Search Results (49)

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: Physical exercise during pregnancy is strongly recommended due to its well-established benefits for both mother and child. However, its impact on the pelvic floor remains insufficiently studied. This study aimed to evaluate pelvic floor adaptations to a structured prenatal exercise program using transperineal ultrasound, and to assess associations with the duration of the second stage of labor and mode of delivery. Methods: This is a planned secondary analysis of a randomized controlled clinical trial (RCT) (NCT04563065) including women with singleton pregnancies at 12–14 weeks of gestation. Participants were randomized to either an exercise group, which followed a supervised physical exercise program three times per week, or a control group, which received standard antenatal care. Transperineal ultrasound was used at the second trimester of pregnancy and six months postpartum to measure urogenital hiatus dimensions at rest, during maximal pelvic floor contraction, and during the Valsalva maneuver, to calculate hiatal contractility and distensibility and to evaluate levator ani muscle insertion. Regression analyses were performed to assess the relationship between urogenital hiatus measurements and both duration of the second stage of labor and mode of delivery. Results: A total of 78 participants were included in the final analysis: 41 in the control group and 37 in the exercise group. The anteroposterior diameter of the urogenital hiatus at rest was significantly smaller in the exercise group compared to controls (4.60 mm [SD 0.62] vs. 4.91 mm [SD 0.76]; p = 0.049). No other statistically significant differences were observed in static measurements. However, contractility was significantly reduced in the exercise group for both the latero-lateral diameter (8.54% vs. 4.04%; p = 0.012) and hiatus area (20.15% vs. 12.55%; p = 0.020). Distensibility was similar between groups. There were no significant differences in the duration of the second stage of labor or mode of delivery. Six months after delivery, there was an absolute risk reduction of 32.5% of levator ani muscle avulsion in the exercise group compared to the control group (53.3% and 20.8%, respectively; p = 0.009). Conclusions: A supervised exercise program during pregnancy appears to modify pelvic floor morphology and function, reducing the incidence of levator ani muscle avulsion without affecting the type or duration of delivery. These findings support the safety and potential protective role of prenatal exercise in maintaining pelvic floor integrity. Full article

Introduction: Overactive bladder (OAB) and urinary incontinence (UI) are prevalent, particularly in older adults, and affect quality of life. OAB involves urgency, frequency, nocturia, and urgency incontinence, often linked to involuntary detrusor contractions. Treatment guidelines recommend a stepwise approach, starting with pelvic floor muscle training (PFMT), followed by pharmacological or minimally invasive therapies, such as neuromodulation. However, the combined effects of PFMT and neuromodulation have not been well established. This study aimed to evaluate the impact of combining pelvic floor exercises with neuromodulation versus PFMT with sham neuromodulation or standard physiotherapy after a 12-week intervention in individuals with OAB and UI. Methods/Materials: A double-blind, randomized controlled trial was designed with three groups: PFMT + neuromodulation, PFMT + sham, and conventional physiotherapy (control) in a 1:1:1 ratio. This study followed the CONSORT guidelines and was registered at ClinicalTrials.gov (NCT06783374). The sample size was calculated using GPower^® software, assuming a Cohen’s effect size of 1.04, a power of 0.80, an alpha of 0.05, and a 15% dropout rate, totaling 63 participants (21 per group). Participants attended 24 sessions over 12 weeks (2 sessions per week). The interventions were based on previously validated protocols. Outcomes: The primary outcomes included health-related quality of life, pelvic floor muscle function, pain, adherence, and general health. The secondary outcomes included Incontinence Quality of Life questionnaire, 3-day bladder diary, International Consultation on Incontinence Questionnaire–Urinary Incontinence Short Form, kinesiophobia, and electromyographic data. Full article

Background: Stress urinary incontinence (SUI) is frequently underrecognized in late pregnancy, with limited tools for effective risk assessment. This study aimed to evaluate the predictive value of clinical and pelvic floor ultrasound parameters for SUI and construct a validated risk model. Methods: Clinical, obstetric, and pelvic floor ultrasound findings were collected from a total of 521 women in late pregnancy who were enrolled in the study. Based on follow-up results, participants were categorized into SUI and non-SUI groups. Logistic regression analyses were used to identify independent risk factors for SUI, which were incorporated into a nomogram. Results: Four independent predictors were identified: vaginal delivery history (odds ratio [OR] = 2.320), bladder neck funneling (OR = 2.349), bladder neck descent (OR = 1.891), and pubococcygeus muscle contraction strain rate (OR < 0.001). The nomogram achieved an AUC of 0.817 (95% CI: 0.770–0.863) in the training set and 0.761 (95% CI: 0.677–0.845) in the test set. Conclusions: The nomogram based on clinical and pelvic floor ultrasound parameters accurately predicts the risk of SUI during late pregnancy, offering a useful tool for early identification and personalized management. 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

Background/Aims: The pelvic floor muscles are important structures involved in pelvic floor tone, pelvic organ support, and continence. The aim of this study was to perform an update on the pelvic floor muscle structure and function alterations of women with pelvic floor dysfunctions. Methods: A systematic search was undertaken in two electronic databases, PubMed/Medline and Ovid Discovery to find manuscripts (in English), published between 1 January 2002 and 31 July 2022, including all clinical studies using the following search terms: “muscle” or “extracellular matrix *” and “pelvic floor dysfunction *”. All clinical trials, observational, or animal studies examining the muscle and reporting pelvic floor dysfunction as a primary outcome were included. Case reports, literature reviews, conference papers and theses, and unpublished data were excluded. To ensure that no eligible articles were overlooked, the reference lists of all included papers underwent manual scrutiny. The bias level was estimated using Newcastle–Ottawa Scale (NOS) for cohort and case-control studies. A qualitative synthesis was performed. Results: The significant qualitative and quantitative heterogeneity between the studies did not allow for a quantitative analysis. Of the 30 articles selected with a total of 5592 women, 15 referred to the analysis of structural muscle defects, which included 3365 participants with urinary incontinence, pelvic organ prolapse, fecal incontinence, cistocele, rectocele, and sexual dysfunction; 10 manuscripts referred to the study of pelvic floor muscle function with a population of 2042 women, such as urinary incontinence, pelvic organ prolapse, fecal incontinence, and sexual dysfunction; and 5 papers evaluated cellular and/or molecular changes affecting the pelvic floor muscles, like urinary incontinence, pelvic organ prolapse, and rectocele, which included a total of 185 participants. Women with pelvic floor muscle defects are at greater risk of pelvic floor dysfunctions, and inversely, women with pelvic floor dysfunctions have more pelvic floor muscle defects than women without pelvic floor dysfunctions. These patients demonstrate a reduction in muscle tone, contraction strength, and resistance, a compromised neuromuscular activity, and an alteration of the normal composition and organization of the muscle cells. Conclusions: Women with pelvic floor dysfunction have anatomical muscle defects, disturbance of muscle function and cellular changes involving muscle cells and nerve fibers. Full article

Background and Objectives: The aim of this study was to compare the effects of pelvic floor muscle contraction training (PFMCT) using verbal education, digital vaginal palpation (DVP), or perineometer on the common errors made during pelvic floor muscle contraction (PFMC) in women. Materials and Methods: A total of 48 women participated, and they were randomly assigned to three groups (Group I: PFMCT with verbal education, n = 16; Group II: PFMCT with DVP, n = 16; and Group III: PFMCT with perineometer, n = 16). Participants who had not previously received PFMCT were evaluated for pelvic floor muscle strength using the Modified Oxford Scale (MOS), and pelvic floor muscle activation was assessed with electromyographic biofeedback (EMG-BF). Possible errors during pelvic floor muscle contraction (gluteal, adductor and/or abdominal muscle contractions, stop breathing (breath holding), enhanced inhaling, and straining) were evaluated through inspection, palpation, or EMG-BF. After pre-training evaluations, all participants received training on pelvic floor. After this general training, each group received PFMCT using the specific training method for their group. After the training, the same evaluations were repeated. The sessions were conducted one-on-one and lasted for an average of one hour. Results: After the training, MOS values increased in Group II and Group III, while EMG-BF values only increased in Group II (p < 0.05). The number of incorrect movements during PFMC decreased after the training in all three groups (p < 0.05). The abdominal muscle contraction value monitored by EMG-BF only decreased in Group II (p < 0.05). Conclusions: Our study demonstrated that the PFMCT applied using the DVP method was more effective in creating more accurate and stronger muscle contractions and reducing common errors when compared to pre- and post-training values. Significant differences were observed between the groups in terms of performance improvements, with Group II showing the most notable progress. These results support the potential for DVP to yield better outcomes when used in PFMT. 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 and Objectives: Urinary incontinence (UI) prevalence reaches the 80% rate in female athletes involved in high-impact sports. In this context, although conservative treatment represents the first therapeutic choice, there is still a lack of knowledge on the efficacy of conservative programs in young female athletes. Therefore, the aim of this study was to investigate the role of pelvic floor rehabilitation in the treatment of UI in young nulliparous female athletes. We performed a literature search using PubMed, Medline, Cochrane Library, Web of Science, and Scopus. The selection of articles was conducted using a specific search string: “[((pelvic floor dysfunction) OR (urinary incontinence) OR (dyspareunia) OR (dysuria)) AND ((sport) OR (sports)) AND ((female) OR (woman) OR (women) OR (girl)) AND ((rehabilitation) OR (rehab) OR (pelvic rehabilitation) OR (exercise))]”. The review protocol was registered in PROSPERO with the ID CRD42024559990. A total of 1018 articles were found in all searches of the databases. After removing duplicates, 663 papers were reviewed in terms of title and abstract. Finally, a total of six studies were included in the present review. The results of this review show that conservative treatment with a personalised pelvic floor muscle training program (PFMTP) represents an effective treatment for UI, decreasing urine loss and improving maximum voluntary pelvic contraction; this is linked with an improvement in quality of life and sports performance, in particular when supervised by a physical therapist. Moreover, due to the reluctance of athletes to talk about UI, an educational program should be considered as part of a prevention programme in pre-season training. 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

Lower back pain (LBP) has been the leading cause of disability since 1990. Objectives: The main objective of this observational case–control study was to evaluate, using ultrasound, whether there were differences in the onset and ratio of core muscle contraction between subjects with non-specific chronic lower back pain and healthy subjects. Methods: A total of 60 participants (52% women), split between those with non-specific chronic lower back pain (n = 26) and healthy (n = 34) subjects, were recruited. Initial muscle contraction of the lateral abdominal wall, pelvic floor, lumbar multifidus, and respiratory diaphragm was measured using ultrasound. The abdominal drawing-in maneuver, contralateral arm elevation, the Valsalva maneuver, and voluntary contraction of the pelvic floor in seated and standing positions were performed. The muscle thickness of the lateral abdominal wall and lumbar multifidus and excursion of the pelvic floor and diaphragm at rest and during testing were also analyzed. Results: No differences were found between the groups in the initial contraction. Statistically significant differences were found in the following variables: diaphragm excursion (p = 0.032, r = 0.277) and lumbar multifidus ratio (p = 0.010, r = 0.333) in the standing–abdominal retraction maneuver; pelvic floor excursion (p = 0.012, r = 0.325) in the standing–contralateral arm raise; and transverse abdominis ratio (p = 0.033, r = 0.275) in the sitting–contralateral arm raise. A statistically significant interaction between the groups and body mass index was observed in resting diaphragm excursion (p = 0.018, partial eta squared = 0.096) during sitting–voluntary pelvic floor contraction. Conclusions: It cannot be concluded that there is a specific pattern of core activation in any of the groups. However, statistically significant differences were found in the contraction indexes of the lumbopelvic musculature. Full article

Background/Objectives: The most common variant of mixed urinary incontinence is stress-induced urge urinary incontinence with the correlating urodynamic findings of cough-induced detrusor overactivity (CIDO). This prospective study assessed the clinical outcomes and leakage improvement among patients with CIDO following conservative or surgical treatment. Methods: We included patients with CIDO treated at our tertiary referral center from January 2018 to July 2021 in this prospective cohort study. The detection of a detrusor contraction after a cough was diagnosed as CIDO by urodynamic multichannel testing. All the patients in our study received personalized care, with behavioral therapy and anticholinergic/betamimetic treatment as a first step. If leakage persisted, patients were given a choice between pelvic floor muscle exercises (PFMEs), periurethral bulking or a midurethral sling. The primary outcome was the mean difference in urine leakage in the pad test before and six months after treatment. Results: Thirty-five patients met the inclusion criteria for CIDO and all presented a positive pad test at baseline (mean: 27 g). All 35 patients participated in behavioral therapy and anticholinergic/betamimetic treatment. Twenty-two patients (62.9%) underwent PFME, twelve patients (34.2%) received periurethral bulking, and nine patients (25.7%) received a midurethral sling. After all the treatments, our cohort showed a significant improvement in the pad test (mean: 5.7 g, p < 0.001). The result was more favorable after periurethral bulking than the midurethral sling (p < 0.001). Conclusions: This study shows the effectiveness of conservative treatment as a first step. In cases needing further treatment, bulking agents may be superior to PFME and midurethral propylene slings, offering new perspectives in the field of urogynecology and urinary incontinence. Full article