Transabdominal ultrasound to assess pelvic floor muscle performance during abdominal curl in exercising women. Barton A, et al. Int Urogynecol J (2015) 26:1789-1795.

Beth Shelly

Pelvic Distance Journal Clun March 2016

 

Background

·         High prevalence of SUI in elite athletes with high impact - jumping, abdominal curl, jogging

·         In studies abdominal curl exercises provokes SUI in up to 16% of women

·         Women with UI or POP display a wide range of change in IAP with abdominal curl

·         10% of women stop exercising due to SUI and another 20% alter or decrease their exercise

·         17 to 35% of women with SUI have bladder base depression with attempted PFM contraction

·         15 to 25% of nulliparous exercising women have SUI

 

Study

·         90 women who participate in exercises weekly (average 3 classes per week)

·         3.5 MHz curved transducer suprapubic transverse position on lower abdomen

·         3 PFM contractions with 10 sec rest between

·         3 curl ups with arms across chest lifting shoulder blades off mat (10 sec rest between)

·         Participants did not see screen

·          Assessors where blinded to continence status

 

Results

·         60% reported current SUI

o   44% SUI with sneeze

o   37% SUI on jumping

o   19% SUI on running

o   4% SUI on abdominal curl up

o   76% of parous women had UI

·         Behavior modifications of women with SUI

o   65% urinated before exercise

o   41% altered or reduced their exercise participation

o   31% wore pads

o   18% reduced fluid intake before exercise

·         25% were unable to elevate bladder base on PFM contraction

o   This inability to elevate was not associated with SUI

o   70% of women with SUI were able to elevate the bladder base with contraction

·         100% of women depressed the bladder base on curl up ave 14.2 mm

o   No sig difference between continent and incontinent women

o   Parous women had sig more bladder base depression than nulliparous

Limitations

·         Selection bias

·         Measurement error due to movement of probe - contraction of the abdominal wall can push the probe upward giving the appearance of downward movement of the bladder neck.  The study should have been done with perennial ultrasound to avoid this issue.   This issue may make this study inaccurate and results should be taken with great caution.

Discussion

·         Correct performance of bladder base elevation does not necessarily protect against SUI

·         US can only measure part of the muscle function and other tests should be used to fully evaluate it

·         Abdominal curl up may be potentially harmful to women who exercise (due to decent of bladder base)

·         "It would seem appropriate to recommend  that  women at risk for pelvic floor dysfunction not participate in abdominal curl up activities in order to minimize the risk of further PFM strain and incontinence."  - quote taken from paper which seems too extreme given the tenuous nature of the method.

·         "it is important for those who experience SUI on exercise to consider selecting lower-impact and or low intensity options."  - another quote from the paper which seems extreme.