Test–retest reliability of pelvic floor muscle contraction measured by 4D ultrasound

Abstract

A correct pelvic floor muscle (PFM) contraction was described by Kegel (1) as an inward lift and squeeze around urethra, vagina and rectum. In addition, DeLancey (2;3) suggested that a PFM contraction may press the urethra against the pubic symphysis (PS), further mechanically increasing urethral pressure. Traditionally PFM function and strength have been assessed by visual observation, digital palpation and use of different manometers and dynamometers (4). None of these measurement methods are capable of simultaneously measuring both the lifting and squeezing function in a responsive, reliable and valid way.Neither can any of these methods measure muscle morphology. Today imaging techniques such as ultrasound and magnetic resonance imaging have the potential of yielding more detailed information about muscle morphology and action during PFM contraction. 3D and 4D ultrasound allow multi planar imaging, assessment in an upright body position and utilizing a rapid sampling time. In addition, there are few contraindications and it may, due to relatively low cost, therefore be adopted into future clinical practice (5). To date, mainly the lift of the bladder neck (BN) has been investigated (6;7). To our knowledge only one study has quantified pubovisceral muscle length reduction (8), and no studies have quantified narrowing of levator hiatus (LH) area and transverse distance during contraction. Position of cervix uteri, rectal ampulla or back sling of the puborectal muscle has not been assessed, neither has the magnitude nor the direction of the displacement of these organs during PFM contraction.The aims of the present study were to evaluate test-retest measurements of functional aspects of PFM contraction using 4D real time ultrasound by:1. Measuring pubovisceral muscle length, LH area, antero-posterior and transverse dimensions at rest and maximal contraction (axial plane) 2. Measuring lift (displacement) of the BN, cervix uteri, rectal ampulla and back sling of the puborectal muscle (sagittal plane) MATERIALS AND METHODSThe study was designed as a test-retest intra-tester study. Two test series were performed with an interval of 7 to 35 days. The participants received a random identification number. The assessor was blinded to the results of test 1 during test 2. SubjectsSeventeen female volunteers were recruited for the study. Inclusion criterion was ability to contract the PFMs. Correct contraction was defined as inward lift of the PFM as assessed by ultrasound. Exclusion criterion was inability to understand instructions given in the Norwegian language. No volunteers had to be excluded. The study was approved by the Regional Medical Ethics Committee, and the Data Inspectorate of Norway. All subjects gave written informed consent to participate. ApparatusA GE Voluson 730 expert ultrasound system (GE Healthcare, Oslo, Norway) with 4-8 MHz curved array 3D/4D ultrasound transducer (RAB 4-8 l/obstetric) was used. The field of view angle was set to its maximum of 70 º in the sagittal plane and volume acquisition an...

Randomized clinical trial of multimodal physiotherapy treatment compared to overnight lidocaine ointment in women with provoked vestibulodynia: Design and methods

“…Using this validated and reliable methodology [44], [45] and [46], several parameters are evaluated at rest and during PFM contraction: levator hiatus area and diameter, bladder neck positioning and displacement as well as levator plate and anorectal angles. An intravaginal dynamometric speculum, developed by our team to evaluate PFM function [47], [48], [49] and [50], is also used in this trial.…”

Perineal Muscle Strength During Pregnancy and Postpartum: the Correlation Between Perineometry and Digital Vaginal Palpation

“…About one third of adult women have Urinary Incontinence (1)(2) (UI), which can impair a woman's physical, sexual, domestic, and professional and leisure activities (2)(3)(4) . Pregnancy, vaginal delivery, parity, duration of the second stage of labor, difficulty in fetal extraction during a cesarean section, newborn's weight, perineal trauma and other mechanical, endocrinal and neural factors can lead to reduction or loss of the pelvic floor muscle tone causing genitourinary disorders (1)(2)(3)(4)(5)(6)(7)(8)(9)(10) . Altered PFMS has been the focus of studies and research due to the evolution of equipment and exams that make its evaluation and prognosis more precise (10) .…”

“…To evaluate the PF muscles and diagnose disorders in the genitourinary and anal tracts, different exams are used: magnetic resonance, manometry, anal endosonography, translabial ultrasound, electromyography, perineometry, digital vaginal palpation, and neurophysiological and urodynamic studies of the PF (2,(5)(6)(7)(8)(10)(11)(12)(13) .…”

Can the Paula method facilitate co-contraction of the pelvic floor muscles? A 4D ultrasound study

“…The PFM surround the pelvic openings and during a voluntary contraction they constrict the urethra and increase urethral closure pressure, lift the pelvic organs inside the pelvis, stabilize and prevent descent during rise in intra-abdominal pressure [7][8][9] and constrict the levator hiatus (LH) [9][10]. Reduction of the LH area and muscle length can be used to measure the effectiveness of a single PFM contraction as this has to be due to shortening of the muscle fibers.…”