Status Plus

abstract

54 - PELVIC FLOOR AND ABDOMINAL MUSCLE CROSS-TALKING IN WOMEN: A SYSTEMATIC REVIEW AND META-ANALYSIS

054

PELVIC FLOOR AND ABDOMINAL MUSCLECROSS-TALKING IN WOMEN: A SYSTEMATIC REVIEW AND META-ANALYSIS

G. VESENTINI1, L. A.RIGHESSO 2, F. PICULO 1, G. MARINI 1,A. BARBOSA 3, R. EL DIB 4, M. V. RUDGE 1;
1Gynecology and Obstetrics, Univ.e Estadual Paulista,Botucatu, Brazil, 2Oral and Maxillofacial Surgery, Univ.Med. Ctr. Mainz, Mainz, Germany, 3UNESP, Assis, Brazil,4Biosciences, Univ.e Estadual Paulista, São José dosCampos, Brazil.

Introduction: The pelvic floormuscle (PFM) training is a well-known treatment for urinaryincontinence (UI), and studies have shown a possible interactionbetween PFMs and abdominal muscles (AbMs). If this theory is truethen physicians could effectively treat women with PFMdysfunction.
Objective: To investigate the cross-talkingbetween AbMs and the PFM in women with or without impaired functionof pelvic floor. We hypothesized that women with impaired function ofpelvic floor would show decreased thickness/activity of the AbMsduring maximal co-contraction of both AbMs and/or PFM compared withthe women with/without history of impaired function of pelvicfloor.
Methods: Searches on Medline, EMBASE, and LILACS(search date June 29 2016) and review of reference lists of previousreview, including any observational study (i.e. cohort orcross-sectional) or any randomized trial addressing the associationbetween transversus abdominis (TrA), obliquus internus abdominis(OI), obliquus externus abdominis (OE) and rectus abdominis (RA) withthe PFM. Pairs of reviewers independently screened potentiallyeligible articles, extracted data from included studies onpopulations, interventions and outcomes, and assessed their risk ofbias. We used the GRADE approach to rate overall certainty of theevidence by outcome. The protocol was reviewed and published(CRD42017055462) by PROSPERO.
Results: Figure 1 presentsthe process of identifying eligible studies, including citationsidentified through search in electronic databases. Sixteen studieswithin a total of 311 participants met the inclusion criteria. Sixstudies were conducted in Australia, three others largely in Europe,three in Canada, three in Asia and one in South America. Typicalfemales were between 28,1 and 66,1. Nine included studies allocatedhealthy women and, further seven wtih women with pelvic floor muscledysfunction. Table 1 shows the studies characteristics that wereidentified in the review. The studies shows increased abovethe baseline level of AbM during PFM contraction either in healthy orwomen with PFM dysfunction.
Conclusions: We have providedcompelling evidence of the influence of the PFMs and AbMs onphysiological functions and cross-talk according to the findings ofpublished articles. There is strong evidence that the AbMs,especially the TrA, OI and RA, participate in the mechanismscontrolling urinary continence, confirming the cross-talk betweenthese muscles. Understanding the pathways related to urinarycontinence in detail is a main goal for the prevention and treatmentof PFM dysfunction. PFM training is a well-established method foraddressing PFM dysfunction, but combining PFM training with AbMtraining may help to achieve the optimal level of PFM musclerecruitment, which may in turn offer a new, powerful approach fortreating PFM dysfunction. Further research using various types ofstatic and dynamic tasks is warranted.
References: IntUrogynecol J Pelvic Floor Dysfunct 2002;13(2):125-132Neurourology and Urodynamics 2009; 28:368-373 NeurourolUrodyn 2015;34:300-308

Table1. Study characteristics related to author, design of study,location, number of participants,

Author,year

Designof study

Location

No.participants

Meanage

Measurementof contraction

Muscletested

Sapsford,2001 

Cross-sectional

Australia

7

49.3

Electromyography

Abdominalmuscles

Neuman,2002 

Cross-sectional

Australia

4

34

Electromyography

PFMand Abdominal Muscles

Madill,2006 

Cross-sectional

Canada

15

36.3

Electromyography

Abdominalmuscles

Thompson,2006

Cross-sectional

Australia

13

37

Electromyography

Abdominalmuscles

Thompson,2006

Cross-sectional

Australia

C:13

I:13

C:37

I:38

Electromyography

Abdominalmuscles

Madill,2008

Cross-sectional

Canada

15

36.3

Electromyography

Abdominalmuscles

Bo,2009

Cross-sectional

Europe

13

46.5

Ultrasonography

PFMand Abdominal Muscles

Madill,2009

Cross-sectional

Canada

C:28

I:44

C:46.8

I:49.65

Electromyography

Abdominalmuscles

Junginger,2010

Cross-sectional

Australia

9

42

Electromyography

PFMand Abdominal Muscles

Arab,2011

Cross-sectional

Asia

C:10

I:10

C:41.66

I:38.47

Ultrasonography

Abdominalmuscles

Strupp,2011

Cross-sectional

Centraland South America

34

28.1

Electromyography

PFMand Abdominal Muscles


Table1. Study characteristics related to author, design of study,location, number of participants,

Tajiri,2011

Cross-sectional

Asia

C:25

I:7

C:45.8

I:50.1

Ultrasonography

Abdominalmuscles

Sapsford,2013

Cross-sectional

Australia

7

40.6

Others

PFMand Abdominal Muscles

Tajiri,2014

Cross-sectional

Asia

15

52

Ultrasonography

Abdominalmuscles

Chmielewska,2015

Cross-sectional

Europe

19

23.6

Electromyography

Abdominalmuscles

Ptaszkowski,2015

Cross-sectional

Europe

C:14

I:16

C:66.1

I:63.9

Electromyography

Abdominalmuscles