Pelvic Floor Stress Response: Reflex Contraction with Pressure Transmission to the Urethra

Thüroff, Joachim W.; Casper, F.; Heidler, H

doi:10.1007/978-3-642-72735-1_19

Cited by 12 publications

(18 citation statements)

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“…The details of urethral closure mechanisms during stress conditions (e.g., coughing or sneezing) have not been studied in animals except in dogs, in which the two components (passive and active) of urethral closure mechanisms were detected [25][26][27]. Our group has recently been involved in the development of a new animal model of SUI to clarify urinary continence mechanisms during the passive elevation of intravesical pressure [10].…”

Section: Discussionmentioning

confidence: 99%

Comparison of leak point pressure methods in an animal model of stress urinary incontinence

et al. 2005

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We compared three different methods of testing leak point pressure (LPP) in rats with or without the pudendal nerves and nerves to the iliococcygeus/pubococcygeus muscles transected: (1) sneeze induced with a whisker in the nostril (sneeze LPP), (2) manually increased abdominal pressure (Crede LPP), and (3) increased intravesical pressure using the vertical tilt table method (vertical tilt table LPP). In sham rats, passive intravesical pressure rises in Crede and vertical tilt table methods induced active urethral closure mechanisms that contributed to high LPPs (41.4 and 35.5 cm H2O, respectively), which were significantly reduced by nerve transection. During sneezing, leakage was observed in nerve-transected rats, but not in sham rats, indicating that sneezing can activate an additional urethral closure mechanism. Measuring LPP during sneezing or passive intravesical pressure rises in the vertical tilt table and Crede method seems to be useful for assessing the continence mechanisms under different stress conditions in rats.

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Section: Discussionmentioning

confidence: 99%

Comparison of leak point pressure methods in an animal model of stress urinary incontinence

et al. 2005

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“…Il est établi que lors d'un effort de toux, on observe une contraction simultanée des muscles du plancher pelvien (et en particulier du faisceau pubo-coccygien du muscle levator ani) et du sphincter strié urétral [14][15][16]. Cette contraction réflexe du sphincter strié urétral lors des efforts de toux et d'éternuement a été montrée expérimentalement chez le chien et la souris [17,18]. L'abdomen de l'animal étant ouvert pour supprimer tout effet de transmission de pression, Thuroff et al ont observé une augmentation de la pression urétrale pendant l'éternuement provoqué.…”

Section: Comportement Des Muscles Striés Pelvi-périnéaux à L'effortunclassified

“…Van Der Kooi et al ont eux observé que chez les femmes ayant une IUE, il existe une absence d'augmentation de la pression urétrale précédant l'augmentation de la pression vésicale [23]. Cette augmentation de pression est liée à la contraction du sphincter strié urétral et des muscles périnéaux [31,32,18].…”

Section: Comportement Des Muscles Striés Pelvi-périnéaux à L'effortunclassified

Motricité et réflexes périnéaux : nouveaux concepts

et al. 2009

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périnéaux lors de la toux. Il pourrait également exister une fatigabilité excessive de la réponse réflexe périnéale chez certaines femmes.Conclusion Il existe des arguments en faveur de l'existence de dysfonctionnements neuromusculaires spécifiques affectant certaines femmes ayant une incontinence urinaire à l'effort. La mise en évidence de ces dysfonctionnements neuromusculaires ouvre de nombreuses perspectives à la fois sur le plan physiopathologique et thérapeutique. En effet, outre les modalités de la rééducation qui pourraient être optimisées selon l'existence ou non d'une fatigue ou d'une altération de la modulation de la contraction à l'effort, diverses approches médicamenteuses pourraient être discutées.Mot clés Réflexes périnéaux · Fatigue · Incontinence urinaire · Plancher pelvien · Urètre · Pression urétrale · MuscleAbstract Introduction The physiology of urinary and fecal stress continence is complex and not much is known about the respective roles of the active and passive mechanisms concerned. A considerable number of perineal reflexes are involved. This review of the literature focuses on the neuromuscular reflex mechanisms involved in female urinary stress continence.Equipment and method A systematic review of the literature based on the Medline, Pascal and Embase data bases using the following keywords: reflex, perineal, fatigue, incontinence, pelvic floor, urethra, urethral pressure, muscle.Results In recent years, new physiopathological hypotheses have been suggested involving abnormal response reflexes in the pelvico-perineal muscles, including a defective Résumé Introduction La physiologie de la continence urinaire et fécale à l'effort est complexe et les rôles respectifs des mécanismes actifs et passifs mis en jeu demeurent mal connus. De nombreux réflexes périnéaux sont impliqués dans cette continence. Cette revue de la littérature se focalise sur les mécanismes neuromusculaires réflexes impliqués dans la continence urinaire à l'effort de la femme.Matériel et méthode Revue systématique de la littéra-ture à partir des bases de données Medline, Pascal et Embase en utilisant les mots clés : réflexe, périnéal, fatigue, incontinence, plancher pelvien, urètre, pression urétrale, muscle.Résultats Depuis quelques années, de nouvelles hypothèses physiopathologiques sont évoquées impliquant des anomalies de la réponse réflexe de la musculature pelvipérinéale dont un défaut de modulation de la réponse réflexe périnéale lors d'effort de toux répétés et des anomalies de la cinétique d'activation des muscles pelvi-REVUE DE LA LITTERATURE / LITERATURE REVIEW

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“…Thus, it is hypothesized that, during coughing, the PFM contraction occurs before the initiation of the cough. This corresponds with experimental studies in dogs and with the findings of electromyographic (EMG) activity from the urethral sphincter just before a cough pulse in women with stress incontinence [5][6][7]. However, very few studies focused on concomitant EMG recordings of PFM and muscles involved in cough initiation, and some of them have observed that, during a voluntary cough, intercostal EMG activity occurs before external anal sphincter (EAS) EMG activity [8].…”

Section: Introductionmentioning

confidence: 99%

External intercostal muscles and external anal sphincter electromyographic activity during coughing

et al. 2007

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Few studies focused on concomitant electromyographic recordings of pelvic floor muscles and muscles involved in cough initiation. The objective of this study was to investigate the temporal course of external anal sphincter activation during coughing. Informed consent was obtained from ten healthy volunteers and ten women presenting with stress urinary incontinence (SUI). Simultaneously, recordings of electromyographic activity of external intercostal muscles (EIC EMGi) and external anal sphincter (EAS EMGi) during coughing have been performed. It was chosen to study intercostals muscles because they are synchronous to diaphragmatic muscle during cough initiation. Median (interquartile range) latency between the onset of the EAS EMGi and the onset of the EIC EMGi was -210 ms (-398; -135) and 0 ms (-30; +111.7) in volunteers' group and in SUI group, respectively (p = 0.0009). Abnormal temporal course of external anal sphincter activation is observed during coughing in women presenting with SUI compared to healthy volunteers.

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Pelvic Floor Stress Response: Reflex Contraction with Pressure Transmission to the Urethra

Cited by 12 publications

References 11 publications

Comparison of leak point pressure methods in an animal model of stress urinary incontinence

Comparison of leak point pressure methods in an animal model of stress urinary incontinence

Motricité et réflexes périnéaux : nouveaux concepts

External intercostal muscles and external anal sphincter electromyographic activity during coughing

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