Functional Anatomy of the Pelvic Floor and Lower Urinary Tract

Wei, John T.; Lancey, John O. L. De

doi:10.1097/00003081-200403000-00004

Cited by 105 publications

(62 citation statements)

References 20 publications

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“…38 However, because they apply tension to the connecting fascia and ligaments to support the pelvic organs and maintain the closing pressure of the bowel and bladder sphincters, they are considered functionally to be part of the PFMs. [40][41][42] We chose the thenar muscle, the abductor pollicis brevis, as a peripheral muscle to measure with the MyotonPRO because its small size is comparable to the perineal muscles, it is easily accessible for measurement, and it has the potential to be used as a training model for a digital palpation scale to be developed using the MyotonPRO as a reference standard for clinicians.…”

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confidence: 99%

Myotonometry Reliably Measures Muscle Stiffness in the Thenar and Perineal Muscles

Davidson¹,

Bryant

Bower

et al. 2017

Physiotherapy Canada

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Purpose: The authors investigated the reliability of myotonometry-measured muscle tone in the thenar and perineal muscles. Methods: Participants were women aged 18-50 years who were asymptomatic for thumb and pelvic floor dysfunction (interrater study n ¼ 20; intrarater study n ¼ 43) or who were symptomatic for vulvodynia (interrater study n ¼ 14; intrarater study n ¼ 32). Mechanical properties (stiffness, frequency, decrement, relaxation time, and creep) of the muscles were measured using a myotonometer (MyotonPRO) while the muscles were in a relaxed state. Measures were performed twice by two assessors. Intra-and interrater reliability were determined using intra-class correlation coefficients (ICCs) and absolute reliability using the standard error of measurement and a minimum detectable change. Results: The primary property of interest, muscle stiffness, showed very good interrater (ICC 0.85-0.86) and intrarater (ICC 0.82-0.88) reliability in the thenar eminence. In the perineal muscles, reliability results ranged from good to very good for interrater (ICC 0.70-0.86) and intrarater (ICC 0.80-0.91) reliability for muscle stiffness. Absolute reliability was confirmed, with all measures showing minimal variance. Conclusions: Muscle stiffness of the smaller muscles of the body can be reliably measured using the MyotonPRO. The device could be used as a reference standard in the development of a digital palpation scale that would facilitate accurate diagnosis of muscle tone.Key Words: muscle; perineum; reproducibility of results; thumb. RÉ SUMÉObjectif : é tudier la fiabilité de la raideur musculaire mesuré e par myotonomé trie dans les muscles de l'é minence thé nar et du pé riné e. Mé thodologie : Les participantes é taient des femmes â gé es de 18 à 50 ans ne pré sentant aucun symptô me de dysfonctionnement du pouce ni du plancher pelvien (é tude interé valuateur n ¼ 20; é tude intra-é valuateur n ¼ 43) ou pré sentant des symptô mes de vulvodynie (é tude interé valuateur n ¼ 14; é tude intra-é valuateur n ¼ 32). Les proprié té s mé caniques (raideur, fré quence, dé cré ment, temps de relaxation et fluage) des muscles au repos ont é té mesuré es à l'aide d'un myotonomè tre (MyotonPRO). Les mesures ont é té prises deux fois par deux é valuateurs. La fiabilité intra-é valuateur et interé valuateur a é té dé terminé e à l'aide des coefficients de corré lation intraclasse (CCI) et la fiabilité absolue à l'aide de l'é cart type de mesure et du changement minimal dé tectable. Ré sultats : la proprié té d'inté rê t principal, la raideur musculaire, a montré une trè s bonne fiabilité interé valuateur (CCI 0,85-0,86) et intra-é valuateur (CCI 0,82-0,88) pour l'é minence thé nar. Concernant les muscles du pé riné e, les ré sultats de fiabilité variaient de bons à trè s bons pour la fiabilité interé valuateur (CCI 0,70-0,86) et intra-é valuateur (CCI 0,80-0,91) pour la raideur musculaire. La fiabilité absolue a é té confirmé e, toutes les mesures montrant une variabilité minimale. Conclusions : la raideur musculair...

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Myotonometry Reliably Measures Muscle Stiffness in the Thenar and Perineal Muscles

Davidson¹,

Bryant

Bower

et al. 2017

Physiotherapy Canada

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“…Se considera actualmente que los prolapsos de la pared vaginal anterior, pueden ser por tres defectos diferentes, que pueden surgir de forma combinada: defecto pericervical, lateral y central 3 .…”

Section: Prolapso De La Pared Vaginal Anteriorunclassified

“…A partir del anillo pericervical, el septo rectovaginal se extiende en dirección al cuerpo perineal. Lesiones de esta estructura llevan a la formación de rectocele y/o enterocele 3 (Fig. 8).…”

Section: Correccion De Los Prolapsos De La Pared Posteriorunclassified

Prolapsos urogenitales: Revisión de conceptos

et al. 2008

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RESUMENPROLAPSOS UROGENITALES: REVISION DE CONCEPTOS El prolapso genital es la exteriorización de los órganos pélvicos por la vagina, siendo una patología que afecta la calidad de vida de toda mujer, provocando, per sé, muy rara vez morbilidad o mortalidad. El prolapso genital se diagnostica en el 50% de las mujeres multíparas y del 10 al20% requiere tratamiento por su sintomatología.Se calcula que una mujer, a lo largo de su vida, tiene 11% de riesgo de necesitar cirugía de corrección de prolapso de los órganos pélvicos o por incontinencia urinaria. Los prolapsos pueden ser de la pared anterior de la vagina (cistocele), de la cúpula vaginal, del útero (histerocele) o de su pared posterior (rectocele o enterocele). De acuerdo al estado general de la paciente y al trofismo de sus tejidos, se puede optar por cirugías obliterativas o reconstructivas, respectivamente. Teniendo en cuenta que para las cirugías reconstructivas se debe realizar, un adecuado diagnóstico, con el fin de poder corregir el defecto, ya sea en su pared anterior, posterior o cúpula, utilizando puntos de sutura, mallas biológicas o sintéticas.Palabras clave: Prolapsos urogenitales. Cirugía de prolapsos. Disfunción del piso pélvico. ABSTRACT UROGENITALS PROLAPS: REVISION OF CONCEPTSThe prolapse is the exteriorization of the pelvic organs through the vagina, this condition may affect the quality of life. The prolapse was diagnosed in 50% of multiparous women It is estimated that a woman throughout her life, has 11% risk of needing surgery for correction of pelvic organ prolapse or urinary incontinence. The prolapse may occur at the anterior vaginal wall (cystocele) at the vaginal, uterus (histerocele) or at the posterior wall (or rectocele enterocele). For the unfit patient obliteratives procedures may be indicated and recontructives for pacients wih good performance status. It is important for reconstructive surgery a correct diagnosis, for the specific defect repair. When indicated, meshes can be used to add strength to the poor quality tissues. REVISIÓN S e considera que el riesgo de desarrollo de prolapsos urogenitales se duplica en cada década de la vida. Debido a esto, en los últimos años, los trabajos de investigación modificaron significativamente la interpretación de la fisiopatología de los prolapsos, dando como resultando, nuevas propuestas para el diagnóstico y, sobre todo, el tratamiento quirúrgico 1 .Debe considerarse que el tratamiento, también podría variar en función de la edad, condiciones clí-nicas de la paciente y perspectivas de vida sexual activa en el futuro.Las cirugías obliterativas, tienen como objetivo, tratar el prolapso a través de la oclusión parcial o total de la vagina. Dependiendo de la exéresis o no del tejido vaginal, son denominadas, colpectomías o colpocleises, respectivamente. Presentan bajo índice de recidiva y complicaciones, sin embargo imposibilitan la actividad sexual futura, por ese motivo son indicadas predominantemente, en las mujeres añosas y con condiciones clínicas desfavorables (Fig. 1).Los procedi...

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“…Pelvic floor dysfunctions occur owing to injuries and deterioration of muscles, nerves, and connective tissues that support and control normal pelvic function [1]. They constitute a complex condition that may be asymptomatic or involve symptoms of anorectal dysfunction, urinary dysfunction, and/or pelvic organ prolapse (PoP) [2].…”

Section: Introductionmentioning

confidence: 99%

Use of pessary in the treatment of pelvic floor dysfunctions: a systematic review

Scarabelot¹,

Pereira²,

Ghizzo³

et al. 2018

Physiother Quart.

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Introduction. To describe and evaluate the scientific evidence on the use of pessary in the treatment of pelvic floor dysfunctions.Methods. This systematic review was performed in accordance with the Preferred Reporting items for Systematic Reviews and Meta-Analyses (PRiSMA) guidelines. The databases searched were Sciencedirect, PubMed, PEdro, and BVS. The following descriptors were used: 'clinical trial,' 'pessary,' 'pelvic floor,' and the Boolean operator 'and.' The search was conducted between November 2016 and February 2017. The methodological quality of the selected articles was analysed with the Physiotherapy Evidence database (PEdro) scale.Results. After the insertion of the filters in the databases, 379 titles were selected, of which 5 articles were picked out in pairs for analysis as a whole. The 3 studies investigating the use of pessary in the treatment of pelvic organ prolapse included women with prolapse stages ii-iii. The rings or Gellhorn pessaries were the most frequently used, and all showed benefits in decreasing urinary symptoms and improvement of prolapse.Conclusions. The pessary is beneficial for the treatment of urinary incontinence and pelvic organ prolapse. Good methodological quality was also identified in most studies included.

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Functional Anatomy of the Pelvic Floor and Lower Urinary Tract

Cited by 105 publications

References 20 publications

Myotonometry Reliably Measures Muscle Stiffness in the Thenar and Perineal Muscles

Myotonometry Reliably Measures Muscle Stiffness in the Thenar and Perineal Muscles

Prolapsos urogenitales: Revisión de conceptos

Use of pessary in the treatment of pelvic floor dysfunctions: a systematic review

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