PELVIC FLOOR MUSCLE CONTRACTION IN DIFFERENT POSTURES IN WOMEN WITH STRESS URINARY INCONTINENCE

N. Krasnopolsky¹, G. Dar¹

¹University of Haifa, Department of Physical Therapy, Haifa, Israel

Background: Stress urinary incontinence (SUI) is a common problem amongst women at any age, accompanied with weak pelvic floor muscles (PFM) and low muscle endurance. Although SUI can occur in different postures which affect PFM recruitment, most of the assessment and research has been conducted in supine position.

Purpose: To compare PFM contraction in different postures between women with and without SUI. In addition, to evaluate subjective reports concerning the difficulty of PFM contraction in both groups and examine the association between the severity of incontinence and the ability to contract PFM.

Methods: The sample included 17 subjects with SUI (research group), according to the International Consultation on Incontinence Questionnaire Short Form (ICIQ-SF), and 25 subjects without SUI (control group), at ages 21-45. No significant differences were observed between groups in demographic characteristics. PFM function was assessed using diagnostic ultrasound (Mindray 6600 6 MHz 35-mm curved linear transducer) in different positions: lying, sitting, standing, and squatting. PFM function was examined by measuring direction and amount of bladder base displacement during contraction and measuring the time of maintaining maximal contraction for endurance. Following the procedure, each subject was questioned regarding the difficulty of PFM contraction.

Results: Significant differences were found for all measurements between groups, suggesting lower PFM contraction and endurance in the SUI group. Significant differences were found in contraction measurements between standing (9.18 mm in the control group and 6.92 mm in the research group) and sitting (4.51 mm for the maximal contraction and 30 sec for the endurance in the control group and 2.68 mm for the maximal contraction and 8 sec for the endurance in the research group) postures, but not for the lying and squatting positions. In both groups, the strongest contraction was measured while standing. A significant difference was found between groups regarding their subjective assessment of the most difficult contraction posture; while the research group reported sitting as the most difficult, and the control reported lying position. An inverse relation was found in the research group: the higher the ICIQ-SF score, the lower the average maximal and endurance contraction during lying, and average maximal contraction during squatting.

Conclusions: This study points out the differences in PFM function between women with and without SUI and emphasizes the effect of different postures on PFM contraction. PFM function was best performed during standing position. Correlation exists between difficulty of PFM contraction in different postures and the subjective reports of the women. Severity of incontinence is related to poor PFM contraction ability.
Future studies should be performed to develop a protocol or determine a set of guidelines for the evaluation and treatment of women suffering from SUI in different postures.

Implications: Examination and treatment of women suffering from SUI should be performed in different postures other than lying, in accordance with the women’s complaints, to help improve their well-being and quality of life.

Funding acknowledgements: None

Keywords:
Stress urinary incontinence (SUI)
Postures
Pelvic floor contraction

Topics:
Pelvic, sexual and reproductive health

Did this work require ethics approval? Yes

Institution: The University of Haifa, Faculty of Social Welfare & Health Sciences

Committee: Human Research Ethics Committee

Ethics number: 119/20