Search Results (66)

Background/Objectives: Urinary incontinence (UI), defined as the involuntary loss of urine, is common among female athletes. As more women engage in competitive sports, numerous studies have explored UI in young, nulliparous, and physically active women. The objectives of this study were (i) to analyze the prevalence, severity, and characteristics of UI in professional nulliparous female soccer players and (ii) to compare the status of the pelvic floor muscles (PFMs) between professional soccer players and physically active young women. Methods: This descriptive cross-sectional study included professional soccer players (n = 18) and physically active women (n = 14). UI was assessed using the ICIQ-SF questionnaire, and PFM function was evaluated through intracavitary examination using the PERFECT method. Additional data were collected on body composition and on urinary, bowel, and sexual health. Results: UI affected 35.7% of physically active women and 50% of professional soccer players. Stress urinary incontinence (SUI) was the most common type, present in 100% of affected soccer players and 60% of affected active women. The severity of UI was mostly mild, with no significant differences between groups. PFM assessment revealed deficiencies in control, relaxation, endurance, and rapid contractions, as well as difficulties performing an effective perineal locking (PL) maneuver during increased intra-abdominal pressure. Conclusions: These findings highlight the need for targeted programs focused on strengthening and educating athletes about their PFMs, aiming to prevent UI and improve both performance and quality of life. The study reinforces the importance of preventive strategies for pelvic floor health in sports. Full article

Background: Pelvic floor muscle (PFM) dysfunctions, such as urinary incontinence (UI), significantly impact women’s quality of life. The abdominal hypopressive technique (AHT), a breathing and posture-based intervention, has emerged as a promising approach to improve PFM function. Despite growing evidence on its efficacy, limited research explores its effect on PFM contractility. Objective: This study aimed to evaluate the effects of an 8-week AHT program on pelvic floor muscle (PFM) strength in adult women with no prior experience with AHT. Methods: A randomized controlled trial was conducted with 42 females (mean age 43 ± 9 years) assigned to an experimental group (EG, n = 21) or a control group (CG, n = 21). The EG completed 24 AHT sessions (30 min/session, 3 sessions/week) over 8 weeks. PFM strength, measured via maximum voluntary contraction (MVC), was assessed pre- and post-intervention using the Phenix Biofeedback Kit. Secondary outcomes included load absorption and muscle efficiency. Muscle efficiency and load absorption were also registered. Results: After the 8-week intervention, significant improvements were observed in the EG for maximal voluntary contraction (MVC1 (from 672.2 ± 344.1 g/cm² to 890.3 ± 435.8 g/cm², p = 0.002) and load absorption (from 83.9 ± 36.8 to 103.1 ± 37.3, p = 0.001), with no significant changes in the CG. Between-group differences for MVC1 (p = 0.001), MVC2 (p = 0.016), and load absorption (p = 0.008) were statistically significant. High adherence (96%) and no adverse events were recorded. Conclusions: An 8-week AHT program significantly improved PFM strength, load absorption, and muscle efficiency in women from the present study comparing with the CG. AHT could be considered a safe, non-invasive, and effective intervention for pelvic floor rehabilitation, with potential benefits for addressing UI and enhancing pelvic floor functionality. Future research should focus on long-term outcomes and comparisons with alternative therapies. Full article

Purpose: Urinary incontinence (UI) significantly impacts the quality of life, necessitating a range of treatments, from behavioral changes to surgical interventions. Electromagnetic muscle stimulation (HIFEM™) therapy presents an innovative, non-invasive approach to strengthening pelvic floor muscles (PFMs). Subjects and Methods: This retrospective, non-interventional case series study explores the efficacy and safety of HIFEM™ treatment in parous women experiencing stress (SUI) and mixed urinary incontinence (MUI). Nineteen women (mean age 54 ± 16) underwent six HIFEM™ sessions, with symptom progression tracked using the International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form (ICIQ-UI SF), along with comfort and satisfaction questionnaires. Results: At baseline, the mean ICIQ-UI SF score was 7.9 ± 4.2 points. By the final questionnaire administration, the average score had dropped to 4.7 ± 3.5, reflecting a 50.6% reduction from baseline (p < 0.001). According to ICIQ-UI SF Item 6, 21% of subjects achieved complete continence. Additionally, the percentage of subjects experiencing urine leakage before reaching the toilet declined by 40% after the sixth treatment. Post treatment, the number of subjects who leaked urine while coughing or sneezing decreased by 50%. Conclusions: The treatment has shown high efficacy in lowering the ICIQ-SF scores across the study group, with a significant number of subjects regaining entire continence. Full article

Background/Objectives: Approximately 30% of women experience pelvic pain one year after vaginal delivery, and this increases to 50% during vaginal intercourse. Multimodal physiotherapy is the first-line treatment for myofascial pain of the pelvic floor muscles (PFM), often incorporating emerging technologies like radiofrequency, despite limited evidence supporting its use. The RASDOP study aims to (i) evaluate the effectiveness of multimodal physiotherapy combining therapeutic education, PFM training, and myofascial pain syndrome (MPS) management with or without radiofrequency, in reducing pain and improving sexual function postpartum; and (ii) explore the barriers and facilitators influencing adherence and perceived self-efficacy towards physiotherapy treatment in women with postpartum pelvic pain. Methods: This study employs a randomized clinical trial with a blinded examiner and two parallel groups, followed by a qualitative phenomenological study. A total of 124 postpartum women with pelvic pain (≥4 cm on the visual analogue scale) will be randomized into two groups: a multimodal physiotherapy group (therapeutic education, MPS treatment, and PFM training) and a radiofrequency + multimodal physiotherapy group (same treatment with additional non-ablative radiofrequency). Both groups will receive 12 supervised individual sessions. Assessments will be conducted pre- and post-intervention, and at 3-, 6-, and 12-month stages post-treatment. Primary outcomes include pain intensity and sexual function, while secondary outcomes involve PFM tone, strength, MPS presence, levator ani length, and distress caused by pelvic floor dysfunction. The qualitative study will utilize semi-structured interviews and focus groups analyzed thematically. Results: Radiofrequency is expected to enhance pain relief, sexual function, and PFM relaxation. Insights into adherence and barriers will aid in personalizing physiotherapy interventions. Conclusions: The RASDOP study will provide evidence on the safety and efficacy of radiofrequency in postpartum pelvic pain treatment and shed light on women’s experiences to improve therapeutic outcomes. Full article

Background/Objectives: Implementing and optimizing pelvic floor muscle (PFM) training programs is crucial for reducing the risk of dysfunctions, improving athletic performance, and enhancing quality of life for athletes. The aim of this study was to assess PFM activation in female athletes during postural challenges. Methods: An observational and descriptive study was conducted with twenty-five female rugby players. Surface electromyography was used to evaluate the PFMs in five different body positions under stable and unstable conditions. Results: The peak amplitude of the PFMs at baseline differed according to the physical demand of each position (p < 0.001). The lowest percentage activation was in the supine position (16.23%), while the highest recruitment was observed during the parallel squat (40.69%). The percentage of maximum voluntary contraction also differed according to each position (p = 0.001). The values were similar in supine position, side plank (104%), and standing position, being significantly lower (p < 0.05) than those reached during the off-knees quadruped hold (121.58%), full plank (121.97%), and parallel squat (151.40%); however, the values were comparable between stable and unstable positions (p = 1.000). Conclusions: Positions that challenge gravity and pelvic biomechanics, such as the squat, plank, and quadruped, facilitate greater activation of the PFMs. Contrary to previous recommendations, these exercises do not appear to have significant negative effects; therefore, consideration should be given to the implementation of these exercises for the management of pelvic floor dysfunction and as part of comprehensive exercise programs designed to improve overall core and pelvic floor function. Full article

Background and Objectives: The primary objective of this study was to assess the impact of pelvic floor muscle (PFM) strengthening on the pelvic floor function in women who have experienced OASIS two years after delivery, and the secondary objective was to educate women about PFM strengthening and instruct them on the correct way to exercise. Methods and Materials: A prospective case-control study was conducted. The participants were divided into two groups: the case group (women who experienced OASIS) and the control group (women who did not experience perineal tears but had similar obstetric-related data to the case). Women were invited for a gynecological exam, PFM assessment, and consultation on PFM training. Women in the case group had three consultations, and women in the control group had two. Women were presented with four sets of questions about pre-pregnancy condition and questions related to UI and FI after delivery. Results were considered significant when p < 0.05. Results: OASIS were detected in 13 (0.4%) women in 2021. Risk factors for OASIS were found to be fetal macrosomia (p = 0.012), fetal occiput posterior position (p = 0.001), and epidural analgesia (p = 0.003). After one year of performing PFM strengthening exercises, some women in the study group exhibited stronger PFM contractions (p = 0.076), while others held the contracted PFM for a longer time (p = 0.133). UI affected women in the control group more often (p = 0.019). Two years after delivery, gas incontinence was mentioned significantly more frequently in the case group (p = 0.019). One year after initial consultation, gas incontinence was also more significantly common in the case group (p = 0.037). Conclusions: This study found that PFM strengthening exercises significantly improved pelvic floor function in women who experienced OASIS two years after delivery. Participants exhibited stronger PFM contractions and an increased ability to maintain these contractions. Women reported a better understanding of PFM exercises and proper techniques. Full article

Background: The aim of the study was to assess the effect of high-intensity focused electromagnetic (HIFEM) technology in the treatment of female stress urinary incontinence (SUI). Materials and Methods: 20 women with SUI were delivered a treatment course with HIFEM technology. Patients attended 6 therapies scheduled twice a week. Validated questionnaires were assessed, including the overactive bladder symptoms score (OABSS), urogenital distress inventory-6 (UDI-6), incontinence impact questionnaire-7 (IIQ-7), international consultation on incontinence questionnaire (ICIQ), and valued living questionnaire (VLQ). Some urodynamic parameters, such as maximum flow rate (Qmax), residual urine (RU), and bladder volume at first sensation to void (Vfst). Bladder neck mobility in ultrasound topography was also collected pre- and post-treatment at 1- and 6-month follow-up visits. Results: HIFEM treatment significantly improved SUI symptoms on pad tests from 4.2 ± 5.5 to 0.6 ± 1.3 and patients’ self-assessment in the 6-month follow-up. Additionally, the data from urinary-related questionnaires, including OABSS (5.3 ± 3.9 to 3.9 ± 3.6), UDI-6 (35.7 ± 22.3 to 15.2 ± 10.6), IIQ-7 (33.1 ± 28.7 to 14.3 ± 17.2), and ICIQ (9.4 ± 5.0 to 5.4 ± 3.6), all showed a significant reduction. Then, the analysis of the urodynamic study revealed that only maximum urethral closure pressure (MUCP) (46.4 ± 25.2 to 58.1 ± 21.2) and urethral closure angle (UCA) (705.3 ± 302.3 to 990.0 ± 439.6) significantly increased after the six sessions of HIFEM treatment. The urethral and vaginal topography were performed and found that HIFEM mainly worked on pelvic floor muscles (PFM) and enhanced their function and integrity. Conclusions: The results suggest that HIFEM technology is an efficacious therapy for the treatment of SUI. Full article

Background/Objectives: Pelvic floor muscles (PFM) play a vital role in the proper functioning of the pelvic and abdominal organs. The PFM are structurally connected to other areas of the body, forming part of the deep front line. Due to its course, this line connects the PFM with the temporomandibular joint (TMJ). The aim of the study was to evaluate the impact of a single 15-minute soft tissue therapy session in the TMJ on the activity of the PFM. Methods: A total of 47 nulliparous women aged 20–29 years old diagnosed with myofascial pain in the TMJ area were included in the study. PFM were assessed using the Noraxon Ultium device and a vaginal probe, utilizing the surface electromyography (sEMG) method. The sEMG signal was processed with MyoResearch XP software version 1.0. Additionally, bladder floor displacement during PFM contractions was evaluated using an ultrasound imaging device set in B-mode (LOGIQ P7/P9). Results: In the experimental group, following the applied soft tissue therapy, a significant decrease in resting PFM activity between maximal contractions was observed (p < 0.05). The resting PFM activity assessed in the final phase of the measurement protocol was also significantly lower (p < 0.05). During endurance contractions in the experimental group, after the therapy, an 18.05% increase in PFM tension amplitude was noted, although this change was not statistically significant. In the control group, a decrease in amplitude was observed during the second assessment in this phase of the test. Conclusions: A single session of soft tissue therapy in the TMJ area may enhance the ability of the pelvic floor muscles to relax and contribute to improved muscle function by increasing their activation levels during submaximal contractions Full article

Several studies have shown interstitial cystitis/bladder pain syndrome (IC/BPS), a chronic condition that poses challenges in both diagnosis and treatment, is associated with painful pelvic floor muscles (PFM) and altered neural drive to these muscles. However, its pathophysiology could also involve other alterations in the electrical activity of PFM motor units (MUs). Studying these alterations could provide novel insights into IC/BPS and help its clinical management. This study aimed to characterize PFM activity at the MU level in women with IC/BPS and pelvic floor myalgia using high-density surface electromyography (HD-sEMG). Signals were recorded from 15 patients and 15 healthy controls and decomposed into MU action potential (MUAP) spike trains. MUAP amplitude, firing rate, and magnitude-squared coherence between spike trains were compared across groups. Results showed that MUAPs had significantly lower amplitudes during contractions on the patients’ left PFM, and delta-band coherence was significantly higher at rest on their right PFM compared to controls. These findings suggest altered PFM tissue and neuromuscular control in women with IC/BPS and pelvic floor myalgia. Our results demonstrate that HD-sEMG can provide novel insights into IC/BPS-related PFM dysfunction and biomarkers that help identify subgroups of IC/BPS patients, which may aid their diagnosis and treatment. Full article

The first line of treatment for urinary incontinence is pelvic floor muscle (PFM) training, aimed at reducing leakage episodes by strengthening these muscles. However, many women struggle with performing correct PFM contractions or have misconceptions about their contractions. To address this issue, we present a novel PFM contraction quality assessment system. This system combines a PFM contraction detector with a maximal PFM contraction performance classifier. The contraction detector first identifies whether or not a PFM contraction was performed. Then, the contraction classifier autonomously quantifies the quality of maximal PFM contractions across different features, which are also combined into an overall rating. Both algorithms are based on artificial intelligence (AI) methods. The detector relies on a convolutional neural network, while the contraction classifier uses a custom feature extractor followed by a random forest classifier to predict the strength rating based on the modified Oxford scale. The AI algorithms were trained and tested using datasets measured by vaginal dynamometry, combined in some cases with digital assessment results from expert physiotherapists. The contraction detector was trained on one dataset and then tested on two datasets measured with different dynamometers, achieving 97% accuracy on the first dataset and 100% accuracy on the second. For the contraction performance classifier, the results demonstrate that important clinical features can be extracted automatically with an acceptable error. Furthermore, the contraction classifier is able to predict the strength rating within a $\pm 1$ scale point with 97% accuracy. These results demonstrate the system’s potential to enhance PFM training and rehabilitation by enabling women to monitor and improve their PFM contractions autonomously. Full article

Objectives: This study analyzed the effect of different positions on pelvic floor muscle (PFM) function in women with and without stress urinary incontinence (SUI). Methods: This study included women with (n = 17, research group) and without (n = 25, control group) SUI. Using abdominal ultrasound, PFM function (maximum contraction and endurance) was measured in four different positions: lying, sitting, standing and squatting. The level of difficulty perceived by the participants was recorded. Results: In both groups, the best contraction was observed in the standing position and the weakest in the lying position. Women with SUI showed a lower ability to perform PFM contraction. A significant difference was found between the groups in the sitting and standing positions, and it was smaller in the research group. In the research group, the contraction displacement during sitting was 2.68 (1.67) mm versus 4.51 (2.62) mm in the control. The displacement during standing was 6.92 (3.50) mm versus 9.18 (5.05) mm, respectively (p < 0.05). In the research group, 52.9% reported the sitting position as the most difficult compared with only 12% in the control group. Conclusions: Women with SUI have lower PFM function while standing or sitting, but not while lying, than those without SUI. Variations in PFM function across different positions exist. A new protocol for PFM examination should be written with the standing position included. Full article

Background: Effective prevention and treatment of pelvic floor dysfunction (PFD) necessitates the identification of lesions within the complex pelvic floor muscle (PFM) groups associated with various symptoms. Here, we developed a multi-region pelvic floor muscle functional diagnosis system (MPDS) based on an inflatable stretchable electrode array, which aids in accurately locating areas related to PFD. Methods: Clinical diagnostic experiments were conducted on 56 patients with postpartum stress urinary incontinence (PSUI) and 73 postpartum asymptomatic controls. MPDS collects pelvic floor electromyography from all participants. By assessing EMG parameters such as activation time differences (ATD) and using Jensen–Shannon (JS) divergence to verify, with the aim of locating target muscle groups with functional abnormalities. Results: Clinical test results showed that by observing the AT sequence of the PSUI group and the control group, muscle groups with functional abnormalities in the Pubococcygeus muscle (PC) and Puborectalis muscle (PR) regions could be preliminarily diagnosed. In the assessment of regional muscle contribution values based on JS divergence, it was verified that the contribution values of rapid contraction in the PC and PR regions of the PSUI group were relatively lower compared to those of the control group, which correlated with urinary control dysfunction. Conclusions: These experiments demonstrate that the MPDS helps in accurately locating target muscle groups with functional abnormalities, showcasing its potential in precise assessment of complex muscle groups such as PFM, which may improve diagnostic precision and reliability. Full article

Background and Objectives: Urinary incontinence (UI) is the involuntary loss of urine caused by a weakness in the pelvic floor muscles (PFMs) that affects urethral closure. Myostatin, which prevents the growth of muscles, is a protein expressed by human skeletal muscle cells. Indeed, it has been observed that myostatin concentration rises during skeletal muscle inactivity and that suppressing serum myostatin promotes muscle growth and strength. Furthermore, therapeutic interventions that reduce myostatin signalling may lessen the effects of aging on skeletal muscle mass and function. For this reason, the aim of the study was to assess if flat magnetic stimulation technology affects serum myostatin levels, as myostatin can block cell proliferation at the urethral sphincter level. Materials and Methods: A total of 19 women, 75% presenting stress urinary incontinence (SUI) and 25% urgency urinary incontinence (UUI), were enrolled. A non-invasive electromagnetic therapeutic system designed for deep pelvic floor area stimulation was used for eight sessions. Results: The ELISA (enzyme linked immunosorbent assay) test indicated that the myostatin levels in blood sera had significantly decreased. Patients’ ultrasound measurements showed a significant genital hiatus length reduction at rest and in a stress condition. The Pelvic Floor Bother Questionnaire consistently revealed a decrease in mean scores when comparing the pre- and post-treatment data. Conclusions: Effective flat magnetic stimulation reduces myostatin concentration and genital hiatus length, minimizing the severity of urinary incontinence. The results of the study show that without causing any discomfort or unfavourable side effects, the treatment plan significantly improved the PFM tone and strength in patients with UI. Full article

Pelvic floor muscle (PFM) strength is a critical factor for optimal pelvic floor function. Fluctuations in strength values based on different phases of the menstrual cycle (MC) could signify a need for a paradigm shift in evaluating, approaching, and planning training. This research aims to examine and contrast the pelvic floor muscle strength during different phases of the menstrual cycle. A prospective observational study employing digital assessment with the modified Oxford scale and vaginal dynamometry measurements was performed, in order to assess the baseline strength and the contraction strength of the PFMs in eumenorrheic females at three different phases of the MC: the early follicular phase (EFP), the late follicular phase (LFP), and the mid-luteal phase (MLP). During two complete cycles, tympanic temperature and body weight were measured and the urinary luteinizing hormone concentration was tested to determine the time of ovulation. In total, 216 dynamometric measurements of PFM strength were obtained from eighteen nulliparous women (25.72 ± 5.03 years). There were no differences between the baseline strength (p = 0.886) and the contraction strength (p = 0.756) with the dynamometric speculum. In the post hoc analysis, the baseline strength, contraction strength, and strength showed no significant differences between MC phases. As no differences in PFM strength in women were found, the PFMs do not seem to be weaker at any time during the menstrual cycle. It appears that the assessment, establishment, and monitoring of a PFM training program could be initiated at any point in the cycle. Full article

Background: The aim of this study was to assess the effect of a single session of EMG biofeedback in a group of postmenopausal women on improving technique in pelvic floor muscle (PFM) contractions (exercises). Methods: Sixty-two women aged 60 to 85 years (69 ± 4; mean ± SD) participated in the study. We assessed the technique of PFM exercises via surface electromyography (EMG) using a vaginal probe. A single assessment sequence consisted of 11 exercises involving the conscious contraction of the PFM, during which the order of activation for selected muscles was determined. We then awarded scores for exercise technique on a scale from 0 to 4, where 4 represented the best technique and 0 represented no activation of PFMs. In the second assessment, we used a biofeedback method to teach PFM exercise technique. Results: In total, 32% (n = 20) of the participants were unable to correctly perform the first PFM contraction, scoring 0.9 ± 0.79. After a single EMG biofeedback session, these women received 1.7 ± 1.08 scores (p = 0.003). In the tenth exercise, there was also a statistically significant improvement between the first (baseline) and second assessment (1.7 ± 1.34 and 2.15 ± 1.09, respectively; p = 0.037). For the remaining exercises, the results were not statistically significant, but we observed a positive trend of change. Conclusions: The use of a single EMG biofeedback session is an effective method of improving technique in PFM exercises in a group of women who initially performed them incorrectly. Full article