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Abstract

Objective

To identify differences in the muscle mechanical properties of the pelvic floor (PF) and lumbar paravertebral (LP) muscles between young nulliparous and uni/multiparous women. Secondarily, specific behaviors, depending on the presence or absence or urinary incontinence (UI), were also researched.

Design

Case–control study.

Setting

Higher education institution.

Participants

One hundred young women participated, divided into two groups depending on whether they had vaginal birth (nulliparous or uni/multiparous). Each group included women with and without UI.

Main measures

A muscle mechanical properties (tone, stiffness, decrement—inverse of elasticity—, and viscoelastic properties: relaxation and creep) assessment of the PF and LP muscles were performed with a hand-held tonometer.

Results

Tone and stiffness of both sides of the PF presented group by UI interaction (p < 0.05), with uni/multiparous women with UI showing higher tone and stiffness compared to multiparous women without UI. In LP muscles, uni/multiparous women showed greater tone and stiffness on the right and left sides [−2.57 Hz (95% confidence interval −4.42,−0.72) and −79.74 N/m (−143.52,−15.97); −2.20 Hz (−3.82,−0.58) and −81.30 N/m (−140.66-,21.95), respectively], as well as a decrease in viscoelastic properties compared to nulliparous women [relaxation: 2.88 ms (0.31,5.44); creep: 0.15 (0.01,0.30); relaxation: 2.69 ms (0.13,5.25); creep: 0.14 (0,0.28), respectively].

Conclusions

Vaginal birth and UI have a differential influence on the muscle mechanical properties of the PF and LP muscles. The determination of muscle mechanical properties by externally applied hand-held tonometry improves the knowledge of the lumbopelvic status, with applicability in clinical and research fields.

Keywords

pelvic floor disorders patient outcome assessment women’s health parity

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References

Hage-Fransen

MAH

Wiezer

Otto

, et al. Pregnancy- and obstetric-related risk factors for urinary incontinence, fecal incontinence, or pelvic organ prolapse later in life: a systematic review and meta-analysis. Acta Obstet Gynecol Scand 2021; 100: 373–382.

Aoki

Brown

Brubaker

, et al. Urinary incontinence in women. Nat Rev Dis Primers 2017; 3: 17042.

Blomquist

Muñoz

Carroll

, et al. Association of delivery mode with pelvic floor disorders after childbirth. J Am Med Assoc 2018; 320: 2438–2447.

Baracho

Da Silva

Baracho

, et al. Pelvic floor muscle strength predicts stress urinary incontinence in primiparous women after vaginal delivery. Int Urogynecol J 2012; 23: 899–906.

Juliato

CRT

. Impact of vaginal delivery on pelvic floor. Rev Bras Ginecol Obstet 2020; 42: 65–66.

Abrams

Andersson

Birder

, et al. Fourth international consultation on incontinence recommendations of the international scientific committee: evaluation and treatment of urinary incontinence, pelvic organ prolapse, and fecal incontinence. Neurourol Urodyn 2015; 240: 213–240.

Tähtinen

Cartwright

Tsui

, et al. Long-term impact of mode of delivery on stress urinary incontinence and urgency urinary incontinence: a systematic review and meta-analysis. Eur Urol 2016; 70: 148–158.

Almousa

Bandin van Loon

. The prevalence of urinary incontinence in nulliparous adolescent and middle-aged women and the associated risk factors: a systematic review. Maturitas 2018; 107: 78–83.

Khorasani

Ghaderi

Bastani

, et al. Effects of home-based stabilization exercises focusing on pelvic floor on postnatal stress urinary incontinence and low back pain: a randomized controlled trial. Int Urogynecol J 2020; 31: 2301–2307.

10.

Gachon

Nordez

Pierre

, et al. Tissue biomechanical behavior should be considered in the risk assessment of perineal trauma at childbirth. Arch Gynecol Obstet 2019; 300: 1821–1826.

11.

Baran

Akbayrak

Özgül

, et al. Musculoskeletal and anthropometric factors associated with urinary incontinence in pregnancy. Physiother Theory Pract 2021; 38: 1789–1798.

12.

Wuytack

Moran

Daly

, et al. Is there an association between parity and urinary incontinence in women during pregnancy and the first year postpartum?: a systematic review and meta-analysis. Neurourol Urodyn 2022; 41: 54–90.

13.

Alcaraz-Clariana

García-Luque

Garrido-Castro

, et al. Influence of spinal movements associated with physical evaluation on muscle mechanical properties of the lumbar paraspinal in subjects with acute low back pain. Diagnostics 2022; 12: 302.

14.

Kadah

Soh

Morin

, et al. Is there a difference in pelvic floor muscle tone between women with and without pelvic pain? A systematic review and meta-analysis. J Sexual Med 2023; 20: 65–96.

15.

Kadah

Soh

Morin

, et al. Are pelvic pain and increased pelvic floor muscle tone associated in women with persistent noncancer pelvic pain? A systematic review and meta-analysis. J Sex Med 2023; 20: 1206–1221.

16.

Bernard

Moffet

Plante

, et al. Pelvic-Floor properties in women reporting urinary incontinence after surgery and radiotherapy for endometrial cancer. Phys Ther 2017; 97: 438–448.

17.

Smith

Coppieters

Hodges

. Postural response of the pelvic floor and abdominal muscles in women with and without incontinence. Neurourol Urodyn 2007; 26: 377–385.

18.

Bø

Sherburn

. Evaluation of female pelvic-floor. Phys Ther 2005; 85: 269–282.

19.

Marshall

Walsh

Baxter

. The effect of a first vaginal delivery on the integrity of the pelvic floor musculature. Clin Rehabil 2002; 16: 795–799.

20.

Rodrigues-de-souza

Alcaraz-clariana

García-Luque

, , et al. Absolute and relative reliability of the assessment of the muscle mechanical properties of pelvic floor muscles in women with and without urinary incontinence. Diagnostics 2021; 11: 2315.

21.

Davidson

Bryant

Bower

, et al. Myotonometry reliably measures muscle stiffness in the thenar and perineal muscles. Physiother Can 2017; 69: 104–112.

22.

Bartsch

Brandl

Weber

, et al. Assessing reliability and validity of different stiffness measurement tools on a multi-layered phantom tissue model. Sci Rep 2023; 13: 815.

23.

Alcaraz-Clariana

García-Luque

Garrido-Castro

, et al. Paravertebral muscle mechanical properties and spinal range of motion in patients with acute neck or low back pain: a case-control study. Diagnostics 2021; 11: 352.

24.

Myoton

. MyotonPro user manual. Tallinn, Estonia: Myoton AS, 2012.

25.

World Health Organisation. Global physical activity questionnaire (GPAQ) [Internet]. Publications, https://www.who.int/publications/m/item/global-physical-activity-questionnaire (2021, accessed 26 July 2022).

26.

Sánchez-Sánchez

Torres-Lacomba

Yuste-Sánchez

, et al. Cultural adaptation and validation of the pelvic floor distress inventory short form (PFDI-20) and pelvic floor impact questionnaire short form (PFIQ-7) Spanish versions. Eur J Obstet Gynecol Reprod Biol 2013; 170: 281–285.

27.

Frawley

Shelly

Morin

, et al. An international continence society (ICS) report on the terminology for pelvic floor muscle assessment. Neurourol Urodyn 2021; 40: 1217–1260.

28.

Rodrigues-de-Souza

Beleza

Garc

, et al. Asymmetries of the muscle mechanical properties of the pelvic floor in nulliparous and multiparous women, and men: a cross-sectional study. Symmetry (Basel) 2022; 14: 2124.

29.

Lohr

Braumann

Reer

, et al. Reliability of tensiomyography and myotonometry in detecting mechanical and contractile characteristics of the lumbar erector spinae in healthy volunteers. Eur J Appl Physiol 2018; 118: 1349–1359.

30.

Verelst

Leivseth

. 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: 852–857.

31.

Vieira

Saltiel

Miranda-Gazzola

APG

, et al. Pelvic floor muscle function in women with and without urinary incontinence: are strength and endurance the only relevant functions? A cross-sectional study. Physiotherapy (United Kingdom) 2020; 109: 85–93.

32.

Falah-Hassani

Reeves

Shiri

, et al. The pathophysiology of stress urinary incontinence: a systematic review and meta-analysis. Int Urogynecol J 2021; 32: 501–552.

33.

Ptaszkowski

Małkiewicz

Zdrojowy

, et al. Assessment of the elastographic and electromyographic of pelvic floor muscles in postmenopausal women with stress urinary incontinence symptoms. Diagnostics 2021; 11: 2051.

34.

Gómez Londoño

Castaño Botero

Saldarriaga Hernández

. Pelvic floor muscle contraction dysfunction in women. Urologia Colombiana 2015; 24: 35–43.

35.

Worman

Stafford

Cowley

, et al. Evidence for increased tone or overactivity of pelvic floor muscles in pelvic health conditions: a systematic review. Am J Obstet Gynecol 2023; 228: 657–674.e91.

36.

Chantereau

Brieu

Kammal

, et al. Mechanical properties of pelvic soft tissue of young women and impact of aging. Int Urogynecol J 2014; 25: 1547–1553.

37.

Zhou

Lee

Wen

, et al. Biomechanical properties and associated collagen composition in vaginal tissue of women with pelvic organ prolapse. J Urol 2012; 188: 875–880.

38.

Larsudd-kåverud

Gyhagen

Åkervall

, et al. The influence of pregnancy, parity, and mode of delivery on urinary incontinence and prolapse surgery-a national register study. Am J Obstetrics Gynecol 2022; S0002-9378: 1–13.

39.

Rejano-Campo

Desvergée

Pizzoferrato

. Relationship between perineal characteristics and symptoms and pelvic girdle pain: a literature review. Prog Urol 2018; 28: 193–208.

40.

Sapsford

Richardson

Maher

, et al. Pelvic floor muscle activity in different sitting postures in continent and incontinent women. Arch Phys Med Rehabil 2008; 89: 1741–1747.

41.

Muckelt

Warner

James

, et al. Protocol and reference values for minimal detectable change of MyotonPRO and ultrasound imaging measurements of muscle and subcutaneous tissue. Sci Rep 2022; 12: 13654.

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Influence of vaginal birth on lumbopelvic muscle mechanical properties on urinary incontinence

Abstract

Objective

Design

Setting

Participants

Main measures

Results

Conclusions

Keywords

Get full access to this article

References

Supplementary Material