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Clinical and MRI changes of puborectalis and iliococcygeus after a short period of intensive pelvic floor muscles training with or without instrumentation

A prospective randomized controlled trial

  • Original Article
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European Journal of Applied Physiology Aims and scope Submit manuscript

Abstract

Purpose

This study evaluates the impact of a 3-week period of intensive pelvic floor muscles training (PFMT), with or without instrumentation, on clinical and static magnetic resonance imaging (MRI) changes of puborectalis (PR) and iliococcygeus (IL) muscles.

Methods

24 healthy young women were enrolled in the study and 17 achieved the 9 sessions of 30 min training exercises and conducted all assessments. Participants were randomly assigned in two training groups: voluntary contractions combined with hypopressive exercises (HYPO) or biofeedback exercises combined with transvaginal electrical stimulations (ELEC). Clinical and T2-weighted MRI assessments were realized before and after training.

Results

Modified Oxford Grading System (MOGS) scores for left PR and perineal body significantly increased in the two groups (p = 0.039, p = 0.008), but MOGS score for right PR significantly increased only in HYPO (p = 0.020). Muscle volumes of right and left IL significantly decreased (p = 0.040, p = 0.045) after training as well as signal intensities of right and left PR (p = 0.040, p = 0.021) and thickness of right and left IL at mid-vagina location (p = 0.012, p = 0.011).

Conclusions

A short period of intensive PFMT induces clinical and morphological changes in PFMs at rest suggesting a decrease in IL volume and adipose content of PR. Although the results suggested that an intensive non-instrumented PFMT is as effective as an instrumented training, future controlled studies with greater sample sizes are needed to establish the relative and absolute effectiveness of each of the two interventions.

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Abbreviations

BMI:

Body mass index

CONSORT:

Consolidated standards of reporting trials

DA:

Diaphragmatic aspiration

DTI:

Diffusion tensor imaging

ELEC:

Biofeedback exercises and transvaginal electrical stimulations group

HYPO:

Voluntary contractions and hypopressive exercises group

ICC:

Intraclass correlation coefficient

IL:

Iliococcygeus

LA:

Levator ani

MOGS:

Modified Oxford grading system

MPL:

Mid-pubic line

MRI:

Magnetic resonance imaging

OI:

Obturator internus

PB:

Perineal body

PC:

Pubococcygeus

PCL:

Pubococcygeal line

PFD:

Pelvic floor dysfunction

PFDI-20:

Pelvic floor distress inventory

PFIQ-7:

Pelvic floor impact questionnaire

PFM:

Pelvic floor muscle

PFMT:

Pelvic floor muscle training

PLP:

Posterior levator plate

PR:

Puborectalis

PV:

Pubovisceralis

RM ANOVA:

Repeated measures analysis of variance

RT:

Resting tone

SD:

Standard deviation

TUI:

Translabial tomographic ultrasound imaging

UI:

Urinary incontinence

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Acknowledgements

The authors would like to thank Caroline Lahaye and Jean-Louis Greffe for their assistance in the development of the protocol, and Jean-Claude Malherbe (Enraf-Nonius) for making the stimulation/biofeedback material available throughout the experiment. They also thank the financial support of Grand Hôpital de Charleroi (GHdC asbl), Philips SA, and the Haute Ecole Louvain en Hainaut for the MRI.

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Authors and Affiliations

  1. Forme and Fonctionnement Humain Lab, Department of Physical Therapy, CERISIC, Haute Ecole Louvain en Hainaut, rue Trieu Kaisin, 136, 6061, Montignies-sur-Sambre, Belgium

    Frédéric Dierick, Ekaterina Galtsova, Clara Lauer & Fabien Buisseret

  2. Le Richemont, rue de l’Enclos, 13, 5537, Bioul, Belgium

    Anne-France Bouché

  3. Grand Hôpital de Charleroi, site Saint-Jospeh, rue Marguerite Depasse, 6, 6060, Gilly, Belgium

    Laurent Martin

Authors
  1. Frédéric Dierick
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  2. Ekaterina Galtsova
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  3. Clara Lauer
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  4. Fabien Buisseret
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  5. Anne-France Bouché
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  6. Laurent Martin
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Contributions

FD and AFB conceived and designed research. FD, EG, CL and LM conducted experiments. FD, EG and CL analyzed data. FD, EG, CL, FB, AFB and LM wrote the manuscript. All authors read and approved the manuscript.

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Correspondence to Frédéric Dierick.

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Communicated by Bénédicte Schepens.

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Dierick, F., Galtsova, E., Lauer, C. et al. Clinical and MRI changes of puborectalis and iliococcygeus after a short period of intensive pelvic floor muscles training with or without instrumentation. Eur J Appl Physiol 118, 1661–1671 (2018). https://doi.org/10.1007/s00421-018-3899-7

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