The influence of perineal training and type of delivery on multidirectional load distribution of the female pelvic floor

Abstract

The pelvic floor is a group of muscles, joints and fascia, forming the base of the abdomino-pelvic cavity, considered an understudied region of the body from a biomechanical perspective. Together these structures contribute to support the pelvic organs and to maintain urinary and fecal continence. Although 45% of the women are not capable to contract the pelvic floor voluntarily, the strength and the capacity to maintain the pelvic floor muscle contraction are related to the severity of incontinence and sexual satisfaction. The most established risk factor for pelvic floor dysfunction and weakening of the pelvic floor musculature is vaginal delivery. The aims of the present study are to: (1) investigate whether antepartum use of a birth trainer reduce pelvic floor weakness; and to (2) investigate the effect of a pompoir training practice on strength, endurance and coordination of these muscles. A multidirectional spatiotemporal load distribution of the pelvic floor will be assessed by a probe fully instrumented with capacitive sensors (Pliance System- Novel, Munich, Germany), and by a dynamometer instrumented with a strain gauge (EMG-system do Brasil 020653/ 2013 - São José dos Campos, SP/Brasil). To answer the first question, 20 primiparous women that went through vaginal labor with and without antepartum training; and to answer the second question 20 nulliparous that practiced or not the pompoir training will be assessed by the same protocol. After vaginal palpation, pelvic floor muscle strength will be evaluated during three consecutive maximal voluntary contractions and one sustained contraction. The variables will be compared between groups by analysis of variance (ANOVA) followed by Newman-Keuls post-hoc test. Alpha will be set at 0.05 for all analysis. (AU)