Abstract
The aim of this study was to observe the abdominal and pelvic floor muscle reaction to an increase in intra-abdominal pressure in both continent and incontinent women. We performed a case control study using a convenience sample of 100 women, seen at two sites. Forty-eight were taken from a group of women with urinary incontinence seen at a tertiary care center, and 52 were studied during a routine gynecologic evaluation at a primary care center. The examination consisted of observation and palpation of the pelvic floor and abdomen during the command to cough and tighten the perineal muscles. The majority of incontinent (93%) and continent (92%) women allowed their perineum to bulge during a cough. The women (88% incontinent and 95% continent) also demonstrated a simultaneous bulging of their abdominal wall during coughing. Continent women exhibited statistically greater perineal strength than the incontinent women (p<0.001). The majority of women bulge their pelvic floor during the increased intra-abdominal pressure of a cough.
This is a preview of subscription content, access via your institution.
References
Rud T, Anderson KE, Asmussen M, Hunting A, Ulmsten U. Factors maintaining the intraurethral pressure in women. Invest Urol 1980; 17: 343–344
Walters MD. Mechanisms of continence and voiding, with International Continence Society classification of dysfunction. Obstet Gynecol Clin North Am 1989;16:773–785
DeLancey JOL. Correlative study of paraurethral anatomy. Obstet Gynecol 1986;68:91–97
Vereecken RL, Verduyn H. The electrical activity of the paraurethral and perineal muscles in normal and pathological conditions. Br J Urol 1970;42:457–463
Constantinou CD, Govan DE. Contribution and timing of transmitted and generated pressure components in the female urethra. Prog Clin Biol Res 1981;78:113–120
Heidler H, Casper F, Thuroff JW. Urethral closure under stress conditions: contribution and relative share of intraurethral and periurethral striated muscles. Neurourol Urodyn 1987;6:151–153
Rud T. The striated pelvic floor muscles and their importance in maintaining urinary continence. Prog Clin Biol Res 1981;78:105–112
Enhorning G. Simultaneous recording of the intravesical and intraurethral pressure. Acta Chir Scand Suppl 1961;276:1–68
Koelbl H, Strassegger H, Riss PA, Gruber H. Morphologic and functional aspects of pelvic floor muscles in patients with pelvic relaxation and genuine stress incontinence. Obstet Gynecol 1989;74:789–795
Eriksen BC, Eik-Nes SH. Long-term electrostimulation of the pelvic floor: primary therapy in female stress incontinence? Urol Int 1989;44:90–95
Burgio KL, Robinson JC, Engel BT. The role of biofeedback in Kegel exercise training for stress urinary incontinence. Am J Obstet Gynecol 1986;154:58–64
Oläh KS, Bridges N, Denning J, Farrar DJ. The conservative management of patients with symptoms of stress incontinence: a randomized, prospective study comparing weighted vaginal cones and interferential therapy. Am J Obstet Gynecol 1990;162:87–92
Vereecken RL, Vereduyn H. The electrical activity of the paraurethral and perineal muscles in normal and pathological conditions. Br J Urol 1970;42:457–463
Bourcier A. Pelvic floor rehabilitation. Int Urogynecol J 1990;1:31–35
Bates P, Bradley WE, Glen E et al. The standardization of terminology of lower urinary tract functions. J Urol 1979;121:551–554
Ferguson KL, McKey PL, Bishop KR, Kloen P, Verheul JB, Dougherty MC. Stress urinary incontinence: effect of pelvic muscle exercise. Obstet Gynecol 1990;75:671–675
Tries J. Kegel exercises enhanced by biofeedback. J Enterostomal Ther 1990;17:67–76
Susset JG, Galea G, Read L. Biofeedback therapy for female incontinence due to low urethral resistance. J Urol 1990;143:1205–1208
Bo K, Kvarstein B, Hagen R, Larsen S. Pelvic floor muscle exercise for the treatment of female stress urinary incontinence: II. Validity of vaginal pressure measurements of pelvic floor muscle strength and the necessity of supplementary methods for control of correct contraction. Neurourol Urodyn 1990;9:479–487
Bo K, Larsen S, Oseid S, Kvarstein B, Hagen R, Jorgensen J. Knowledge about the ability to correct pelvic floor muscle exercises in women with urinary stress incontinence. Neurourol Urodyn 1988;7:271–262
Laycock J. Pelvic floor re-education. Nursing 1991;4:139–141
Sampselle CM, Brink CA, Wells TJ. Digital measurement of pelvic muscle strength in childbearing women. Nurs Res 1989;38:134–138
Brink CA, Sampselle CM, Wells TJ, Diokno AC, Gillis GL. A digital test for pelvic muscle strength in older women with urinary incontinence. Nurs Res 1989;38:196–199
Bo K, Stien R. Pelvic floor muscle and urethral wall sphincter activity patterns during hip adductor, gluteal and abdominal muscle contractions in healthy nulliparous women. Neurourol Urodyn 1992;11:311–312
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
McIntosh, L.J., Mallett, V.T., Frahm, J.D. et al. Abdominal and perineal muscle reaction to an increase in intra-abdominal pressure. Int Urogynecol J 5, 90–93 (1994). https://doi.org/10.1007/BF00375818
Issue Date:
DOI: https://doi.org/10.1007/BF00375818