Assessing the Effect of Passive Ankle Dorsi Flexion while Doing Strengthening Exercises of Pelvic Floor Muscles on Pelvic Floor Muscles Strength in Women with Pelvic floor Muscles Relaxation Syndrome

Document Type : Original Article

Authors

1 Lecturer of midwifery, Faculty of nursing & midwifery, Mashhad University of Medical Science, Mashhad, Iran.

2 M.Sc. Student of midwifery, Faculty of nursing & midwifery, Mashhad University of Medical Science, Mashhad, Iran.

3 Associate Professor of Obstetrics and Gynecology, Women’s Health Research Center, Faculty of Medicine, Mashhad University of Medical sciences, Mashhad, Iran.

4 Assistant Professor of Exercise Physiology, Faculty of nursing & midwifery, Mashhad University of Medical Science, Mashhad, Iran.

5 Associate Professor of Biostatistics, Faculty of Medicine, Mashhad University of Medical sciences, Mashhad, Iran.

Abstract

Introduction: The main cause of pelvic organs prolapse is failure of levator ani muscle. Conservative treatments like strengthening exercises of pelvic floor muscles lead to increasing contractile force and strength of muscles. The aim of this study was to assess the effect of passive ankle dorsi flexion on pelvic floor muscle activity during exercises.
 
Methods: This clinical trial study was carried out on 39 women aged 25-55 years with pelvic floor muscles relaxation who referred to women's clinic of educational hospitals of Mashhad University of Medical Sciences in 2010. After clinical examination and confirmation of pelvic floor muscle relaxation, women were divided randomly into two groups: doing strengthening exercises of PFM in standing position with passive ankle dorsi flexion (on wooden surface with 15 degree angle) (n=20) and horizontal standing position (n=19) for 8 weeks. Pelvic floor muscles strength was assessed with brink score before and after intervention. Data analyzed by using analytic-descriptive statistics. P value less than 0.05 was considered significant.
 
Results: Increased percent of pelvic floor muscles strength in standing position group was more than dorsi flexion (51.47% vs. 49.2%). But based on independent t-test, the difference between mean of Brink score in 2 groups was not statistically significant (p=0.516). Chi-Square test showed the difference between improvement percent of stress urinary incontinence was not statistically significant in 2 groups (p=0.572).
 
Conclusion: Doing Pelvic floor muscle exercises with passive ankle dorsi flexion and horizontal standing position can increase the effectiveness of kegel exercises but effectiveness of horizontal standing position is more than passive ankle dorsi flexion.

Keywords


1. Berek JS. Berek & Novak’s gynecology, 14th ed. Philadelphia:Lippincott Williams & Wilkins;2007: 858-911.
2. Knight D, Scott P. How to treat pelvic organ prolapse in women. Australian Doctor Education 2010 July; 24-30.
Available at: www.australiandoctor.com.au.
3. Cass I, Karlan Y. Ovarian and tubal cancers. In: Gibbs RS, Karlan BY, Haney AF, Nygaard IE. Danforth’s
obstetrics & gynecology. 10th.Philadelphia:Lippincott Willims & Wilkins;2008:1022-59.
4. Kerkhof MH, Hendriks L, Brö lmann HA. Changes in connective tissue in patients with pelvic organ prolapsed--
a review of the current literature. Int Urogynecol J Pelvic Floor Dysfunct 2009 Apr;20(4):461-74.
5. Walker GJ, Gunasekera P. Pelvic organ prolapse and incontinence in developing countries: review of prevalence
and risk factors. Int Urogynecol J 2011 Feb;22(2):127-35.
6. Garshasbi A, Faghihzadeh S, Falah N. [The status of pelvic supporting organs in population of Iranian women
18-68 years of age and possible related factos] [Article in Persian]. Arch Iran Med 2006;9(2):124-8.
7. Smith DB. Female pelvic floor health: a developmental review. J Wound Ostomy Continence Nurs 2004 MayJun;31(3):130-7.
8. Dwyer Pl, Lee ET, Hay DM. Obesity and urinary incontinence in woman. Br J Obstet Gynecol 1988
Jan;95(1):91-6.
9. Luft J, VGriheas-Nichols AA. Identifying the risk factors for developing incontinence: can we modify individual
risk? Geriatr Nurs 1988 Mar-Apr;19(2):66-70.
10. Swift SE, Tate SB, Nicholas J. Correlation of symptoms with degree of pelvic organ support in a general
population of women: what is pelvic organ prolapse? Am J Obstet Gynecol 2003 Aug;18(9):372-7.
11. Harvey MN, Versi E. Urogynecology and pelvic floor dysfunction. In: Ryan KJ, Berkowitz RS, Barbieri RL,
Dunaif A. Kistner’s gynecology and women’s health. 7th ed. St Louis:Mosby;1999:570-609.
12. Roc JA, Jones III HW. Te Linde’s operative gynecology. 10th ed. Philadelphia:Lippincott Williams &
Wilkins;2008.
13. DeCherney AH, Nathan L. Current obstetric and gynecologic diagnosis and treatment. 9th ed. New
York:McGraw-Hill;2003.
14. Namvar F, Golmakani N, Khadem N. [A comparative study of the effects of vaginal cones and pelvic floor
muscles exercises in women with pelvic floor muscles atony] [Article in Persian]. J Sabzevar Uni Med Sci
2001;4:16-24.
15. Rovner ES, Wein AJ. Treatment options for stress urinary incontinence. Rev urol 2004;6 Suppl 3:S29-47.
16. Hacker NF, Moore JG, Gambone JC. Essentials of obstetrics and gyneclogy. 4th ed.
Philadelphia:Saunders;2004:309-19.
17. Finnish Medical Society Duodecim. Urinary incontinence in women. In: EBM Guidelines. Evidence-Based
Medicine [Internet]. Helsinki, Finland: Wiley Interscience. John Wiley & Sons; 2008 Aug 8 [Various].
Available at: http://guideline.gov/content.aspx?id=13195
 
18. Bo K. Pelvic floor muscle training is effective in treatment of female stress urinary incontinence, but how does
it work? Int Urogynecol J Pelvic Floor Dysfunct 2004 Mar-Apr;15(2):76-84.
19. Neumann P, Gill V. Pelvic floor and abdominal muscle interaction: EMG activity and intra-abdominal
pressure. Int Urogynecol J Pelvic Floor Dysfunct 2002;13(2):125-32.
20. Capson AC, Nashed J, Mclean L. The role of lumbopelvic posture in pelvic floor muscle activation in continent
women. J Electromyogr Kinesiol 2011 Feb;21(1):166-77.
21. Chen CH, Huang MH, Chen TW, Weng MC, Lee CL, Wang GJ. Relationship between ankle position and pelvic
floor muscle activity in female stress urinary incontinence. Urology 2005 Aug;66(2):288-92.
22. Cerruto M, Vedovi E, Mantovani W, Gozzi L, Marangoni E, Fumene P, et al. The effect of adaptable removable
insoles at resting and during walk on female pelvic floor muscle activity. J Urol 2009 Apr;181(4):559.
23. Chen HL, Lin YC, Chien WJ, Huang WC, Lin HY, Chen PL. The effect of ankle position on pelvic floor muscle
contraction activity in women. J Urol 2009 Mar;181(3):1217-23.
24. Dö rflinger A, Gorton E, Stanton S, Dreher E. Urethral pressure profile: is it affected by position? Neurourol
Urodyn 2002;21(6):553-7.
25. Cerruto M, Vedovi E, Rossi S, Mantovani W, Pozzo A, Cangemi A, et al. The effect of ankle inclination in
supine and standing position on the electromyigraphic activity of abdominal and pelvic floor muscles in women
with and without stress urinary incontinence: preliminary results from a pilot study. Eur Urol Suppl 2008
Mar;7(3):I-IXV.
26. Bø K, Stien R. Needle EMG registration of striated urethral wall and pelvic floor muscle activity patterns during
cough, valsalva, abdominal, hip adductor and gluteal muscle contractions in nulliparous healthy females.
Neurourol Urodyn 1994;13(1):35-41.
27. Drysdale CL, Earl JE; Hertel J. Surface electromyographic activity of the abdominal muscles during pelvic-tilt
and abdominal-hollowing exercises. J Athl Train 2004 Mar;39(1):32-6.