Characterization of Pelvic Floor Activity in Healthy Subjects and with Chronic Pelvic Pain: Diagnostic Potential of Surface Electromyography

Abstract

Chronic pelvic pain (CPP) is a highly disabling disorder in women usually associated with hypertonic dysfunction of the pelvic floor musculature (PFM). The literature on the subject is not conclusive about the diagnostic potential of surface electromyography (sEMG), which could be due to poor signal characterization. In this study, we characterized the PFM activity of three groups of 24 subjects each: CPP patients with deep dyspareunia associated with a myofascial syndrome (CPP group), healthy women over 35 and/or parous (>35/P group, i.e., CPP counterparts) and under 35 and nulliparous (<35&NP). sEMG signals of the right and left PFM were recorded during contractions and relaxations. The signals were characterized by their root mean square (RMS), median frequency (MDF), Dimitrov index (DI), sample entropy (SampEn), and cross-correlation (CC). The PFM activity showed a higher power (>RMS), a predominance of low-frequency components (<MDF, >DI), greater complexity (>SampEn) and lower synchronization on the same side (<CC) in CPP patients, with more significant differences in the >35/P group. The same trend in differences was found between healthy women (<35&NP vs. >35/P) associated with aging and parity. These results show that sEMG can reveal alterations in PFM electrophysiology and provide clinicians with objective information for CPP diagnosis.

Treatment of Dyspareunia with Botulinum Neurotoxin Type A: Clinical Improvement and Influence of Patients’ Characteristics

“…This is the first study monitoring changes in the PFM myoelectrical activity in the follow-up visits after BoNT/A administration to treat CPP associated with a deep dyspareunia by means of sEMG recordings. Signals were acquired with an sEMG recording system that has previously shown its potential to objectively evaluate the PFM [17]. The signal amplitude was lower after infiltration, with significant differences at Week 24 during PFM contractions.…”

“…To assess the amplitude of the signal during PFM contractions and relaxation, the root mean square (RMS) [16] of the 5 contractions was computed and averaged, as well as that of a basal segment of 10 s before contractions. Further details on signals processing can be consulted in a previous study by the authors [17]. A specialist collected the patient's sociodemographic (age, academic background, work activity) and anthropometric (body mass index) characteristics, as well as obstetric (vaginal deliveries, caesarean sections, third-degree perineal tears), urogynaecological (menopause, dysmenorrhoea, ovulatory pain) and musculoskeletal medical history and comorbidities.…”

“…To assess the amplitude of the signal during PFM contractions and relaxation, the root mean square (RMS) [16] of the 5 contractions was computed and averaged, as well as that of a basal segment of 10 s before contractions. Further details on signals processing can be consulted in a previous study by the authors [17].…”

What are the best indicators of myoelectric manifestation of fatigue?

“…The complexity of the EMG signal is attributed to the mechanisms underlying its generation that contain some non-linear or chaotic features [35,36]. As a result, in recent years, several complexity-based EMG indicators have been introduced [37][38][39][40][41] in order to detect alteration of EMG features caused by muscle fatigue that may not be detected by linear indicators. In a recent literature review, Rampichini et al, [28] classified four groups of complexity-based MMF indicators, namely, fractal and self-similarity, correlation, entropy, and deterministic chaos.…”

Efficacy of Standardized Rehabilitation in the Treatment of Diastasis Rectus Abdominis in Postpartum Women

“…Traditional Chinese medicine acupuncture has a good effect on pain and body discomfort, 18 while electrophysiology has a good physical therapy effect on muscles. 15 , 19 Taking advantage of these two characteristics, Standardized Rehabilitation process is a complete systematic treatment mode, including 40 minutes of manual massage (Part 1) and 30 minutes of treatment with electrophysiological equipment (Part 2) ( Figure 1 ). The standardized rehabilitation process was completed once every other day, and the entire standardized rehabilitation was performed 10 times before completion.…”