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Phase-locked parallel movement of diaphragm and pelvic floor during breathing and coughing—a dynamic MRI investigation in healthy females

Abstract

Introduction and hypothesis

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).

Methods

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.

Results

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.

Conclusions

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.

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Abbreviations

IAP:

Intra-abdominal pressure

MRI:

Magnetic resonance imaging

PF:

Pelvic floor

PFM:

Pelvic floor muscles

PCL:

Pubococcygeal line

PRS:

Puborectalis muscle sling

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Correspondence to Helena Talasz.

Electronic supplementary material

Video 1a

Real-time dynamic MRI of in-phase parallel movements of diaphragmatic cupolae and PF as well as changes in waist diameter during forceful breathing in a healthy 24-year-old woman with clinically tested normal PFM function (subject 9). To understand the videos more easily, red arrows have been inserted indicating the position of the PF and the diaphragmatic cupolae. a Coronal plane (AVI 422 kb)

Video 1b

Real-time dynamic MRI of in-phase parallel movements of diaphragmatic cupolae and PF as well as changes in waist diameter during forceful breathing in a healthy 24-year-old woman with clinically tested normal PFM function (subject 9). To understand the videos more easily, red arrows have been inserted indicating the position of the PF and the diaphragmatic cupolae. b Mid-sagittal plane (AVI 290 kb)

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Talasz, H., Kremser, C., Kofler, M. et al. Phase-locked parallel movement of diaphragm and pelvic floor during breathing and coughing—a dynamic MRI investigation in healthy females. Int Urogynecol J 22, 61–68 (2011). https://doi.org/10.1007/s00192-010-1240-z

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  • DOI: https://doi.org/10.1007/s00192-010-1240-z

Keywords

  • Abdominal core
  • Breathing
  • Coughing
  • Diaphragm
  • Pelvic floor