Resting Thickness of Transversus Abdominis and Lumbar Multifidus and Their Changes during Contraction in Women with Stress Urinary Incontinence
Date Issued
2009
Date
2009
Author(s)
Chih, Shu-Yun
Abstract
Background and Purpose: Altered motor control strategies of pelvic floor muscles (PFM) and superficial trunk muscles in women with stress urinary incontinence (SUI) were found recently. The similar contraction pattern of trunk muscles was also demonstrated in subjects with spinal instability due to low back pain (LBP). Transversus abdominis (TrA) and lumbar multifidus (MF) which are classified to deep trunk muscles and primarily provide spinal stability are also dysfunctioned in patients with low back pain. However, muscle activities of TrA and lumbar MF are not evaluated in women with SUI. Real-time ultrasonography is the most common tool for assessing deep trunk muscles activities in recent years. The aims of the study are to assess the difference in resting thickness and change on contraction of TrA and lumbar MF in women with or without SUI through real-time ultrasonography. Further, to compare the differences among the women with different severities of SUI. ethods: This is a cross-sectional study. Fifteen women who suffered SUI episode at least once during previous month were recruited as SUI group, and 10 age-matched asymptomatic women were recruited as control group. The morphometric change of TrA and lumbar MF were recorded by ultrasound. Each muscle in both sides was assessed for 3 times. Order of evaluation of muscles and sides was randomized. Data were exported for linear measurements analysis using a custom- written Matlab program. Statistical analysis was performed using SPSS 11.0. T- test and Mann-Whitney U test were used to compare the muscles thickness at rest and change of muscle thickness on contraction between women with SUI and asymptomatic controls, and women with different severities. esults: There were no significant differences in resting muscle thickness of TrA and lumbar multifidus between women with and without SUI. However, change in muscle thickness of TrA and lumbar MF in women with SUI was significantly less than asymptomatic controls. (TrA: SUI 0.14±0.06cm vs. asymptomatic 0.22±0.06cm, p=0.001; lumbar MF: SUI 0.29±0.17cm vs. asymptomatic 0.51±0.20cm, p=0.006; intermediate MF: SUI 0.11±0.07cm vs. asymptomatic 0.40±0.19cm, p<0.0005). Further, measured variables were not different between women with different severities of SUI. onclusion: The morphometric change on contraction of TrA and lumbar MF is smaller in women with SUI comparing to those without SUI recorded by ultrasound. Integrating TrA and lumbar MF with PFM training is suggested in treatment for women with SUI.
Subjects
stress urinary incontinence
ultrasonography
transversus abdominis
lumbar multifidus
spinal stability
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