Valsalva versus straining: There is a distinct difference in resulting bladder neck and puborectalis muscle position

Aims:To test the reliability and validity of intravaginal pressure measurements acquired during pelvic floor muscle (PFM) tasks in different body positions using the FemFit®, a new intravaginal pressure device.Methods: Twenty healthy adult women participated in this study. Two assessment sessions were conducted. Intravaginal pressure measurements using the FemFit® were repeated during PFM contraction and straining maneuvers while lying and standing. Maximal intravaginal pressures were collated and compared within and between sessions. They were also correlated to maximal force measurements obtained by dynamometry and vaginal digital palpation. Test-retest reliability was assessed using intraclass correlation coefficient, standard error of measurement and Bland-Altman plots. The validity of the pressure measurements was assessed using Pearson's correlation (dynamometry) and Spearman's rho (palpation).Results: This test-retest study indicate excellent reliability for PFM contraction and straining maneuver both in lying and standing, within and between sessions. For the straining maneuver while standing, increased variability was suggested by a wider limit of agreement on Bland-Altman plots (spanning 31.3 to 43.3mm Hg). A significant moderate to strong correlation was found when comparing measurements of PFM contraction using the FemFit® and the dynamometer or the palpation (Pearson's coefficient = 0.72, P = .006; Spearman's rho = 0.68, P = .005, respectively). Conclusion: Our research findings suggest that intravaginal pressures can be reliably measured during PFM contraction and straining manoeuver while lying and standing, using the FemFit® device, both within and between sessions. A moderate to strong correlation between the FemFit® pressure and the force measurements obtained by dynamometry or palpation reinforce the validity of measurements. K E Y W O R D Sfemale, intra-abdominal pressure, intravaginal pressure, pelvic floor, physiotherapy

Section: First Sessionmentioning

confidence: 99%

Reliability and validity of intravaginal pressure measurements with a new intravaginal pressure device: The FemFit®

Cacciari

Kruger

Goodman

et al. 2019

“…For instance, abdominal straining leads to the relaxation of pelvic floor muscle which favors urinary incontinence in women. 28 The observation of Plevnick 29 that the increase of abdominal pressure acts opening the bladder neck is another argument in favor. Additionally, Hasegawa et al 30 suggested that the patients who urinate with straining sometimes suffered from SUI.…”

Section: Discussionmentioning

confidence: 99%

Do voiding urodynamic parameters predict the success of adjustable transobturator male system (ATOMS) to treat postprostatectomy urinary incontinence?

Chamorro

Ruiz

Garcia

et al. 2020

Objective To evaluate whether urodynamic voiding risk factors can be predictive of failure of postprostatectomy urinary incontinence (PPI) treatment with adjustable transobturator male system (ATOMS). Materials and Methods We carried out a longitudinal study on 77 males treated for PPI with ATOMS. Patients were submitted preoperatively to a urodynamic study. The postoperative outcome was checked by pad‐test. Treatment success was defined as daily pad‐test below 10 mL. Statistical analysis used were Fisher exact test, χ2 lineal by lineal test, Student t test, and logistic regression analysis. The signification level was set at 95% bilateral. Results Treatment was successful in 54 patients (70%) achieving continence. The urodynamic parameters that related to postoperative continence outcome were the cystometric bladder capacity (direct relationship with continence (P = .019), type of voiding (more probability to achieve continence in patients who voided voluntarily followed by patients with involuntary voiding and abdominal straining voiding) (P = .034), Bladder Outlet Obstruction Index (BOOI) (inversely related with continence) (P = .025), and maximum voiding abdominal pressure (inversely related with continence) (P = .049). Multivariate analysis showed that cystometric bladder capacity (odds ratio [OR], 1.01; confidence interval [CI], 1.02‐1.00), BOOI (OR, 0.97; CI, 0.99‐0.94), and maximum abdominal bladder pressure (OR, 0.97; CI, 0.98‐0.94) were independent risk factors to predict treatment success after ATOMS implant. Conclusions The study of functional voiding parameters is useful to know the risk factors that influence postoperative outcome of PPI with ATOMS device. These findings could be of primary importance to facilitate optimum patient selection for this implant and therefore improve operative results.

“…11 During Valsalvaforced expiration against a closed glottis-the PFM move cranially (15 mm) or slightly caudally (2 mm) and during straining-strain as if defecating with relaxed PFM-the PFM displace caudally (8-15 mm). 12,13 Incontinent women show an extended amount of caudal displacement. 13 During coughing, the anterior and posterior urethra, as well as the anorectal angle displacement has been described in a ventral caudal for the continent and dorso caudal direction for incontinent women with maximum displacement varying from 4 to 12 mm.…”

Section: Introductionmentioning

confidence: 99%

“…12,13 Incontinent women show an extended amount of caudal displacement. 13 During coughing, the anterior and posterior urethra, as well as the anorectal angle displacement has been described in a ventral caudal for the continent and dorso caudal direction for incontinent women with maximum displacement varying from 4 to 12 mm. 14 PFM displacement is mainly investigated during coughing, Valsalva, straining, and voluntary PFM contraction.…”

Section: Introductionmentioning

confidence: 99%

“…During a voluntary contraction, PFM elevates in cranial and ventral directions . During Valsalva—forced expiration against a closed glottis—the PFM move cranially (15 mm) or slightly caudally (2 mm) and during straining—strain as if defecating with relaxed PFM—the PFM displace caudally (8‐15 mm) . Incontinent women show an extended amount of caudal displacement .…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Pelvic floor muscle displacement during jumps in continent and incontinent women: An exploratory study

Moser

Leitner

Eichelberger

et al. 2019

Introduction The prevalence of stress urinary incontinence during high‐impact activities is high. Enhanced comprehension of pelvic floor muscle (PFM) displacement and activity is clinically relevant for the development of specific approaches in rehabilitation. The aim of the study is to investigate and to compare PFM displacement between the continent and incontinent women during jumps. Methods A cross‐sectional, exploratory design was applied to investigate PFM displacement during drop jumps (DJ) and countermovement jumps (CMJ). PFM displacement was assessed in craniocaudal translation and forward‐backward rotation with an electromagnetic tracking system. Results Twenty‐eight continent and 22 incontinent women were included. During the first landing of DJ, a primary caudal, during the second landing of DJ/CMJ a primary cranial translation and during all jump a primary backward rotation was observed. No significant difference between the groups was found. Discussion PFM displacement during running demonstrated caudal translation/forward rotation before and cranial translation/backward rotation after heel strike. During the second landing of DJ/CMJ a cranial translation/backward rotation and during the first landing of DJ a caudal translation/backward rotation has been observed after ground contact. This may be due to the longer lasting bodyweight force in the first landing of DJ. No eccentric‐concentric stretch‐shortening cycle could be seen. Conclusion This study indicates that during jumps two opposite reactions of involuntary PFM displacement happen, but no stretch‐shortening cycle with an eccentric‐concentric contraction could be found. Jumping stimuli inducing involuntary PFM displacement should be used for future investigations to consider a beneficial effect concerning continence.