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High-density surface electromyographic assessment of pelvic floor hypertonicity in IC/BPS patients: a pilot study

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Abstract

Introduction and hypothesis

To assess the feasibility of objectively assessing pelvic floor hypertonicity (PFH) in women with interstitial cystitis/bladder pain syndrome (IC/BPS) using an intra-vaginal high-density surface electromyography (HD-sEMG) probe.

Methods

Seven female subjects (mean age 44 ± 13 years) with a prior diagnosis of IC/BPS were recruited. A full digital pelvic examination was administered to identify hypertonic muscles. Intra-vaginal HD-sEMG was acquired during rest. Root-mean-squared (RMS) amplitude during rest was calculated for each channel to define a hypertonicity index and hypertonic zone. Innervation zones (IZs) were identified from the bipolar mapping of decomposed HD-sEMG signals and summarized into an IZ distribution mapping.

Results

Of the seven subjects recruited, five had normal pelvic floor muscle tone and two exhibited hypertonicity upon muscle palpation. Subjects with PFH demonstrated a higher hypertonicity index (12.6 ± 3.5 vs. 4.5 ± 1.2) in sessions 1 and 2. The hypertonic zone defined by the 64-channel RMS mapping coincided with the digital pelvic examination findings. The corresponding IZs were localized for each motor unit. The hypertonicity indices between two consecutive sessions were well correlated (CC = 0.95).

Conclusions

This study represents the first effort to employ intra-vaginal HD-sEMG to assess PFH in women with IC/BPS. Our results demonstrate the feasibility of HD-sEMG to provide a quantitative diagnosis of PFH and the precise localization of hypertonic muscles and IZs. The proposed HD-sEMG-based techniques provide promising tools for clinical diagnosis and treatment of PFH, such as the personalized guidance of BoNT injections.

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Abbreviations

PFH:

Pelvic floor hypertonicity

IC/BPS:

Interstitial cystitis or bladder pain syndrome

EMG:

Electromyography

IZ:

Innervation zone

MUAP:

Motor unit action potential

HD-sEMG:

High-density surface electromyography

BoNT:

Botulinum neurotoxin

PFM:

Pelvic floor muscles

RPC:

Right pubococcygeus

RPR:

Right puborectalis

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Funding

This study received funding support from the SUFU Foundation, NIH DK113525 and AG053778.

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Authors and Affiliations

  1. Department of Biomedical Engineering, University of Houston, Houston, TX, 77204, USA

    Nicholas Dias, Chuan Zhang & Yingchun Zhang

  2. Department of Urology, Baylor College of Medicine, Houston, TX, 77030, USA

    Christopher P. Smith

  3. Department of Surgery, Washington University School of Medicine, St. Louis, MO, 63110, USA

    H. Henry Lai

Authors
  1. Nicholas Dias
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  2. Chuan Zhang
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  3. Christopher P. Smith
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  4. H. Henry Lai
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  5. Yingchun Zhang
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Contributions

ND: Data collection, Data analysis, Result interpretation, Manuscript writing/editing; CZ: Data collection, Data analysis, Manuscript writing/editing; CS: Project development, Data collection, Result interpretation, Manuscript writing/editing; HL: Result interpretation, Manuscript writing/editing; YZ: Project development, Data collection, Data analysis, Result interpretation, Manuscript writing/editing.

Corresponding author

Correspondence to Yingchun Zhang.

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Ethics approval

The study protocol was reviewed and approved by the Institutional Review Board of The University of Houston and Baylor College of Medicine. All subjects gave written informed consent.

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Dias, N., Zhang, C., Smith, C.P. et al. High-density surface electromyographic assessment of pelvic floor hypertonicity in IC/BPS patients: a pilot study. Int Urogynecol J 32, 1221–1228 (2021). https://doi.org/10.1007/s00192-020-04467-2

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  • DOI: https://doi.org/10.1007/s00192-020-04467-2

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