Female stress, urge, and mixed urinary incontinence are associated with a chronic and progressive pelvic floor/vaginal neuromuscular disorder: An investigation of 317 healthy and incontinent women using vaginal surface electromyography

Abstract

Reduction of the maximum vaginal surface electromyography (EMG) activity has previously been demonstrated in women with stress, urge, and mixed incontinence in comparison with healthy volunteers [Gunnarsson and Mattiasson, Scand J Urol Nephol 157:89–95, 1994]. The present study was performed to investigate if these EMG changes are age dependent and whether healthy parous women in general might show an age‐related decrease of vaginal and pelvic neuromuscular activity. A total of 317 women, 144 with urinary incontinence and 173 healthy volunteers, 20 to 76 years of age, were investigated. The maximum EMG activity during repeated short contractions (2 s) was measured. We found that parous women who have maintained continence through the years had a normal pelvic floor function as estimated with vaginal surface EMG. In contrast, all three groups of incontinent women showed a successive decrease of the EMG activity with increasing age. This difference was highly significant (P < 0.001) in women above the age of 50. No significant differences could be seen between groups when stress, urge, and mixed incontinent women were compared. Even though any convincing correlation between the amount of urinary leakage and the reduction of EMG activity was not found, we conclude that a chronic and progressive deterioration of the pelvic‐vaginal neuromuscular function occurs in women who develop urinary incontinence. The results support the view that a common pathophysiological mechanism in patients with stress, urge, and mixed incontinence might exist. The findings might help to establish a new perspective for the understanding of the pathophysiology, diagnosis, treatment, and prevention of female incontinence. Neurourol. Urodynam. 18:613–621, 1999. © 1999 Wiley‐Liss, Inc.

Prevalence of urinary leakage in nulliparous women with respect to physical activity and micturition habits

“…The connection between this symptom of dysfunctional PFM and UL has, as far as we know, not reported before in a population-based study. This is in line with findings that women with UI have less muscular activity measured by EMG [19], and supports the theory of a common etiology due to a disturbed function of the PFM and a chronic and progressive detoriation of the pelvic-vaginal neuromuscular function [20]. Strong/ functional PFM probably help to support the organs against increased intraabdominal pressure.…”

Postural activity of the pelvic floor muscles is delayed during rapid arm movements in women with stress urinary incontinence

“…As previous studies report decreased PF muscle strength [37,38], endurance [39,40] and mass [38,41,42] in this population, this finding was unexpected. However, increased amplitude of PF muscle activity has been reported at rest [24,40,43] and during coughing [17] in women with SUI.…”

Las características anatomofuncionales del suelo pélvico y la calidad de vida de mujeres con incontinencia urinaria de esfuerzo sometidas a ejercicios perineales

“…Está formado por fibras musculares estriadas esquelé ticas de tipo I (contracció n lenta o tó nica) y de tipo II (contracció n rá pida o fá sica), por lo que tambié n pueden evaluarse a travé s de la electromiografía de superficie (EMG) 23 . Se ha verificado la reducció n de la actividad electromiográ fica de superficie en mujeres con IUE e incontinencia Tabla 2 -Aná lisis comparativo (media7desviació n está ndar) de las características morfofuncionales del suelo pé lvico del GE y del GC en el inicio y en el final del estudio mixta cuando comparadas con mujeres sanas, lo que sugiere un deterioro de la funció n neuromuscular de esas mujeres 24 . En el presente estudio, la actividad electromiográ fica reveló valores aumentados estadísticamente significativos a favor del GE (tabla 2), lo que puede indicar que los ejercicios para el suelo pé lvico pueden recuperar la funció n neuromuscular de este grupo muscular.…”