Electromyographic evaluation of synergist muscles of the pelvic floor muscle depending on the pelvis setting in menopausal women: A prospective observational study.

BACKGROUND: Pelvic floor muscle (PFM) training is recommended to increase their strength and endurance. Muscles which act synergistically with PFM are taken into consideration in the therapeutic management of weakened PFM. RESEARCH QUESTION: how does electromyography activity of the synergists muscle to PFM change concerning pelvis position and does the greater bioelectric activity of synergist muscles affect PFM function? METHODS: A prospective, observational study evaluating the surface electromyography (sEMG) activity of selected synergist muscles of the PFM depending on the orientation of the pelvis. One hundred thirty-one menopausal women registered for the study were screened for inclusion and exclusion criteria, and by the results, eighty-two participants were enrolled for measurements. The comparisons of results between the values obtained in different positions of the pelvis (anterior pelvic tilt - P1, posterior pelvic tilt - P2 and neutral pelvic tilt - P3) were performed using Kruskal-Wallis test. A multivariate linear regression analysis was used to assess relationships between the bioelectrical activity of PFM and activity of all tested muscles - rectus abdominis (RA), gluteus maximus (GM), and adductor magnus (AM). RESULTS: Higher RA, GM, AM bioelectrical activity was observed in the P2 as compared to P3 (during resting and functional PFM activity)(p < 0.05). Multivariate linear regression did not find the association between the bioelectrical activity of PFM and the activity of all synergist muscles in each position. SIGNIFICANCE: sEMG activity of selected muscles acting synergistically with PFM differ depending on the pelvis position and is the highest in the posterior pelvic tilt. Greater activity of the synergists, resulting from the pelvic position, does not affect the myoelectric activity of PFM. It seems that muscles that act synergistically with PFM may not play such a significant role in the therapeutic management of PFM.

Evaluation of factors affecting the sense of coherence in women during pregnancy: A prospective pilot study.

BACKGROUND: Pregnancy is a special time in the life of a woman, which induces many changes not only in the biological, but also in the biopsychosocial dimension. OBJECTIVES: The aim of the study was to evaluate the factors affecting the sense of coherence (SOC) among women during pregnancy. It was hypothesized that a high SOC will depend on a high level of received support, lack of the risk of mental disorders in the perinatal period and physiological course of pregnancy. MATERIAL AND METHODS: Factographic material was collected by a diagnostic survey method. As a 1st research tool, the Polish adaptation of the Sense of Coherence - Orientation to Life Questionnaire (SOC-29) was used. Another research tool was the Edinburgh Postnatal Depression Scale (EPDS), used here for pregnant women and therefore called Edinburgh Depression Scale (EDS). RESULTS: We analyzed the data of all 200 women with physiological pregnancies and 200 women with complicated pregnancies from whom a complete valid responses were obtained. All women were aged between 18 and 36 years. Significant predictors of low SOC results in the model were: age (odd ratio [OR] = 0.929, 95% confidence interval [CI] 0.870-0.992, p = 0.0280), being multipara (OR = 1.996, 95% CI 1.271-3.135, p = 0.0027), having never/occasionally husband/partner support (OR = 1.978, 95% CI 1.070-3.656, p = 0.0295), and EDS results (OR = 1.312, 95% CI 1.169-1.472, p = 0.0000). CONCLUSIONS: Predisposing factors for the occurrence of a low rate of SOC in pregnant women are: lower age, multiparity, lack of social support, especially from the husband/partner, and the risk of depression during pregnancy. This may result from the fact that a strong SOC develops in the process of socialization, and with age we acquire the ability to accurately assess reality.

Assessment of bioelectrical activity of pelvic floor muscles depending on the orientation of the pelvis in menopausal women with symptoms of stress urinary incontinence: continued observational study.

BACKGROUND: Menopausal women often experience the prolapse of the uterus, bladder and rectum resulting from the failure and weakening of the pelvic floor muscles (PFM). Strengthening of the PFM through the standard exercises is recognized as an effective way of preventive measures and conservative treatment of the symptoms listed above, but still need to be improved. AIM: The goal was the objective assessment of resting and functional bioelectrical activity of PFM in women during menopause and its comparison in three different positions of the pelvis: anterior pelvic tilt - position 1 (P1), posterior pelvic tilt - position 2 (P2), and neutral pelvic tilt - position 3 (P3). DESIGN: Prospective, cross-sectional observational study. SETTING: Department and Clinic of Urology of a University Hospital. POPULATION: The target group of this study included women in the menopausal period (inpatient and outpatient). METHODS: The study evaluating resting and functional activity of the PFM depending on the orientation of pelvis. Bioelectric activity was assessed with an electromyographic instrument (sEMG) and endovaginal electrodes. The inclination angle was measured with an inclinometer. The comparisons of results between the values obtained in P1, P2, and P3 were performed using one-way Analysis of Variance (ANOVA). RESULTS: One hundred thirty-one registered for the study were screened for inclusion and exclusion criteria and on the basis of the results 82 participants were enrolled for analysis. The highest mean resting activity of sEMG PFM (µV) was observed in P2 and it amounted to 11.6 µV (SD=5.5 µV) in P1 the value equaled 9.8 µV (SD=4.8 µV) and P3-9.0 µV (SD=4.2 µV). The results revealed a significant statistical difference (main effect: P=0.0007). Considering the functional sEMG activity of PFM (µV), the highest mean value was recorded in P2. CONCLUSIONS: Posterior pelvic tilt position determines higher resting and functional bioelectric activity of PFM. Additionally, electromyographic activity of PFM increases during the pelvic movement backwards. CLINICAL REHABILITATION IMPACT: These positions should be implemented in therapy in order to improve the effectiveness of the effect on the pelvic floor.

Assessment of bioelectrical activity of synergistic muscles during pelvic floor muscles activation in postmenopausal women with and without stress urinary incontinence: a preliminary observational study.

OBJECTIVE: Muscles such as adductor magnus (AM), gluteus maximus (GM), rectus abdominis (RA), and abdominal external and internal oblique muscles are considered to play an important role in the treatment of stress urinary incontinence (SUI), and the relationship between contraction of these muscles and pelvic floor muscles (PFM) has been established in previous studies. Synergistic muscle activation intensifies a woman's ability to contract the PFM. In some cases, even for continent women, it is not possible to fully contract their PFM without involving the synergistic muscles. The primary aim of this study was to assess the surface electromyographic activity of synergistic muscles to PFM (SPFM) during resting and functional PFM activation in postmenopausal women with and without SUI. MATERIALS AND METHODS: This study was a preliminary, prospective, cross-sectional observational study and included volunteers and patients who visited the Department and Clinic of Urology, University Hospital in Wroclaw, Poland. Forty-two patients participated in the study and were screened for eligibility criteria. Thirty participants satisfied the criteria and were categorized into two groups: women with SUI (n=16) and continent women (n=14). The bioelectrical activity of PFM and SPFM (AM, RA, GM) was recorded with a surface electromyographic instrument in a standing position during resting and functional PFM activity. RESULTS: Bioelectrical activity of RA was significantly higher in the incontinent group than in the continent group. These results concern the RA activity during resting and functional PFM activity. The results for other muscles showed no significant difference in bioelectrical activity between groups. CONCLUSION: In women with SUI, during the isolated activation of PFM, an increased synergistic activity of RA muscle was observed; however, this activity was not observed in asymptomatic women. This may indicate the important accessory contribution of these muscles in the mechanism of continence.

Evaluation of bioelectrical activity of pelvic floor muscles and synergistic muscles depending on orientation of pelvis in menopausal women with symptoms of stress urinary incontinence: a preliminary observational study.

OBJECTIVES: Evaluation of resting and functional bioelectrical activity of the pelvic floor muscles (PFM) and the synergistic muscles, depending on the orientation of the pelvis, in anterior (P1) and posterior (P2) pelvic tilt. DESIGN: Preliminary, prospective observational study. SETTING: Department and Clinic of Urology, University Hospital in Wroclaw, Poland. PARTICIPANTS: Thirty-two menopausal and postmenopausal women with stress urinary incontinence were recruited. Based on inclusion and exclusion criteria, sixteen women aged 55 to 70 years were enrolled in the study. PRIMARY OUTCOME MEASURES: Evaluation of resting and functional bioelectrical activity of the pelvic floor muscles by electromyography (sEMG) and vaginal probe. SECONDARY OUTCOME MEASURES: Evaluation of activity of the synergistic muscles by sEMG and surface electrodes. RESULTS: No significant differences between orientations P1 and P2 were found in functional and resting sEMG activity of the PFM. During resting and functional PFM activity, higher electrical activity in P2 than in P1 has been recorded in some of the synergistic muscles. CONCLUSIONS: This preliminary study does not provide initial evidence that pelvic tilt influences PFM activation. Although different activity of synergistic muscles occurs in various orientations of the pelvic tilt, it does not have to affect the sEMG activity of the PFM.

[Intrahepatic cholestasis of pregnancy: a disorder with increased fetal risks. Part II: fetal condition and medical management]. / Wewnatrzwatrobowa cholestaza ciezarnych--niedoceniony problem medycyny plodowej. Czesc II: Stan plodu i postepowanie lekarskie.

The aim of this review was to present recent information about the fetal condition in cases of intrahepatic cholestasis of pregnancy. A relatively mild course of maternal disease does not predict fetal well-being accurately. Increased risk of sudden intrauterine death was emphasized, implicating the need for more stringent obstetric monitoring of fetal condition in this disorder. A pathogenetic mechanism leading to sudden deterioration of fetal wellbeing was proposed and discussed. Current recommendations regarding medical management of intrahepatic cholestasis of pregnancy were also presented.

[Intrahepatic cholestasis of pregnancy: a disorder of increased fetal risks. Part I. Maternal condition]. / Wewnatrzwatrobowa cholestaza ciezarnych--niedoceniony problem medycyny plodowej. Cesc I. Stan matki.

The aim of this review was to present the latest developments regarding maternal condition in cases of intrahepatic cholestasis of pregnancy. The changing clinical picture and altered hormonal milieu were related to the underlying cellular and molecular pathomechanisms. Intrahepatic cholestasis of pregnancy may be considered as an obstetric endocrinopathy. The relatively mild course of maternal disease masks the multisystemic nature of the disorder.