COMPARATIVE ROLES OF DIFFERENT PELVIC FLOOR MUSCLES BASELINE ACTIVITIES IN FEMALE STRESS URINARY INCONTINENCE
YANG1, W. HUANG 2;
1Obstetrics And Gynecology, Shung-Ho Hosp. Taipei Med. Univ., New Taipei City, Taiwan, 2Obstetrics And Gynecology, Cathay Gen. Hosp., Taipei, Taiwan.
Introduction: Understanding the pelvic floor muscle (PFM) function of urinary incontinent women is clinically important not only to discern the underlying pathophysiology specifically for the individual patient but also to plan tailored treatment strategies.
Objective: To explore the impacts of different pelvic floor muscle (PFM) baseline activities, both volitional and reflex, on urethral and sexual functions in women with stress urinary incontinence.
Methods: Secondary analysis of a prospectively maintained database identified 125 sexual active women with urodynamic stress incontinence who had met the eligibility criteria. All patients had undergone intravaginal digital examination and pelvic floor ultrasonography to detect volitional and reflex PFM activities, respectively, and responded to questionnaire surveys, including short forms of the urogenital distress inventory (UDI-6), incontinence impact questionnaire (IIQ-7), and Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire. On pelvic floor ultrasound, an inward clitoral motion and an anorectal lift preceding or during coughing were regarded as the presence of reflex activities of the PFM.
Results: Of the 125 women, 29 (23.2%) had volitional PFM contraction strength of less than grade 2; 73 (58.4%), grade 2 to 3; and 23, (18.4%) greater than grade 3 based on the modified Oxford grading scale. During or preceding coughing, an inward clitoral motion and an anorectal lift were not observed on ultrasound in 9 (7.2%) and 8 (6.4%) women, respectively. Urethral and sexual functions were unchanged by the volitional PFM contraction strength and the presence or absence of reflex anorectal lift. In contrast, the absence of reflex inward clitoral motion was significantly associated with lower maximum urethral closure pressure (P = 0.042) and higher scores of UDI-6 (P = 0.006) and IIQ-7 (P = 0.029)(Table 1).
Conclusions: Lack of reflex inward clitoral motion implies poorer urethral function in terms of urethral closure and incontinence symptoms and quality of life.