COUGH, STRAIN, OR VALSALVA ? WHOCARES ?
D. EL-HAMAMSY1, A.WATSON 1, J. CORDEN 2, F. REID 3, A.R. SMITH 4;
1Warrell Unit, St Mary's Hosp.,Manchester, United Kingdom, 2Trustech, St Mary's Hosp.,Manchester, United Kingdom, 3The Warrell Unit, Manchester,United Kingdom, 4St Mary's Hosp., Manchester, UnitedKingdom.
Introduction: Twenty-one yearsago the Pelvic Organ Prolapse Quantification system (POP-Q) waspublished providing a standardised method to measure anatomicalprolapse. However, the pressure exerted on the pelvic floor whenPOP-Q is measured has not been standardised.
Objective: Weset out to determine which manoeuvres are being used in clinicalpractice to raise intra-abdominal pressure (IAP) during assessment ofpelvic floor dysfunction, if clinicians recognised the differences inthese manoeuvres and if clinicians perceive any difficulty inpatients performing them.
Methods: In 2016, 200questionnaires were distributed at the United Kingdom ContinenceSociety (UKCS) meeting and 100 at East Anglia Obstetrics andGynaecology Society (EAOGS) meeting to evaluate the manoeuvres usedto raise IAP when performing clinical examination to assess pelvicfloor dysfunction.
Results: Forty-two (21%) participantsresponded in the UKCS group and 26 (26%) in the EAOGS group. A widerange of manoeuvres were used by different staff groups (figure 1).Thirty respondents (44%) felt patients struggled to raise their IAPwith any manoeuvre. We found Valsalva was used more commonly by thosewho attend UKCS than EAOGS. Forty-one respondents (60%) felt a deviceto standardise the rise of IAP during examination of prolapse wouldbe useful. There was little agreement about the effect each manoeuvrehad on IAP (figure 2).
Conclusions: Other studies (1,2)have shown that Valsalva , cough and strain result in differentIAP and different movement of the diaphragm and levator ani. Thisdoes not appear to be recognised in clinical practice. To improve ourunderstanding of pelvic floor dysfunction there is a need tostandardise the mechanism by which IAP is raised during clinicalassessment.
Eur J ObstetGynecol Reprod Biol. 2012 Oct;164(2):227-33.