The influence of various risk factors on the strength of pelvic floor muscle in women

Katarina Parezanović Ilić; Ljiljana Mladenović Segedi; Aleksandra Jurišić Škevin; Ivana Živanović Mačužić; Vesna Grbović; Jasmin S Nurković; Milan Jovanović; Dejan Jeremić

doi:10.2298/VSP150420083P

Katarina Parezanović Ilić Clinical Centre Kragujevac, Department of Physical Medical Sciences and Rehabilitation, Kragujevac, Serbia; University of Kragujevac, Faculty of Medicine, Department of Physical Medicine and Rehabilitation.
Ljiljana Mladenović Segedi Clinical Centre of Vojvodina, Opstretics and Gynaecology Clinic, Novi Sad, Serbia
Aleksandra Jurišić Škevin Clinical Centre Kragujevac, Department of Physical Medical Sciences and Rehabilitation, Kragujevac, Serbia; University of Kragujevac, Faculty of Medicine, Department of Physical Medicine and Rehabilitation.
Ivana Živanović Mačužić University of Kragujevac, Faculty of Medicine, Department of Anatomy and Forensic Medicine, Kragujevac, Serbia.
Vesna Grbović Clinical Centre Kragujevac, Department of Physical Medical Sciences and Rehabilitation, Kragujevac, Serbia
Jasmin S Nurković Clinical Centre Kragujevac, Department of Physical Medical Sciences and Rehabilitation, Kragujevac, Serbia; State University of Novi Pazar, Department of Biomedical Sciences, Novi Pazar, Serbia.
Milan Jovanović Military Medical Academy, Department of Surgery, Belgrade, Serbia.
Dejan Jeremić University of Kragujevac, Faculty of Medicine, Department of Anatomy and Forensic Medicine, Kragujevac, Serbia.

DOI: https://doi.org/10.2298/VSP150420083P

Keywords: pelvic floor, muscle tonus, women, risk factors, pelvic organ prolapse, pelvic inflammatory disease, urinary incontinence, physical and rehabilitation medicine,

Abstract

Background/Aim. Damage of any element of pelvic floor leads to its functional damages, reflected in the occurrence of urinary incontinence, prolapse of pelvic organs, fecal incontinence and sexual dysfunction. Basic aim of our paper was to investigate the influence of various risk factors on pelvic floor muscle strength in women. Methods. The study included 90 female patients and examined how age, job, body weight and height, number of deliveries, sports activities, incontinence occurrence, previous prolapse-caused gynecological surgeries, other gynecological surgeries and other conservatively treated gynecological diseases influence the value of pelvic floor muscle strength. Pelvic floor muscle strength was measured using vaginal dynamometer. Results. Univariate regression analysis showed that parameters such as age, demanding job, body height, number of deliveries, sports activities, prolapse-caused gynecological surgeries, other gynecological surgeries and other gynecological diseases were in positive correlation with the values of pelvic floor muscle strength. In multivariate regression model, incontinence and gynecological operation of prolapse were singled out as independent risk factors. Conclusion. If risk factors that cause damage to pelvic floor muscle are known, it is possible to prevent the damages and improve the quality of women's life.

References

Petros P. The female pelvic floor; function, dysfunction and management according to the ıntegral theory. 2nd ed. Heidel-berg, Germany: Springer Medizin Verlag; 2007.

Barber MD. Symptoms and outcome measures of pelvic organ prolapse. Clin Obstet Gynecol 2005; 48(3): 648−61.

Leijonhufvud A, Lundholm C, Cnattingius S, Granath F, Andolf E, Altman D. Risks of stress urinary incontinence and pelvic or-gan prolapse surgery in relation to mode of childbirth. Am J Obstet Gynecol 2011; 204(1): 70.e1−7.

Lince SL, Kempen LC, Vierhout ME, Kluivers KB. A systematic review of clinical studies on hereditary factors in pelvic organ prolapse. Int Urogynecol J 2012; 23(10): 1327−36.

Thyer I, Shek C, Dietz HP. New imaging method for assessing pelvic floor biomechanics. Ultrasound Obstet Gynecol 2008; 31(2): 201−5.

Isherwood PJ, Rane A. Comparative assessment of pelvic floor strength using a perineometer and digital examination. BJOG 2000; 107(8): 1007−11.

Hundley AF, Wu JM, Visco AG. A comparison of perineometer to brink score for assessment of pelvic floor muscle strength. Am J Obstet Gynecol 2005; 192(5): 1583−91.

Thompson JA, O'Sullivan PB, Briffa NK, Neumann P. Comparison of transperineal and transabdominal ultrasound in the assess-ment of voluntary pelvic floor muscle contractions and func-tional manoeuvres in continent and incontinent women. Int Urogynecol J Pelvic Floor Dysfunct 2007; 18(7): 779−86.

Thompson JA, O'Sullivan PB, Briffa NK, Neumann P. Assessment of voluntary pelvic floor muscle contraction in continent and incontinent women using transperineal ultrasound, manual muscle testing and vaginal squeeze pressure measurements. Int Urogynecol J Pelvic Floor Dysfunct 2006; 17(6): 624−30.

Bø K, Finckenhagen HB. Vaginal palpation of pelvic floor muscle strength: Inter-test reproducibility and comparison between palpation and vaginal squeeze pressure. Acta Obstet Gynecol Scand 2001; 80(10): 883−7.

Peschers UM, Gingelmaier A, Jundt K, Leib B, Dimpfl T. Evaluation of pelvic floor muscle strength using four different techniques. Int Urogynecol J Pelvic Floor Dysfunct 2001; 12(1): 27−30.

Parezanović-Ilić K, Jevtić M, Jeremić B, Arsenijević S. Muscle strength measurment of pelvic floor in women by vaginal dy-namometar. Srp Arh Celok Lek 2009; 137(9−10): 511−7. (Ser-bian)

Parezanović-Ilić K, Jeremić B, Mladenović Segedi L, Arsenijević S, Jevtić M. Physical therapy in the treatment of stress urinary inconti-nence. Srp Arh Celok Lek 2011; 139(9−10): 638−44. (Serbian)

Morin M, Bourbonnais D, Gravel D, Dumoulin C, Lemieux M. Pelvic floor muscle function in continent and stress urinary in-continent women using dynamometric measurements. Neu-rourol Urodyn 2004; 23(7): 668−74.

Verelst M, Leivseth G. Force and stiffness of the pelvic floor as function of muscle length: A comparison between women with and without stress urinary incontinence. Neurourol Urodyn 2007; 26(6): 852−7.

DeLancey JO, Trowbridge ER, Miller JM, Morgan DM, Guire K, Fenner DE, et al. Stress urinary incontinence: Relative impor-tance of urethral support and urethral closure pressure. J Urol 2008; 179(6): 2286−90; discussion 2290.

Slieker-ten Hove MC, Pool-Goudzwaard AL, Eijkemans MJ, Steegers-Theunissen RP, Burger CW, Vierhout ME. The prevalence of pelvic organ prolapse symptoms and signs and their relation with bladder and bowel disorders in a general female population. Int Urogynecol J Pelvic Floor Dysfunct 2009; 20(9): 1037−45.

Patel PD, Amrute KV, Badlani GH. Pathophisiology of pelvic organ prolaps and stress urinary incontinence. Indian J Urol 2006; 22(4): 310−6.

Reay Jones NH, Healy JC, King LJ, Saini S, Shousha S, Allen-Mersh TG. Pelvic connective tissue resilience decreases with vaginal delivery, menopause and uterine prolapse. Br J Surg 2003; 90(4): 466−72.

Grodstein F, Fretts R, Lifford K, Resnick N, Curhan G. Association of age, race, and obstetric history with urinary symptoms among women in the Nurses' Health Study. Am J Obstet Gy-necol 2003; 189(2): 428−34.

Fritel X, Schaal JP, Fauconnier A, Bertrand V, Levet C, Pigné A. Pelvic floor disorders 4 years after first delivery: A comparative study of restrictive versus systematic episiotomy. BJOG 2008; 115(2): 247−52.

Copas P, Bukovsky A, Asbury B, Elder RF, Caudle MR. Estrogen, progesterone, and androgen receptor expression in levator ani muscle and fascia. J Womens Health Gend Based Med 2001; 10(8): 785−95.

Jones GL, Kennedy SH, Jenkinson C. Health-related quality of life measurement in women with common benign gynecologic conditions: A systematic review. Am J Obstet Gynecol 2002; 187(2): 501−11.

Sampselle CM, Brink CA, Wells TJ. Digital measurement of pelvic muscle strength in childbearing women. Nurs Res 1989; 38(3): 134−8.

Sampselle CM. Changes in pelvic muscle strength and stress urinary incontinence associated with childbirth. J Obstet Gy-necol Neonatal Nurs 1990; 19(5): 371−7.

Weber AM, Richter HE. Pelvic organ prolapse. Obstet Gynecol 2005; 106(3): 615−34.

FitzGerald MP, Burgio KL, Borello-France DF, Menefee SA, Schaffer J, Kraus S, et al. Pelvic-floor strength in women with inconti-nence as assessed by the brink scale. Phys Ther 2007; 87(10): 1316−24.

Uma R, Libby G, Murphy DJ. Obstetric management of a wom-an's first delivery and the implications for pelvic floor surgery in later life. BJOG 2005; 112(8): 1043−6.