Başer Seçer Melda, Korkmaz Dayican Damla, Celiker Tosun Ozge, Yavuz Onur, Kurt Sefa
Manisa Celal Bayar University Health Services Vocational School, Manisa, Turkey.
İzmir Tınaztepe University, School of Physical Therapy and Rehabilitation, Izmir, Turkey.
Eur J Obstet Gynecol Reprod Biol. 2025 May;309:89-96. doi: 10.1016/j.ejogrb.2025.03.032. Epub 2025 Mar 16.
The aim of this study was to examine the synergistic relationship between the pelvic floor muscles (PFM) and abdominal muscles in older women with urinary incontinence (UI). Our secondary aim is to compare PFM and abdominal muscle functions and synergistic relationship according to incontinence type in younger and older women.
This cross-sectional study was conducted with 46 older and 31 younger women. Urogenital Distress Inventory (UDI-6) and Over Active Bladder-Validated 8 (OAB-V8) were used to evaluate the severity of participants' urinary symptoms, and the Incontinence Impact Questionnaire (IIQ-7) was used to evaluate the quality of life related to the symptoms. PFM function was evaluated by superficial electromyography (EMG) and digital palpation; abdominal muscle function was evaluated by EMG.
The average ages of the participants in the younger and old female groups were 49.74 ± 7.25 years and 74.87 ± 5.41 years, respectively. PFM endurance (p = 0.005), number of fast repetitions (p = 0.073) and work average value of the participants in the older women group were found to be lower than those in the younger women group (p = 0.002). In the group of older women with mixed incontinence (MUI), PFM endurance (p = 0.022), PFM (p = 0.002), Transversus abdominis (TrA) (p = 0.007), rectus abdominis (RA) (p = 0.015), internal oblique (IO)(p = 0.002) and external oblique (EO) abdominal muscles (p = 0.001) work average values were significantly lower. In the younger women group with urge incontinence (UUI), the PFM work average value was higher than in the older women group (p = 0.021). During PFM contraction, a moderate positive correlation was found between PFM and RA (r = 0.498, p = 0.001), IO (r = 0.405, p = 0.006) and EO (r = 0.442, p = 0.002) in the older women group.
This study showed that older women with UI demonstrated reduced PFM endurance, fewer fast PFM contractions, and lower PFM and abdominal muscle activity compared to younger women with UI. A positive association was observed between the PFM and the RA, IO, and EO muscles specifically in older women with UI. Importantly, our findings indicate that both PFM and abdominal muscle function decline with age in women, irrespective of UI status, leading to a worsening of related symptoms. Consequently, we recommend the implementation of preventive physiotherapy and rehabilitation programs beginning at a young age to preserve and optimize PFM and abdominal muscle function in women.
本研究旨在探讨老年尿失禁（UI）女性盆底肌（PFM）与腹肌之间的协同关系。我们的次要目的是比较年轻和老年女性根据失禁类型的PFM和腹肌功能及协同关系。
本横断面研究纳入了46名老年女性和31名年轻女性。采用泌尿生殖系统困扰量表（UDI-6）和膀胱过度活动症验证量表8（OAB-V8）评估参与者的泌尿症状严重程度，采用尿失禁影响问卷（IIQ-7）评估与症状相关的生活质量。通过表面肌电图（EMG）和指诊评估PFM功能；通过EMG评估腹肌功能。
年轻女性组和老年女性组参与者的平均年龄分别为49.74±7.25岁和74.87±5.41岁。发现老年女性组参与者的PFM耐力（p = 0.005）、快速重复次数（p = 0.073）和工作平均值低于年轻女性组（p = 0.002）。在混合性尿失禁（MUI）的老年女性组中，PFM耐力（p = 0.022）、PFM（p = 0.002）、腹横肌（TrA）（p = 0.007）、腹直肌（RA）（p = 0.015）、腹内斜肌（IO）（p = 0.002）和腹外斜肌（EO）的工作平均值显著较低。在急迫性尿失禁（UUI）的年轻女性组中，PFM工作平均值高于老年女性组（p = 0.021）。在老年女性组中，PFM收缩时，发现PFM与RA（r = 0.498，p = 0.001）、IO（r = 0.405，p = 0.006）和EO（r = 0.442，p = 0.002）之间存在中度正相关。
本研究表明，与患有UI的年轻女性相比，患有UI的老年女性PFM耐力降低、PFM快速收缩次数减少，且PFM和腹肌活动较低。特别是在患有UI的老年女性中，观察到PFM与RA、IO和EO肌肉之间存在正相关。重要的是，我们的研究结果表明，无论UI状态如何，女性的PFM和腹肌功能均随年龄下降，导致相关症状恶化。因此，我们建议从年轻时就开始实施预防性物理治疗和康复计划，以维持和优化女性的PFM和腹肌功能。
