Devreese A, Staes F, Janssens L, Penninckx F, Vereecken R, De Weerdt W
Department of Physiotherapy and Rehabilitation, University Hospital Gasthuisberg, Belgium.
J Urol. 2007 Aug;178(2):558-62. doi: 10.1016/j.juro.2007.03.097. Epub 2007 Jun 14.
Pelvic floor exercises are invaluable for regaining continence but mechanisms are not fully understood. To contribute to the understanding of these mechanisms we investigated the contraction sequence of superficial vs deep pelvic floor muscles in 6 positions in continent and incontinent women.
The onset of contraction of the superficial and deep pelvic floor muscles was recorded by perineal and intravaginal surface electromyography in 32 continent and 50 incontinent women. The agreement between perineal and intravaginal recordings was calculated with the kappa statistic and the percent of agreement. Differences in onset between superficial and deep pelvic floor muscle contractions are reported as the median and IQR.
Perineal and intravaginal electromyography recordings used to define the onset of muscle activity showed a high level of agreement. In the continent group the superficial muscles almost always contracted before the deep muscles in all 6 positions. In the incontinent group the reverse sequence was observed in 3 of 6 positions. Higher and less consistent time differences in the onset of contraction of the 2 muscle layers were found in incontinent vs continent women.
Contractions of the superficial and deep pelvic floor muscles can be recorded by intravaginal or perineal electrodes. A consistent contraction sequence can be found in continent women but it is lacking in incontinent women. This might be a possible explanation for incontinence. Including differentiated muscle contraction exercises in pelvic floor muscle exercise programs may further optimize treatment outcomes.
盆底肌锻炼对于恢复控尿功能非常重要，但其机制尚未完全明确。为了有助于理解这些机制，我们研究了 continent 和 incontinent 女性在 6 种体位下浅层与深层盆底肌的收缩顺序。
通过会阴和阴道内表面肌电图记录 32 名 continent 女性和 50 名 incontinent 女性浅层和深层盆底肌的收缩起始情况。用 kappa 统计量和一致性百分比计算会阴和阴道内记录之间的一致性。浅层和深层盆底肌收缩起始时间的差异以中位数和四分位数间距报告。
用于确定肌肉活动起始的会阴和阴道内肌电图记录显示出高度一致性。在 continent 组中，在所有 6 种体位下，浅层肌肉几乎总是比深层肌肉先收缩。在 incontinent 组中，在 6 种体位中的 3 种观察到相反的顺序。与 continent 女性相比， incontinent 女性两层肌肉收缩起始的时间差异更大且更不一致。
阴道内或会阴电极可记录浅层和深层盆底肌的收缩情况。continent 女性中可发现一致的收缩顺序，但 incontinent 女性中则缺乏这种顺序。这可能是尿失禁的一个可能解释。在盆底肌锻炼计划中纳入有区别的肌肉收缩锻炼可能会进一步优化治疗效果。
