-
Physical Medicine and Rehabilitation... Aug 2017Understanding the anatomic relationship of the pelvic floor muscles with the pelvic girdle, spine, and hips aids the rehabilitation provider in diagnosis, management,... (Review)
Review
Understanding the anatomic relationship of the pelvic floor muscles with the pelvic girdle, spine, and hips aids the rehabilitation provider in diagnosis, management, and appropriate referrals. The bony anatomy of the pelvic girdle consists of 3 bones and 3 joints. The pelvic floor muscles are comprised mainly of the levator ani muscles with somatic innervation from the lumbosacral plexus. The bony and muscular pelvis is highly interconnected to the hip and gluteal musculature, which together provide support to the internal organs and core muscles. Pelvic floor physiology is centered on bladder and bowel control, sexual functioning, and pregnancy.
Topics: Female; Humans; Lumbosacral Plexus; Muscle, Skeletal; Pelvic Floor; Pregnancy; Referral and Consultation
PubMed: 28676358
DOI: 10.1016/j.pmr.2017.03.003 -
Scientific Reports Dec 2019Pelvic floor muscles (PFMs) play a crucial role in urinary continence. Therefore, training the PFMs remains the most popular conservative treatment for urinary... (Randomized Controlled Trial)
Randomized Controlled Trial
Pelvic floor muscles (PFMs) play a crucial role in urinary continence. Therefore, training the PFMs remains the most popular conservative treatment for urinary incontinence (UI). The effect of training other body muscles on the PFMs is unclear and mostly hypothetical. The objective of our study was to evaluate the effectiveness of postoperative diaphragm muscle, abdominal muscle and PFM training on PFM strength (PFMS) and endurance (PFME) as well as on UI in men after radical prostatectomy (RP). Per-protocol PFMS, PFME and urine loss measurements were performed at 1, 3, and 6 months postoperatively. The primary endpoints were PFMS and PFME differences among the study groups. The secondary endpoint was the correlation between UI and PFMS and PFME. In total, 148 men were randomized to the treatment groups. An increase in PFMS and PFME was observed in all groups compared to baseline (p < 0.001). The greatest difference in PFMS was in the PFM training group, but diaphragm training had the best effect on PFME. The highest (from moderate to strong) correlation between UI and PFME and PFMS (r = -0.61 and r = -0.89, respectively) was observed in the diaphragm training group. Despite different but significant effects on PFMS and PFME, all rehabilitation-training programmes decreased UI in men after RP.
Topics: Abdominal Muscles; Aged; Diaphragm; Education; Exercise Therapy; Humans; Male; Middle Aged; Muscle Strength; Muscle, Skeletal; Pelvic Floor; Prospective Studies; Prostate; Prostatectomy; Treatment Outcome; Urinary Incontinence
PubMed: 31844133
DOI: 10.1038/s41598-019-55724-4 -
Annals of the New York Academy of... Apr 2007The anatomic structures in the female that prevent incontinence and genital organ prolapse on increases in abdominal pressure during daily activities include sphincteric... (Review)
Review
The anatomic structures in the female that prevent incontinence and genital organ prolapse on increases in abdominal pressure during daily activities include sphincteric and supportive systems. In the urethra, the action of the vesical neck and urethral sphincteric mechanisms maintains urethral closure pressure above bladder pressure. Decreases in the number of striated muscle fibers of the sphincter occur with age and parity. A supportive hammock under the urethra and vesical neck provides a firm backstop against which the urethra is compressed during increases in abdominal pressure to maintain urethral closure pressures above the rapidly increasing bladder pressure. This supporting layer consists of the anterior vaginal wall and the connective tissue that attaches it to the pelvic bones through the pubovaginal portion of the levator ani muscle, and the uterosacral and cardinal ligaments comprising the tendinous arch of the pelvic fascia. At rest the levator ani maintains closure of the urogenital hiatus. They are additionally recruited to maintain hiatal closure in the face of inertial loads related to visceral accelerations as well as abdominal pressurization in daily activities involving recruitment of the abdominal wall musculature and diaphragm. Vaginal birth is associated with an increased risk of levator ani defects, as well as genital organ prolapse and urinary incontinence. Computer models indicate that vaginal birth places the levator ani under tissue stretch ratios of up to 3.3 and the pudendal nerve under strains of up to 33%, respectively. Research is needed to better identify the pathomechanics of these conditions.
Topics: Biomechanical Phenomena; Female; Humans; Pelvic Floor; Urethra
PubMed: 17416924
DOI: 10.1196/annals.1389.034 -
Archivio Italiano Di Urologia,... Mar 2016Generally, descriptions of the pelvic floor are discordant, since its complex structures and the complexity of pathological disorders of such structures; commonly the... (Review)
Review
Generally, descriptions of the pelvic floor are discordant, since its complex structures and the complexity of pathological disorders of such structures; commonly the descriptions are sectorial, concerning muscles, fascial developments, ligaments and so on. On the contrary to understand completely nature and function of the pelvic floor it is necessary to study it in the most unitary view and in the most global aspect, considering embriology, philogenesy, anthropologic development and its multiple activities others than urological, gynaecological and intestinal ones. Recent acquirements succeeded in clarifying many aspects of pelvic floor activity, whose musculature has been investigated through electromyography, sonography, magnetic resonance, histology, histochemistry, molecular research. Utilizing recent research concerning not only urinary and gynecologic aspects but also those regarding statics and dynamics of pelvis and its floor, it is now possible to study this important body part as a unit; that means to consider it in the whole body economy to which maintaining upright position, walking and behavior or physical conduct do not share less than urinary, genital, and intestinal functions. It is today possible to consider the pelvic floor as a musclefascial unit with synergic and antagonistic activity of muscular bundles, among them more or less interlaced, with multiple functions and not only the function of pelvic cup closure.
Topics: Electromyography; Female; Humans; Magnetic Resonance Imaging; Male; Muscle, Skeletal; Pelvic Floor
PubMed: 27072173
DOI: 10.4081/aiua.2016.1.28 -
Obstetrics and Gynecology Clinics of... Sep 2017Vulvar pain affects up to 20% of women at some point in their lives, and most women with vulvar pain have associated pelvic floor impairments. Pelvic floor dysfunction... (Review)
Review
Vulvar pain affects up to 20% of women at some point in their lives, and most women with vulvar pain have associated pelvic floor impairments. Pelvic floor dysfunction is associated with significant functional limitations in women by causing painful intercourse and urinary, bowel, and sexual dysfunction. A quick screening of the pelvic floor muscles can be performed in the gynecology office and should be used when patients report symptoms of pelvic pain. It is now known the vulvar pain syndromes are heterogeneous in origin; therefore, successful treatment plans are multimodal and include physical therapy.
Topics: Female; Humans; Pelvic Floor; Pelvic Pain; Physical Therapy Modalities; Vulvodynia
PubMed: 28778646
DOI: 10.1016/j.ogc.2017.05.006 -
Therapeutische Umschau. Revue... 2019Female pelvic floor: anatomy and normal function In the course of evolution, the complex interaction of anatomical structures of the pelvic floor has led to bladder and... (Review)
Review
Female pelvic floor: anatomy and normal function In the course of evolution, the complex interaction of anatomical structures of the pelvic floor has led to bladder and bowel continence, sexual sensations and reproduction. All these functions and abilities play an important individual and social role, thanks to which higher interactions have become possible. For a better understanding of these functions, underlying anatomical concepts are essential. The knowledge gained through dissection of corpses in earlier centuries is now being expanded through modern imaging techniques and image processing. In the following article, we want to give readers an overview of the anatomically important structures and the functions of the pelvic floor.
Topics: Female; Humans; Pelvic Floor
PubMed: 31113318
DOI: 10.1024/0040-5930/a001035 -
Current Opinion in Obstetrics &... Oct 2016Provide an evidence-based review of pelvic floor functional anatomy related to pelvic organ prolapse. (Review)
Review
PURPOSE OF REVIEW
Provide an evidence-based review of pelvic floor functional anatomy related to pelvic organ prolapse.
RECENT FINDINGS
Pelvic organ support depends on interactions between the levator ani muscle and pelvic connective tissues. Muscle failure exposes the vaginal wall to a pressure differential producing abnormal tension on the attachments of the pelvic organs to the pelvic sidewall. Birth-induced injury to the pubococcygeal portion of the levator ani muscle is seen in 55% of women with prolapse and 16% of women with normal support. Failure of the lateral connective tissue attachments between the uterus and vagina to the pelvic wall (cardinal, uterosacral, and paravaginal) are strongly related with prolapse (effect sizes ∼2.5) and are also highly correlated with one another (r ∼ 0.85). Small differences exist with prolapse in factors involving the vaginal wall length and width (effect sizes ∼1). The primary difference in ligament properties between women with and without prolapse is found in ligament length. Only minor differences in ligament stiffness are seen.
SUMMARY
Pelvic organ prolapse occurs because of injury to the levator ani muscles and failure of the lateral connections between the pelvic organs to the pelvic sidewall. Abnormalities of the vaginal wall fascial tissues may play a minor role.
Topics: Biomechanical Phenomena; Elasticity; Female; Humans; Ligaments; Pelvic Floor; Pelvic Organ Prolapse; Uterus; Vagina; Viscosity
PubMed: 27517338
DOI: 10.1097/GCO.0000000000000312 -
Neurourology and Urodynamics Aug 2023Some authors suggest that breathing exercises should be recommended instead of or in combination with pelvic floor muscle training (PFMT) to prevent and treat urinary... (Review)
Review
INTRODUCTION
Some authors suggest that breathing exercises should be recommended instead of or in combination with pelvic floor muscle training (PFMT) to prevent and treat urinary incontinence (UI) and pelvic organ prolapse (POP).
AIMS
The primary aim of the present study was to investigate the evidence for breathing as an intervention alone or in addition to PFM contraction in treatment of UI and POP.
MATERIALS & METHODS
This systematic review included short-term experimental studies and randomize controlled trials (RCTs) indexed on PubMed, EMBASE, and PEDro database. A form was used to extract data that was analyzed qualitatively due to the heterogeneity in interventions and outcome measures of the included studies. The individual methodological quality of RCTs was analyzed using the PEDro scale.
RESULTS
A total of 18 studies were included, 374 participants from short-term experimental studies and 765 from nine RCTs. PEDro score varied from 4 to 8. Activation of the PFM during expiration was significantly less than during a PFM contraction. In general, the RCTs showed that training the PFM is significantly more effective to improve PFM variables and UI and POP than breathing exercises, and that adding breathing exercises to PFMT have no additional effect.
CONCLUSION
This systematic review indicates that the evidence for incorporating breathing exercise in clinical practice in addition to or instead of PFMT is scant or non-existing, both based on short-term experimental studies and small RCTs.
Topics: Humans; Pelvic Floor; Exercise Therapy; Urinary Incontinence; Breathing Exercises; Pelvic Organ Prolapse; Treatment Outcome
PubMed: 37260116
DOI: 10.1002/nau.25218 -
Sao Paulo Medical Journal = Revista... 2012Previous studies have shown that women with pelvic floor dysfunctions present decreased cross-sectional area (CSA) of the levator ani muscle. One way to assess the... (Randomized Controlled Trial)
Randomized Controlled Trial
CONTEXT AND OBJECTIVE
Previous studies have shown that women with pelvic floor dysfunctions present decreased cross-sectional area (CSA) of the levator ani muscle. One way to assess the effects of training programs is to measure the CSA of the muscle, using ultrasonography. The aim here was to evaluate the efficacy of pelvic floor muscle training and hypopressive exercises for increasing the CSA of the levator ani muscle in women with pelvic organ prolapse.
DESIGN AND SETTING
Prospective randomized controlled trial at the Urogynecology outpatient clinic of Universidade Federal de São Paulo.
METHODS
Fifty-eight women with stage II pelvic organ prolapse were divided into three groups for physiotherapy: a pelvic floor muscle training group (GI); a hypopressive exercise group (GII); and a control group (GIII). The patients underwent transperineal ultrasonographic evaluation using a transducer of frequency 4-9 MHz. The (CSA) of the levator ani muscle was measured before physiotherapy and after 12 weeks of treatment.
RESULTS
The groups were homogeneous regarding age, number of pregnancies, number of vaginal deliveries, body mass index and hormonal status. Statistically significant differences in CSA were found in GI and GII from before to after the treatment (P < 0.001), but not in relation to GIII (P = 0.816).
CONCLUSIONS
The CSA of the levator ani muscle increased significantly with physiotherapy among the women with pelvic organ prolapse. Pelvic floor muscle training and hypopressive exercises produced similar improvements in the CSA of the levator ani muscle.
Topics: Epidemiologic Methods; Exercise Therapy; Female; Humans; Middle Aged; Muscle Contraction; Muscle, Skeletal; Pelvic Floor; Pelvic Organ Prolapse; Ultrasonography
PubMed: 22344353
DOI: 10.1590/s1516-31802012000100002 -
The Israel Medical Association Journal... Jan 2023
Topics: Humans; Pelvic Floor; Urodynamics; Urinary Bladder; Urologic Surgical Procedures
PubMed: 36718741
DOI: No ID Found