrics and GynecologyCHA Bundang Medical Center, CHA UniversitySeongnam-siRepublic of Korea

Personalised recommendations