Impact of Two Reflex Pelvic Floor Muscle Contraction Patterns on Female Stress Urinary Incontinence

Abstract

Purpose: To explore the impact of two reflex pelvic floor muscle contraction patterns during coughing on incontinence severity and incontinence-related quality of life in women with stress urinary incontinence (SUI).

Materials and Methods: A total of 208 women with the symptomatic and urodynamic evidence of SUI and 126 women with no experience of urinary incontinence were recruited in a 5-year period. During hard coughs, reflex pelvic floor muscle contraction was detected using introital ultrasound and two reflex contraction patterns were recognized: an inward clitoral motion and a superior-anterior anorectal lift. The assessment of incontinent severity and impact of quality of life included 1-hour pad tests and short forms of the Urogenital Distress Inventory and the Incontinence Impact Questionnaire.

Results: There is no significant difference in the demographics and the distribution and concordance of two reflex contractions between women with or without urinary incontinence. Neither type of reflex contraction during coughing was identified in 14 incontinent women (7 %) and 5 continent women (4 %). The concordant rate for synchronous activities of both reflex contractions during coughing was 80 % (167) and 81 % (102) for incontinent and continent women, respectively. Incontinent women without clitoral reflex motion had significantly greater incontinent severity on 1-hour pad tests (p = 0.018) and higher sum scores of the short form of Incontinence Impact Questionnaire (p = 0.026). By contrast, incontinent women with and without reflex anorectal lifts had similar incontinence severity and impact.

Conclusion: In women with SUI, loss of clitoral reflex motion is associated with worse incontinent severity and impact.

Zusammenfassung

Ziel: Untersuchung der Auswirkung von zwei reflektorischen Muskelkontraktionsmustern des Beckenbodens während des Hustens auf die Schwere der Inkontinenz und die durch die Inkontinenz bedingte Lebensqualität von Frauen mit stressbedingter Harninkontinenz (SUI).

Material und Methoden: Insgesamt 208 Frauen mit symptomatischem oder urodynamischem Nachweis einer SUI und 126 Frauen ohne Erfahrungen von Harninkontinenz wurden über einen Zeitraum von 5 Jahren einbestellt. Während eines starken Hustens wurde die reflektorische Muskelkontraktion des Beckenbodens mittels introitaler Sonografie nachgewiesen und zwei reflektorische Kontraktionsmuster erkannt: eine Bewegung der Klitoris nach innen und eine superior-anteriore anorektale Anhebung. Die Bewertung der Schwere der Inkontinenz und der Beeinträchtigung der Lebensqualität beinhaltete einen 1-stündigen Pad-Test und eine Kurzform des „Urogenital Distress Inventory“ und des „Incontinence Impact Questionnaire“.

Ergebnisse: Es gibt keinen signifikanten Unterschied zwischen Frauen mit und ohne Harninkontinenz in Bezug auf demografische Faktoren sowie der Verteilung und Übereinstimmung der beiden reflektorischen Kontraktionen. Bei 14 inkontinenten (7 %) und 5 kontinenten Frauen (4 %) wurde beim Husten keine der beiden Formen der reflektorischen Kontraktionen ermittelt. Die Übereinstimmungsrate für synchrone Aktivitäten der beiden reflektorischen Kontraktionen beim Husten betrug 80 % (167) bei den inkontinenten und 81 % (102) bei den kontinenten Frauen. Inkontinente Frauen ohne Reflexbewegung der Klitoris hatten eine signifikant stärkere Inkontinenz im 1-stündigen Pad-Test (p = 0,018) und eine größere Punktzahl bei der Kurzform des Inkontinenz-Fragebogens (p = 0,026). Im Gegensatz dazu hatten inkontinente Frauen mit und ohne reflektorische anorektale Anhebungen eine ähnliche Stärke der Inkontinenz und Beeinträchtigung.

Schlussfolgerung: Bei Frauen mit SUI ist der Verlust der Reflexbewegung der Klitoris mit einem größeren Ausmaß an Inkontinenz und Beeinträchtigung verbunden.

Key words

ultrasound - pelvis - incontinence severity - stress urinary incontinence - reflex pelvic floor muscle contraction

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