Effect of Abdominal and Pelvic floor Activation on Urine Flow in Women

Sapsford and Hodges

Jane O. Franczak

12/10/14

 

Purpose:

to see the effect of muscle contraction of abdominals on urine flow versus the effect of PFM contraction

Background

Urine stop test (stopping the flow of urine midstream) used to test the ability to activate PFM and indication of strength

Argument: Don’t use it for training due to the possibility of retention of urine(post void residual) and interfere with normal reflexative action of micturition or bladder’s ability to fully empty.

Abdominal drawing in ( activation of TrA) in association with increased mid urethral pressure. (Due to co-activation of PFM)

Goal: Determine if there is a slowing or cessation of urine flow when attempt is made to stop flow via strong TVA contraction and if so, compare time it takes to interrupt flow between max PFM voluntary contraction and abdominal maneuver.

 Materials and methods

10 PTs, mean age 44, parity 0-2, BMI 20-26 kg/m2

Dantec Uodyn.1000 uroflowmeter
funnel shaped device measures flow rate.
flow time- start to stop flow, seconds
time to max flow ( start to peak flow, s)
max flow rate (amp of max flow )ml/s
voided volume ml
time to stop = flow time-time to max flow
3 sec delay btw cessation of inflow and recording (meter was in base of device)

 Pretraining

1-2 wks b4 study

supine and hooklying
U/s to monitor activity of TA and OI
@end of exp phase.
Practiced in sitting
Test 2x 1-2 wks apart, comfortably fully bladder
seated on toilet over uroflowmeter
Either contract PFM max and hold or draw in abdom and hold
After interruption, relaxed , flow resumed. Voided vol recorded
Second trial, opp ms pattern investigated.
PFM contract vs abdom contract

measured: flow time,

time to max flow

time to stop flow

max flow

flow @ time of stop

voided volume

Results- 8 participants ( 2 excluded due to being unable to void. All 8 stopped flow @ midstream with both patterns) 

PFM- Mean time to stop flow = 4 (2-8)s after max flow
Abdoms- mean time to stop flow = 4.3 (2-7)s
No difference
Mean max flow - greater in PFM group vs, abdom
time to stop- no difff. in time to interrupt.
All voided > 150 ml(154-500 ml)
No signif relationship btw voided vol and max flow.
or btw voided vol and time to stop flow. ( see graph p 1228)

Discussion

No change in time to stop via PFM or abdom. Authors argue it is because of a co-contraction of periurethral ms complex rather than due to effect of abdoms on urethral pressure.

Participants weren’t instructed to isolate abdoms. No  way to measure activation of PFM in conjunction with abdoms as vol. or invol. Evidence shows co-contraction does occur.

Participants hesitated in starting urine flow. Seems like they told tester urination started then tester stop watch was started. Repeat tests were difficult bec it requires bladder filling and repeat test visits.

Limitations

Unable to monitor ms. activity during study

Longer latencies to stop urine flow in Sapsford study comp. to Sampselle and Delaney. (3.3 sec anticipated, 3,6 s. instruction not anticipated)

Time to interrupt flow was longer in incontinence  and nulliparous group. Small # of participants so they can’t compare on parity, but 2 were older women with history of vaginal deliveries could explain longer latency.

Unable to explain why longer time needed for greater max flow rate in PFM group vs abdom group.

Can’t extrapolate results to ppl with UI ( all participants were healthy PT’s who are physically active either by working or exercise who could understand the contractions.

2 who dropped out couldn’t void in research setting.

Coordinated PFM activity

Voluntary abdom contraction can produce PFM activity.

Amp. of PFM activity same during strong drawing in of abdoms as with MVC of PFM and same with mid urethral pressure,

Cortical connection contributes to co-activation of PFM and abdoms.

Drawing in TrA abdoms firmly and strong PFM contraction: both reduce urinary flow in healthy women.

Application to clinic - activation of abdominals with assoc PFM activity could contribute to restricted urine flow in children with voiding dysfunction. Dyscoordination of the relationship can contribute to problems with voiding dysfunction.