School and Graduate Institute of Physical Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan.
Phys Ther. 2011 Jul;91(7):1030-8. doi: 10.2522/ptj.20100186. Epub 2011 May 12.
Pelvic-floor muscle (PFM) strengthening has been widely used to treat people with urinary incontinence (UI). However, its effect on bladder neck position and stiffness is unknown.
The aim of the study was to investigate the effect of PFM strengthening on bladder neck mobility for women with stress UI (SUI) or mixed UI (MUI).
This study was conducted as a single-group pretest-posttest design.
This study was conducted mainly at the Life Quality & Health Promotion Laboratory at National Taiwan University and partly in the Ultrasonography Room of the Department of Obstetrics and Gynecology at National Taiwan University Hospital. Patients Twenty-three patients (mean age=51.9 years, SD=6.1) participated in the study.
Each participant underwent a PFM strengthening program for 4 months. Bladder neck position at rest and during a cough, the Valsalva maneuver, and a PFM contraction was assessed by transperineal ultrasonography before and after the intervention. Severity Index score, self-reported improvement, PFM strength (force-generating capacity), and vaginal squeeze pressure were assessed for treatment effect.
The position of the bladder neck at PFM contraction and bladder neck mobility for maximal incursion from rest to PFM contraction were elevated, with effect sizes of 0.48 and 0.84, respectively. Bladder neck position and bladder neck mobility were not changed during a cough and the Valsalva maneuver. All participants reported diminution of incontinence, and PFM strength and maximal vaginal squeeze pressure were improved after the intervention. Limitations The limitations of the present trial included the pretest-posttest design and the absence of intra-abdominal pressure measuring and exercise adherence recording.
Four months of daily PFM strengthening can significantly improve the ability of the PFM to elevate the bladder neck voluntarily, but may not improve its stiffness during a cough and the Valsalva maneuver for women with SUI and MUI.
盆底肌（PFM）强化已广泛用于治疗尿失禁（UI）患者。然而，其对膀胱颈位置和僵硬度的影响尚不清楚。
本研究旨在探讨 PFM 强化对压力性尿失禁（SUI）或混合性尿失禁（MUI）女性膀胱颈活动度的影响。
本研究采用单组前后测设计。
本研究主要在台湾大学生活质量与健康促进实验室进行，部分在台湾大学医院妇产科超声室进行。
23 名患者（平均年龄=51.9 岁，标准差=6.1）参与了本研究。
每位参与者接受为期 4 个月的 PFM 强化训练。在干预前后，通过经会阴超声评估膀胱颈在休息时和咳嗽、Valsalva 动作以及 PFM 收缩时的位置。使用严重指数评分、自我报告改善情况、PFM 力量（产生力量的能力）和阴道挤压压力评估治疗效果。
PFM 收缩时膀胱颈位置和从休息到 PFM 收缩时膀胱颈最大内陷的活动度升高，效应量分别为 0.48 和 0.84。咳嗽和 Valsalva 动作时，膀胱颈位置和膀胱颈活动度无变化。所有参与者报告失禁减少，干预后 PFM 力量和最大阴道挤压压力均得到改善。
本试验的局限性包括前后测设计以及缺乏腹内压测量和运动依从性记录。
每天进行 4 个月的 PFM 强化可以显著提高 PFM 自愿抬高膀胱颈的能力，但对 SUI 和 MUI 女性咳嗽和 Valsalva 动作时膀胱颈的僵硬度可能没有改善。
