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Modern Theories of Pelvic Floor Support

A Topical Review of Modern Studies on Structural and Functional Pelvic Floor Support from Medical Imaging, Computational Modeling, and Electromyographic Perspectives

  • Female Urology (L Cox, Section Editor)
  • Published:
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Abstract

Purpose of Review

Weakened pelvic floor support is believed to be the main cause of various pelvic floor disorders. Modern theories of pelvic floor support stress on the structural and functional integrity of multiple structures and their interplay to maintain normal pelvic floor functions. Connective tissues provide passive pelvic floor support while pelvic floor muscles provide active support through voluntary contraction. Advanced modern medical technologies allow us to comprehensively and thoroughly evaluate the interaction of supporting structures and assess both active and passive support functions. The pathophysiology of various pelvic floor disorders associated with pelvic floor weakness is now under scrutiny from the combination of (1) morphological, (2) dynamic (through computational modeling), and (3) neurophysiological perspectives. This topical review aims to update newly emerged studies assessing pelvic floor support function among these three categories.

Recent Findings

A literature search was performed with emphasis on (1) medical imaging studies that assess pelvic floor muscle architecture, (2) subject-specific computational modeling studies that address new topics such as modeling muscle contractions, and (3) pelvic floor neurophysiology studies that report novel devices or findings such as high-density surface electromyography techniques. We found that recent computational modeling studies are featured with more realistic soft tissue constitutive models (e.g., active muscle contraction) as well as an increasing interest in simulating surgical interventions (e.g., artificial sphincter). Diffusion tensor imaging provides a useful non-invasive tool to characterize pelvic floor muscles at the microstructural level, which can be potentially used to improve the accuracy of the simulation of muscle contraction. Studies using high-density surface electromyography anal and vaginal probes on large patient cohorts have been recently reported. Influences of vaginal delivery on the distribution of innervation zones of pelvic floor muscles are clarified, providing useful guidance for a better protection of women during delivery.

Summary

We are now in a period of transition to advanced diagnostic and predictive pelvic floor medicine. Our findings highlight the application of diffusion tensor imaging, computational models with consideration of active pelvic floor muscle contraction, high-density surface electromyography, and their potential integration, as tools to push the boundary of our knowledge in pelvic floor support and better shape current clinical practice.

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Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

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Authors and Affiliations

  1. Department of Biomedical Engineering, Cullen College of Engineering, University of Houston, 360 HBS Building, 4811 Calhoun Rd., Houston, TX, 77004, USA

    Yun Peng & Yingchun Zhang

  2. Department of Urology, Houston Methodist Hospital, Houston, TX, 77030, USA

    Brandi D. Miller & Timothy B. Boone

Authors
  1. Yun Peng
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  2. Brandi D. Miller
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  3. Timothy B. Boone
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  4. Yingchun Zhang
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Correspondence to Yingchun Zhang.

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Yun Peng, Brandi D. Miller, Timothy B. Boone, and Yingchun Zhang each declare that they have no conflicts of interest.

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This article does not contain any studies with human or animal subjects performed by any of the authors.

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This article is part of the Topical Collection on Female Urology

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Peng, Y., Miller, B.D., Boone, T.B. et al. Modern Theories of Pelvic Floor Support. Curr Urol Rep 19, 9 (2018). https://doi.org/10.1007/s11934-018-0752-9

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