Comparisons of pelvic floor muscle performance, anxiety, quality of life and life stress in women with dry overactive bladder compared with asymptomatic women.

Sharon Knight, Janis Luft, Sanae Nakagawa, Wendy B. Katzman, BJU International Volume 109, Issue 11, pages 1685–1689, June 2012.

“RESULTS - Anxiety scores were significantly higher in women with dry OAB than in controls. No significant differences were found in sEMG measures of pelvic muscle contraction or relaxation. There was no significant correlation between sEMG pretest resting baseline measurements and the Beck Anxiety Inventory, the Pelvic Floor Distress Inventory, the Pelvic Floor Impact Questionnaire or life stress scores among symptomatic women.”

In other words, the PFM is not dysfunctional in every patient with UI.  It is important to list impairments correctly.  If the muscle is normal do not list it as underactive.  Sometimes I use “PFM in-coordination” as I think it more clearly identifies the issue.  PFM contractions can help but not because the patient has weakness but because it does not contract at the correct time.  Rhythmical contractions can also affect the nerves to the bladder.   

 This study also points out, we must be aware of (and providing input for) the patient’s anxiety around urgency.  Most PTs realize that anxiety increases urgency but I am afraid, sometimes, the PT focuses too much on the PFM (which might be normal) and too little on the nerves to the bladder which desperately need training.