Australian Pelvic Floor Questionnaire: translation, cultural adaptation, and validation.

INTRODUCTION AND HYPOTHESIS: The aim was to translate, culturally adapt, and validate the APFQ (Australian Pelvic Floor Questionnaire) for the population of Brazilian pregnant and postpartum women. METHODS: The translation and validation of the APFQ were performed according to Beaton's guideline recommendations, with a sample of 150 patients (75 pregnant, 75 postpartum). Cronbach's alpha assessed the scale's internal consistency and reproducibility with the intraclass correlation coefficient (ICC). To analyze the construct validity, two questionnaires were applied, and the Spearman correlation was performed. Confirmatory factor analysis (CFA) was executed to assess the fit of the data to the theoretical model. The ability to generate diagnosis was analyzed by sensitivity and specificity. RESULTS: Only 1% of the sample scored in the prolapse domain, so it was removed from the validation analyses. Cronbach's alpha values greater than 0.70 were obtained for the bladder and bowel domains, and 0.69 for sexual function. As for reproducibility, the ICC was greater than 0.75 for all domains. Spearman's correlation was good for bowel (r=0.74), moderate for bladder (r=0.58), and poor for sexual function (r=0.23). CFA results showed a non-optimal adherence: despite the Chi-squared value being significant (p<0.001), the CMIN- which is the adherence of the data to the model- value is less than 3. Sensitivity above 80% was obtained, whereas specificity of 43%, 16%, and 12% was obtained for bowel, bladder, and sexual functions respectively. CONCLUSION: The APFQ was translated, culturally adapted, and validated for Brazilian pregnant and postpartum women. It showed good indexes of internal consistency, construct validity, reproducibility, and sensitivity. However, the prolapse domain could not be validated.

Intravaginal pressure profile of continent and incontinent women.

A well-functioning pelvic floor muscle plays an important role in maintaining urinary continence. The aim of this study was to describe and compare the intravaginal pressure profile using a multisensor device along the vaginal length in women with and without urinary incontinence (UI), while performing pelvic floor muscle tasks. Fifty-four adult pre-menopausal women (31 continent and 23 incontinent) participated in this cross-sectional observational cohort study. The intravaginal pressure profile was assessed at rest, during maximum and sustained pelvic floor muscle contractions, using the Pliance® multisensor device. Between-group comparisons were performed considering the overall pressure and the pressure profile of 10-subregions along the vaginal length. In the overall pressure assessment, women with UI presented lower pressures at rest, similar pressures during maximum contraction and lower capacity to maintain pressure during sustained contraction compared to those in the continent group. The pressure profile assessment showed between-group differences that were consistent throughout tasks, with the incontinent group presenting lower pressures than the continent group, specifically in the mid-vaginal length, around 3-4 cm from the vaginal opening. We observed consistent deficits in pressure generation in incontinent compared to continent women, precisely in the region of the pelvic floor muscles. With this protocol and novel instrument, we obtained a reliable and consistent intravaginal pressure profile of continent and incontinent women. This approach could assist clinicians in the assessment of pelvic floor muscle function and foster a better understanding of the urinary incontinence mechanism.

High spatial resolution pressure distribution of the vaginal canal in Pompoir practitioners: A biomechanical approach for assessing the pelvic floor.

BACKGROUND: Pompoir is a technique poorly studied in the literature that claims to improve pelvic floor strength and coordination. This study aims to investigate the pelvic floor muscles' coordination throughout the vaginal canal among Pompoir practitioners and non-practitioners by describing a high resolution map of pressure distribution. METHODS: This cross-sectional, study included 40 healthy women in two groups: control and Pompoir. While these women performed both sustained and "waveform" pelvic floor muscle contractions, the spatiotemporal pressure distribution in their vaginal canals was evaluated by a non-deformable probe fully instrumented with a 10×10 matrix of capacitive transducers. FINDINGS: Pompoir group was able to sustain the pressure levels achieved for a longer period (40% longer, moderate effect, P=0.04). During the "waveform" contraction task, Pompoir group achieved lower, earlier peak pressures (moderate effect, P=0.05) and decreased rates of contraction (small effect, P=0.04) and relaxation (large effect, P=0.01). During both tasks, Pompoir group had smaller relative contributions by the mid-region and the anteroposterior planes and greater contributions by the caudal and cranial regions and the latero-lateral planes. INTERPRETATION: Results suggest that specific coordination training of the pelvic floor muscles alters the pressure distribution profile, promoting a more-symmetric distribution of pressure throughout the vaginal canal. Therefore, this study suggests that pelvic floor muscles can be trained to a degree beyond strengthening by focusing on coordination, which results in changes in symmetry of the spatiotemporal pressure distribution in the vaginal canal.

Effect of combined actions of hip adduction/abduction on the force generation and maintenance of pelvic floor muscles in healthy women.

Pelvic floor muscle (PFM) force and coordination are related to urinary incontinence severity and to sexual satisfaction. Health professionals frequently combine classic PFM exercises with hip adduction/abduction contraction to treat these disorders, but the real benefits of this practice are still unknown. Based on a theoretical anatomy approach whereby the levator ani muscle is inserted into the obturator internus myofascia and in which force generated by hip movements should increase the contraction quality of PFMs, our aim was to investigate the effects of isometric hip adduction and abduction on PFM force generation. Twenty healthy, nulliparous women were evaluated using two strain-gauge dynamometers (one cylinder-like inside the vaginal cavity, and the other measuring hip adduction/abduction forces around both thighs) while performing three different tasks: (a) isolated PFM contraction; (b) PFM contraction combined with hip adduction (30% and 50% maximum hip force); and (c) PFM contraction combined with hip abduction (30% and 50% maximum hip force). Data were sampled at 100Hz and subtracted from the offset if existent. We calculated a gradient between the isolated PFM contraction and each hip condition (Δ Adduction and Δ Abduction) for all variables: Maximum force (N), instant of maximum-force occurrence (s), mean force in an 8-second window (N), and PFM force loss (N.s). We compared both conditions gradients in 30% and 50% by paired t-tests. All variables did not differ between hip conditions both in 30% and 50% of maximum hip force (p>.05). PFM contraction combined with isometric hip abduction did not increase vaginal force in healthy and nulliparous women compared to PFM contraction combined with isometric hip adduction. Therefore, so far, the use of hip adduction or abduction in PFM training and treatments are not justified for improving PFM strength and endurance.

Novel instrumented probe for measuring 3D pressure distribution along the vaginal canal.

We developed an intravaginal instrumented probe (covered with a 10×10 matrix of capacitive sensors) for assessing the three-dimensional (3D) spatiotemporal pressure profile of the vaginal canal. The pressure profile was compared to the pelvic floor (PF) digital assessment, and the reliability of the instrument and repeatability of the protocol was tested. We also tested its ability to characterize and differentiate two tasks: PF maximum contraction and Valsalva maneuver (maximum intra-abdominal effort with downward movement of the PF). Peak pressures were calculated for the total matrix, for three major sub-regions, and for 5 planes and 10 rings throughout the vaginal canal. Intraclass correlation coefficients indicated excellent inter- and intra-rater reliability and intra-trial repeatability for the total and medial areas, with moderate reliability for the cranial and caudal areas. There was a moderate correlation between peak pressure and PF digital palpation [Spearman's coefficient r=0.55 (p<0.001)]. Spatiotemporal profiles were completely different between tasks (2-way ANOVAs for repeated measures) with notably higher pressures (above 30kPa) for the maximum contraction task compared to Valsalva (below 15kPa). At maximum contraction, higher pressures occurred in the mid-antero-posterior zone, with earlier peak pressure onsets and more variable along the vaginal depth (from rings 3 to 10-caudal). During Valsalva, the highest pressures were observed in rings 4-6, with peak pressure onsets more synchronized between rings. With this protocol and novel instrument, we obtained a high-resolution and highly reliable innovative 3D pressure distribution map of the PF capable of distinguishing vaginal sub-regions, planes, rings and tasks.