Relationship among vaginal palpation, vaginal squeeze pressure, electromyographic and ultrasonographic variables of female pelvic floor muscles

Abstract

Background: The proper evaluation of the pelvic floor muscles (PFM) is essential for choosing the correct treatment. Currently, there is no gold standard for the assessment of female PFM function. Objective: To determine the correlation between vaginal palpation, vaginal squeeze pressure, and electromyographic and ultrasonographic variables of the female PFM. Method: This cross-sectional study evaluated 80 women between 18 and 35 years of age who were nulliparous and had no pelvic floor dysfunction. PFM function was assessed based on digital palpation, vaginal squeeze pressure, electromyographic activity, bilateral diameter of the bulbocavernosus muscles and the amount of bladder neck movement during voluntary PFM contraction using transperineal bi-dimensional ultrasound. The Pearson correlation was used for statistical analysis (p<0.05). Results: There was a strong positive correlation between PFM function and PFM contraction pressure (0.90). In addition, there was a moderate positive correlation between these two variables and PFM electromyographic activity (0.59 and 0.63, respectively) and movement of the bladder neck in relation to the pubic symphysis (0.51 and 0.60, respectively). Conclusions: This study showed that there was a correlation between vaginal palpation, vaginal squeeze pressure, and electromyographic and ultrasonographic variables of the PFM in nulliparous women. The strong correlation between digital palpation and PFM contraction pressure indicated that perineometry could easily be replaced by PFM digital palpation in the absence of equipment.

“Comparative intra‐ and inter‐rater reliability of maximal voluntary contraction with unidigital and bidigital vaginal palpation and construct validity with Peritron manometer”

“…14,15,30 The high correlations found between unidigital and bidigital palpation and manometry suggest that both methods and both vaginal palpation options present similarity in the evaluation and quantification of PFM function. 3 Likewise, other authors reported high correlations between the MOS and unidigital palpation in nulliparous 22 and in heterogeneous elderly women 21 with the Peritron manometer. However, a higher correlation was observed between bidigital palpation and manometry in the present study than those found in other studies.…”

Correlation between electromyography and perineometry in evaluating pelvic floor muscle function in nulligravidas: A cross‐sectional study

“…It is believed that the training protocol performed prior to the pressure evaluation had the same effects on the PFM contraction efficiency, as for both evaluations (electromyographic and perineometric) the same protocol of training and muscular evaluation was obeyed. Previous training may have been responsible for the high and positive correlation between electromyography and perineometry found in this study and not found in other correlation studies that used only the verbal command to request the contraction of PFM …”

“…There are studies that evaluated the relationship between various methods of PFM evaluation (vaginal palpation, IVP, electromyography, and ultrasonography), they used the verbal command to request and record the contraction of pelvic floor muscles, finding a moderate correlation between electromyography and perineometry. 14,15 It is known that only verbal instruction does not improve the ability to perform adequate contractions of the PFM 25 and some women cannot contract the PFM singly, associating it with the contraction of accessory muscles. 14 Due to this, our study conducted a training with electromyographic biofeedback so that the participants could dissociate the contraction of the PFM from other accessory muscles, thus evaluating the contraction of the PFM themselves, both in electromyography and perineometry.…”

“…Previous training may have been responsible for the high and positive correlation between electromyography and perineometry found in this study and not found in other correlation studies that used only the verbal command to request the contraction of PFM. 14,15 The evaluation is simpler with perineometry, as with electromyography, the electromyographic signal must be treated and analyzed to decode the data in order to determine the normalized values of the contractions. Our results agree with the literature that vaginal squeeze pressure is a clinically useful measurement technique when used with careful instructions to the patient and visual observation of the perineum by the physical therapist.…”

Avaliação da contratilidade dos músculos do assoalho pélvico em mulheres com dor pélvica crônica

“…Segundo alguns autores, existe forte correlação entre a palpação digital e a pressão de contração dos MAP, sendo que na ausência de equipamentos, a perineometria pode ser facilmente substituída pela palpação digital (RIESCO et al, 2010;PEREIRA et al, 2014;CHEVALIER, FERNANDEZ-LAO, CUESTA-VARGAS, 2014). Alguns estudos avaliaram os MAP de mulheres com DPC quanto a presença de espasmos ou pontos dolorosos e utilizaram a palpação digital (Gurian et al, 2012;Montenegro et al, 2010b;Montenegro et al, 2009;Hull;Corton, 2009) (ALMEIDA, 2002;LOOS et al, 2008).…”