Comparison of Abdominal Muscle Thickness with Vaginal Pressure Changes in Healthy Women. Kim BI, Hwang-Bo G, Kim H. J Phys Ther Sci 26:427-430, 2014.

Michelle Spicka, DPT

June 4^th Pelvic Physical Therapy Distance Journal Club

 

Objective: The purpose of this study was to compare the effect of childbirth delivery method on vaginal pressure and abdominal thickness during Valsalva maneuver.

Methods: Subjects were 30 female adults in their 20s and 30s.  Subjects were divided into nulliparous, vaginal delivery and Cesarean delivery groups with 10 subjects in each group.

A digital perineometer was used to measure the vaginal contraction pressure during Valsalva.  Ultrasound was used to measure the thickness of the abdominal muscles.

Valsalva maneuver was defined as the maximum straining effort with forced expiration against a closed glottis. 

Results:

·         Significant differences in the thickness of the TA in all groups between rest and Valsalva

·         During the Valsalva, there was significant differences between in both the TA and IO between the nulliparous group and the vaginal delivery group; significant differences in the IO between the nulliparous group and the Cesarean group

·         Vaginal pressure was 25.5 in the nulliparous group, 16.1 in the vaginal delivery group and 15.33 in the c-section group during Valsalva

Discussion:

·         During Valsalva, the mobilization activity of the TA was greater in the nulliparous group than in the other 2 groups.

o   Likely due to excessive extension of the abdominal muscles during pregnancy weakening the contraction ability of the abdominal muscles

·         No change in the EO in any of the groups

·         During PF contractions, the vaginal delivery group showed lower muscle activities than the c-section group.

·         Pregnancy and delivery method may affect pelvic floor and abdominal muscles during the Valsalva 

Concerns about these articles:

1)      Broad generalizations based on findings

2)      Pressure measurements during the Valsalva by the perineometer  could actually be recording intra abdominal pressure more than pelvic floor muscle activity.

3)      No normative Valsalva data

 

Additional resources:

1)      Ultrasound is a reliable method for assessment of abdominal muscle activity with and without PFM contraction.  J Back Musculoskelet Rehabil 2013 Dec. 20.

2)      Sapsford, et al has shown in multiple studies that during maximum contraction of the pelvic floor muscles, all the abdominal muscles, including the TA, IO, EO and rectus abdominis were activated.  Man Ther 2004; Neurourol Urodyn 2001. 

3)      Kim et al (Arch Plast Surg 2012) used CT to analyze patient’s age, gestational history, history of laparotomy and BMI with correlation to thickness of the rectus abdominis muscle.  They found age, gestational history and history of laparotomy influenced rectus abdominis muscle thickness.

4)      Pereira et al (Neurourol Urodyn 2013) found co-activation of the transversus abdominis/internal oblique and the pelvic floor muscles in young, asymptomatic nulliparous women.  This pattern was modified in the primigravid pregnant and primiparous postpartum women regardless of delivery mode.  Only nulliparous women presented significant simultaneous TA/IO and PFM co-activation when asked to contract PFM or TA/IO

5)      Kim et al (Clin Rehabil 2012) found that exercising the pelvic floor muscles by utilizing trunk stabilization under physical therapy supervision may be beneficial for the management of postpartum urinary incontinence.