Co-activation analysis between the abdominal and pelvic floor muscles and its relationship with the pelvic floor's ultrasound biometric parameters in women with predominantly stress urinary incontinence

Abstract

Introduction: Recent studies describe the coordinated and simultaneous activity between the abdominal and pelvic floor muscles (PFM), which seems to favor urinary continence mechanisms. Aim: To investigate whether the co-activation between the abdominal and pelvic floor muscles interfere on pelvic floor's ultrasound biometric parameters in women with predominantly stress urinary incontinence, compared to continent women. Methodology: Women aged at least 18 years will be recruited into one of the following groups: (a) Incontinents: presence of stress urinary incontinence (SUI) or mixed urinary incontinence (IUM) with predominance of SUI and (b) Continents: absence of urinary loss. The presence or absence of urinary symptoms will be investigated through the questionnaires: International Consultation on Incontinence Questionnaire - Urinary Incontinence - Short Form (ICIQ UI-SF) and ICIQ - Overactive Bladder (ICIQ-OAB). We are going to investigate the clinical data, PFM strength by digital palpation, co-activation percentage through PFM and abdominal muscles' electromyographic assessment and the pelvic floor's ultrasound biometric parameters, including: genital hiatus anteroposterior diameter in the midsagittal plane, levator plate angle, anorectal angle, bladder neck elevation, genital hiatus dimensions (area and latero-lateral and anteroposterior diameters), puborectal muscle thickness and PFM distensibility during rest, on PFM contraction, on abdominal contraction as well PFM and abdominal simultaneous contraction. A correlation study between the co-activation percentage and ultrasound parameters will be performed, as well as comparisons between groups, using the Statistical Package for Social Sciences - SPSS and adopting a 5% significance level.