Introduction and hypothesis
The aim of this study was to assess pelvic floor muscle (PFM) function using transabdominal ultrasound (TAUS) in women attending group exercise classes. Specific aims were to: (1) identify the ability to perform a correct elevating PFM contraction and (2) assess bladder-base movement during an abdominal curl exercise.
Ninety women participating in group exercise were recruited to complete a survey and TAUS assessment performed by two qualified Continence and Women’s Health physiotherapists with clinical experience in ultrasound scanning. The assessment comprised three attempts of a PFM contraction and an abdominal curl exercise in crook lying. Bladder-base displacement was measured to determine correct or incorrect activation patterns.
Twenty-five percent (n = 23) of women were unable to demonstrate an elevating PFM contraction, and all women displayed bladder-base depression on abdominal curl (range 0.33–31.2 mm). Parous women displayed, on average, significantly more bladder-base depression than did nulliparous women [15.5 (7.3) mm vs 11.4 (5.8) mm, p < 0.009). Sixty percent (n = 54) reported stress urinary incontinence (SUI). There was no association between SUI and the inability to perform an elevating PFM contraction (p = 0.278) or the amount of bladder-base depression with abdominal curl [14.1 (7.6) mm SUI vs 14.2 (6.7) mm non-SUI].
TAUS identified that 25 % of women who participated in group exercise were unable to perform a correctly elevating PFM contraction, and all depressed the bladder-base on abdominal curl. Therefore, exercising women may be at risk of PFM dysfunction when performing abdominal curl activities.
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Milsom I, Altman D, Cartwright R, Lapitan MC, Nelson R, Sillen U, Tikkinen K (2013) Epidemiology of urinary incontinence (UI) and other lower urinary tract symptoms (LUTS), pelvic organ prolapse (POP) and anal incontinence (AI). In: Abrams P, Cardozo L, Khoury S, Wein A (eds) Fifth international consultation on incontinence. Health Publications, Paris
Avery JC, Gill TK, MacLennan AH, Chittleborough CR, Grant JF, Taylor AW (2004) The impact of incontinence on health-related quality of life in a South Australian population sample. Aust N Z J Public Health 28:173–179
Koelbl H, Igawa T, Salvatore S, Laterza RM, Lowry A, Sievert K-D, Sultan A (2013) Pathophysiology of urinary incontinence, faecal incontinence and pelvic organ prolapse. In: Abrams P, Cardozo L, Khoury S, Wein A (eds) Fifth International consultation on incontinence. Health Publications, Paris
Bo K (2004) Urinary incontinence, pelvic floor dysfunction, exercise and sport. Sports Med 34:451–464
Goldstick O, Constantini N (2014) Urinary incontinence in physically active women and female athletes. Br J Sports Med 48:296–298
Bo K, Sundgot Borgen J (2010) Are former female elite athletes more likely to experience urinary incontinence later in life than non-athletes? Scand J Med Sci Sports 20:100–104
Nygaard IE (1997) Does prolonged high-impact activity contribute to later urinary incontinence? A retrospective cohort study of female olympians. Obstet Gynecol 90:718–722
Fozzatti C, Riccetto C, Herrmann V, Brancalion MF, Raimondi M, Nascif CH, Marques LR, Palma PP (2012) Prevalence study of stress urinary incontinence in women who perform high-impact exercises. Int Urogynecol J 23:1687–1691
Salvatore S, Serati M, Laterza R, Uccella S, Torella M, Bolis PF (2009) The impact of urinary stress incontinence in young and middle-age women practising recreational sports activity: an epidemiological study. Br J Sports Med 43:1115–1118
McKenzie S, Preedy T, Thompson J, Briffa K (2014) Women who attend group exercise classes or gymnasiums have a high prevalence of stress urinary incontinence. 23rd National Conference on Incontinence 12th September; Cairns
Deeble M, French S, Thompson J, Andrews A, Briffa K (2012) Should women with pelvic floor dysfunction do sit-ups? Australian and New Zealand Continence Journal 19: ISSN 1448-0131
Jácome C, Oliveira D, Marques A, Sá-Couto P (2011) Prevalence and impact of urinary incontinence among female athletes. Int J Gynecol Obstet 114:60–63
Dumoulin C, Hay-Smith J (2010) Pelvic floor muscle training versus no treatment, or inactive control treatments, for urinary incontinence in women. Cochrane Database Syst Rev. doi:10.1002/14651858.CD005654.pub2
Miller J, Ashton-Miller J, Delancey J (1998) A pelvic muscle precontraction can reduce cough-related urine loss in selected women with mild SUI. J Am Geriatr Soc 46:870–874
Moore K, Dumoulin C, Bradley C, Burgio K, Chambers T, Hagen S, Hunter K, Imamura M, Thakar R, Williams K, Vale L (2013) Adult conservative management. In: Abrams P, Cardozo L, Khoury S, Wein A (eds) Fifth international consultation on incontinence. Health Publications, Paris
Delancey J, Ashton-Miller J (2004) Pathophysiology of adult urinary incontinence. Gastroenterology 126:S23–S32
Thompson JA, O’Sullivan PB (2003) Levator plate movement during voluntary pelvic floor muscle contraction in subjects with incontinence and prolapse: a cross-sectional study and review. Int Urogynecol J 14:84–88
Thompson JA, O’Sullivan PB, Briffa NK, Neumann P (2007) Comparison of transperineal and transabdominal ultrasound in the assessment of voluntary pelvic floor muscle contractions and functional manoeuvres in continent and incontinent women. Int Urogynecol J 18:779–786
Thompson J, O’Sullivan P, Briffa K, Neumann P (2006) Altered muscle activation patterns in symptomatic women during pelvic floor muscle contraction and Valsalva manouevre. Neurourol Urodyn 25:268–276
Theofrastous J, Wyman J, Bump R, McClish D, Elser D, Robinson D, Fantl J (1997) Relationship between urethral and vaginal pressures during pelvic muscle contraction. Neurourol Urodyn 16:553–558
Bump R, Hurt W, Fantl J, Wyman J (1991) Assessment of Kegel pelvic muscle exercise performance after brief verbal instruction. Am J Obstet Gynecol 165:322–329
Thompson JA, O’Sullivan PB, Briffa K, Neumann P, Court S (2005) Assessment of pelvic floor movement using transabdominal and transperineal ultrasound. Int Urogynecol J 16:285–292
Dietz H, Wilson P, Clarke B (2001) The use of perineal ultrasound to quantify levator activity and teach pelvic floor muscle exercises. Int Urogynecol J 12:166–169
Dietz H, Steensma A, Vancaillie T (2003) Levator function in nulliparous women. Int Urogynecol J 14:24–26
Junginger B, Baessler L, Sapsford R, Hodges P (2010) Effect of abdominal pressure and pelvic floor tasks on muscle activity, abdominal pressure and bladder neck. Int Urogynecol J 21:69–77
Chehrehrazi M, Arab AM, Karimi N, Zargham M (2009) Assessment of pelvic floor muscle contraction in stress urinary incontinent women: comparison between transabdominal ultrasound and perineometry. Int Urogynecol J 20:1491–1496
Frawley HC, Galea MP, Phillips BA, Sherburn M, Bø K (2006) Effect of test position on pelvic floor muscle assessment. Int Urogynecol J 17:365–371
Ree M, Nygaard I, Bo K (2007) Muscular fatigue in the pelvic floor muscles after strenuous physical activity. Acta Obstet Gynecol Scand 87:870–876
Laycock J, Jerwood D (2001) Pelvic floor muscle assessment. The PERFECT scheme. Physiotherapy 87:631–642
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Barton, A., Serrao, C., Thompson, J. et al. Transabdominal ultrasound to assess pelvic floor muscle performance during abdominal curl in exercising women. Int Urogynecol J 26, 1789–1795 (2015). https://doi.org/10.1007/s00192-015-2791-9