What improvements in levator ani motor function lead to improvement in stress urinary incontinence signs and symptoms in females?

Flávia Ignácio Antônio; Marina Petter Rodrigues; Kaylee Brooks; Kevin Varette; Linda McLean

doi:10.1007/s00192-021-04931-7

What improvements in levator ani motor function lead to improvement in stress urinary incontinence signs and symptoms in females?

Int Urogynecol J. 2022 Oct;33(10):2735-2747. doi: 10.1007/s00192-021-04931-7. Epub 2021 Sep 3.

Authors

Flávia Ignácio Antônio¹, Marina Petter Rodrigues², Kaylee Brooks¹, Kevin Varette³, Linda McLean⁴

Affiliations

¹ School of Rehabilitation Sciences, Faculty of Health Sciences, University of Ottawa, Ottawa, ON, Canada.
² School of Medicine, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil.
³ School of Rehabilitation Therapy, Faculty of Health Sciences, Queen's University, Kingston, ON, Canada.
⁴ School of Rehabilitation Sciences, Faculty of Health Sciences, University of Ottawa, Ottawa, ON, Canada. linda.mclean@uottawa.ca.

PMID: 34477898
DOI: 10.1007/s00192-021-04931-7

Abstract

Introduction and hypothesis: The objectives were to determine whether levator ani muscle (LAM) motor function is associated with female stress urinary incontinence (SUI) severity, and whether changes in LAM motor function induced through pelvic floor muscle training (PFMT) are associated with improvements in SUI signs and symptoms.

Methods: Pelvic morphology and LAM function were evaluated using ultrasound imaging and manual palpation using the elements of the PERFECT Scheme (Power, Endurance, Repetitions, Fast contractions, Elevation, Co-contraction and Timing) before and after women with SUI underwent a 12-week PFMT intervention. SUI severity was determined subjectively (ICIQ-FLUTS-UI) and objectively (30-min pad test [30MPT]).

Results: At baseline (n = 97), less leakage on the 30MPT was weakly associated with higher bladder neck position (ρ_s = -0.209,p = 0.044), yet with lower LAM function based on the PERFECT Scheme (overall score: ρ_s = 0.206, p = 0.043; repeated maximum voluntary contractions (MVCs): ρ_s = 0.203, p = 0.046; power/motor control: ρ_s = 0.214, p = 0.035). Lower symptom severity (ICIQ-FLUTS-UI) was associated with observed perineal lift during coughing (U = 34.000; p = 0.042). All measures of SUI severity and LAM function were significantly improved after PFMT intervention. Greater improvements in bladder neck elevation during MVC (ρ_s = -0.261, p = 0.027) and greater reductions in levator plate length during MVC (ρ_s = 0.292, p = 0.016) were weakly associated with greater reductions in leakage (30MPT), the latter also being associated with more improvement symptoms (ICIQ-FLUTS-UI; ρ_s = 0.238, p = 0.041). Greater improvement in the ability to repeat MVCs (ρ_s = 0.303, p = 0.009) was weakly associated with smaller improvements in symptoms (ICIQ-FLUTS-UI).

Conclusion: Improvements in bladder neck support and elevation show weak associations with improvement in SUI signs and symptoms. LAM function as measured by the PERFECT Scheme is not associated with SUI severity in women, and improvements in LAM function when measured by the PERFECT Scheme are not associated with improvements in SUI signs and symptoms.

Keywords: Conservative treatment; Pelvic floor; Physiotherapy; Stress urinary incontinence; Ultrasound imaging.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Exercise Therapy / methods
Female
Humans
Pelvic Floor*
Perineum / physiology
Treatment Outcome
Urinary Incontinence, Stress* / diagnostic imaging
Urinary Incontinence, Stress* / therapy

Abstract

Publication types

MeSH terms

Grants and funding