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Muscle Function and Ageing

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Pelvic Floor Re-education

Abstract

Normal muscle physiology in relation to the pelvic floor is discussed to enable an understanding of dysfunction of the pelvic floor, particularly of the anal and urethral sphincters, as a consequence of denervation, vaginal delivery, and ageing. Clinical, electrophysiological, and magnetic resonance imaging (MRI) assessments are reviewed, and the mechanisms of repair and rehabilitation are outlined.

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References

  1. Salmons S. Striated muscle. In: Gray’s Anatomy. 38th Edition. Bannister LH, Berry MM, Collins P, et al., editors. London: Churchill Livingstone; 1995:739.

    Google Scholar 

  2. Eisenberg BR. Section 10. Quantitative ultrastructure of mammalian skeletal muscle. In: Handbook of Physiology. Peachey LD and Adrian RH, editors. Bethesda, MD: American Physiological Society; 1983:73112.

    Google Scholar 

  3. Russell B, Motlagh D, Ashley WW. Form follows function: how muscle shape is regulated by work. J Appl Physiol. 2000;88:1127–1132.

    CAS  PubMed  Google Scholar 

  4. Tidball JG. Mechanical signal transduction in skeletal muscle growth and adaptation. J Appl Physiol. 2005;98:1900–1908.

    Article  CAS  PubMed  Google Scholar 

  5. Eisenberg BR, Salmons S. The reorganization of subcellular structure in muscle undergoing fast to slow type transformation: a stereological study. Cell Tissue Res. 1981;220:449–471.

    Article  CAS  PubMed  Google Scholar 

  6. Deindl FM, Vodusek DB, Heese U, et al. Activity patterns of pubococcygeal muscles in nulliparous continent women. Br J Urol. 1993;72:46–51.

    Article  CAS  PubMed  Google Scholar 

  7. Bump RC, Hurt WG, Fantl JA, et al. Assessment of Kegel exercise performance after brief verbal instruction. Am J Obstet Gynecol. 1991;165:322–329.

    CAS  PubMed  Google Scholar 

  8. Bo K, Talseth T. Change in urethral pressure during voluntary pelvic floor muscle contraction and vaginal electrical stimulation. Int Urogynecol J Pelvic Floor Dysfunct. 1997;8:3–7.

    Article  CAS  PubMed  Google Scholar 

  9. Hale DS, Benson T, Brubaker L, et al. Histologic analysis of needle biopsy of urethral sphincter from women with normal and stress incontinence with comparison of electomyographic findings. Am J Obstet Gynecol. 1999;180:342–348.

    Article  CAS  PubMed  Google Scholar 

  10. Heidkamp MC, Leong FC, Brubaker L, et al. Pudendal denervation affects the structure and function of the striated, urethral sphincter in female rats. Int Urogynec J. 1998;9:88–93.

    Article  CAS  Google Scholar 

  11. Constantinou CE, Govan DE. Spatial distribution and timing of transmitted and reflexly generated urethral pressures in healthy women. J Urol. 1982;127:964–969.

    CAS  PubMed  Google Scholar 

  12. Petros PE, Ulmsten U. Role of the pelvic floor in bladder neck opening and closure I: muscle forces. Int Urogynecol J Pelvic Floor Dysfunct. 1997; 8:74–80.

    Article  CAS  PubMed  Google Scholar 

  13. Lieber RL. Physiologic basis of fatigue. In: Butler JP, editor. Skeletal muscle. Structure and function. Baltimore: Williams and Wilkins; 1992:100–105.

    Google Scholar 

  14. Verelst M, Leivseth G. Are fatigue and disturbances in pre-programmed activity of pelvic floor muscles associated with female stress urinary incontinence? Neurourol Urodyn. 2004;23:143–147.

    Article  CAS  PubMed  Google Scholar 

  15. Lieber RL, Friden J. Mechanisms of muscle injury gleaned from animal models. Am J Phys Med Rehabil. 2002;81:S70–S79.

    Article  PubMed  Google Scholar 

  16. Chien KR, Karsenty G. Longevity and lineages: toward the integrative biology of degenerative diseases in heart, muscle, and bone. Cell. 2005; 120:533–544.

    Article  CAS  PubMed  Google Scholar 

  17. Partridge T. Reenthronement of the muscle satellite cell. Cell. 2004;119:447–448.

    Article  CAS  PubMed  Google Scholar 

  18. Sherwood RI, Christensen JL, Conboy IM, et al. Isolation of adult mouse myogenic progenitors: functional heterogeneity of cells within and engrafting skeletal muscle. Cell. 2004;119:543–544.

    Article  CAS  PubMed  Google Scholar 

  19. Hawke TJ, Garry DJ. Myogenic satellite cells: physiology to molecular biology. J Appl Physiol. 2001;91:534–551.

    CAS  PubMed  Google Scholar 

  20. Kennedy JM, Eisenberg BR, Reid SK, et al. Nascent muscle fibre appearance in overloaded chicken slow tonic muscle. Am J Anat. 1988;181:201–215.

    Article  Google Scholar 

  21. Pizza FX, Peterson JM, Bass JH, et al. Neutrophils contribute to muscle injury and impair its resolution after lengthening contractions in mice. J Physiol. 2005;562:899–913.

    Article  CAS  PubMed  Google Scholar 

  22. Dreyfus PA, Chretien F, Chazaud B, et al. Adult bone marrow-derived stem cells in muscle connective tissue and satellite cell niches. Am J Pathol. 2004;164:773–779.

    PubMed  Google Scholar 

  23. Dix DJ, Eisenberg BR. Myosin mRNA accumulation and myofibrillogenesis at the myotendinous junction of stretched muscle fibers. J Cell Biol. 1990;111:1884–1894.

    Article  Google Scholar 

  24. Yu JG, Carlsson L, Thornell LE. Evidence for myofibril remodeling as opposed to myofibril damage in human muscles with DOMS: an ultrastructural and immunoelectron microscopic study. Histochem Cell Biol. 2004;121:219–227.

    Article  CAS  PubMed  Google Scholar 

  25. Chiarelli P, Murphy B, Cockburn J. Women’s knowledge, practises and intentions regarding correct pelvic floor exercises. Neurourol Urodyn. 2003;22:246–249.

    Article  PubMed  Google Scholar 

  26. Graves JE, Webb DC, Pollock ML, et al. Pelvic stabilization during resistance training: its effect on the development of lumbar extension strength. Arch Phys Med Rehabil. 1994;75:210–215.

    Article  CAS  PubMed  Google Scholar 

  27. Sapsford R. Rehabilitation of pelvic floor muscles utilizing trunk stabilization. Manual Therapy. 2004;9:3–12.

    Article  PubMed  Google Scholar 

  28. Laycock J. Assessment and treatment of pelvic floor dysfunction [master’s thesis]. West York-shire, UK: University of Bradford; 1992.

    Google Scholar 

  29. Brink CA, Wells TJ, Sampselle CM, et al. A digital test for pelvic muscle strength in women with urinary incontinence. Nurs Res. 1994;43:352–356.

    Article  CAS  PubMed  Google Scholar 

  30. Bo K, Finckenhagen HB. Vaginal palpation of pelvic floor muscle strength: inter-test reproductibility and comparison between palpation and vaginal squeeze pressure. Acta Obstet Gynecol Scand. 2001;80:883–887.

    CAS  PubMed  Google Scholar 

  31. Devreese A, Staes F, De Weerdt W, et al. Clinical evaluation of pelvic floor muscle function in continent and incontinent women. Neurourol Urodyn. 2004;23:190–197.

    Article  PubMed  Google Scholar 

  32. Jundt K, Reckemeyer I, Namdar N, et al. Changes in pelvic floor function after childbirth. Neurourol Urodyn. 2002;21:364–365.

    Google Scholar 

  33. Blowman D, Pickles C, Emery S, et al. Prospective double blind controlled trial of intensive physiotherapy with and without stimulation of pelvic floor in treatment of genuine stress incontinence. Physiotherapy. 1991;77:661–664.

    Google Scholar 

  34. Schwartz S, Cohen ME, Herbison GJ, et al. Relationship between two measures of upper extremity strength: manual muscle test compared to hand-held myometry. Arch Phys Med Rehabil. 1992;73:1063–1068.

    CAS  PubMed  Google Scholar 

  35. Herbison GJ, Cohen ME, et al. Strength post-spinal cord injury: myometer vs. manual muscle test. Spinal Cord. 1996;34:543–548.

    CAS  PubMed  Google Scholar 

  36. Hahn I, Milsom I, Ohlsson BL, et al. Comparative assessment of pelvic floor function using vaginal cones, vaginal digital assessment and vaginal pressure measurements. Gynecol Obstetric Invest. 1996;41:269–274.

    Article  CAS  Google Scholar 

  37. Kerschan-Schindl K, Uher E, Wiesinger G, et al. Reliability of pelvic floor muscle strength measurement in elderly incontinent women. Neurourol Urodyn. 2002;21:42–47.

    Article  CAS  PubMed  Google Scholar 

  38. Bo K, Fickenhagen HB. Vaginal assessment of pelvic floor muscle strength: Inter-test reproducibility and comparison between assessment and vaginal squeeze pressure. Acta Obstet Gynecol Scand. 2001;80:883–887.

    CAS  PubMed  Google Scholar 

  39. Romanzi L, Polaneczky M, Glazer HI. Simple test of pelvic muscle contraction during pelvic examination: Correlation to surface electromyography. Neurourol Urodyn. 1999;18:603–612.

    Article  CAS  PubMed  Google Scholar 

  40. Dumoulin D, Bourbonnais D, Lemiuex M-C. Development of a dynameter for measuring the isometric force of the pelvic floor musculature. Neurourol Urodyn. 2003a;22:648–653.

    Article  PubMed  Google Scholar 

  41. Thompson DL, Smith DA. Continence nursing: a whole person approach. Holist Nurs Pract. 2002;16:14–31.

    PubMed  Google Scholar 

  42. Thompson JA, O’Sullivan PB. Levator plate movement during voluntary pelvic floor muscle contraction in subjects with incontinence and prolapse: a cross-sectional study and review. Int Urogynecol J. 2003;14:84–88.

    Article  Google Scholar 

  43. DeLancey JO, Kearney R, Chou Q, et al. The appearance of levator ani muscle abnormalities in magnetic resonance images after vaginal delivery. Obstet Gynecol. 2003;101:46–53.

    Article  PubMed  Google Scholar 

  44. Miller JM, Umek WH, DeLancey JOL, et al. Can women without visible pubococcygeal muscle in MR images still increase urethral closure pressure? Am J Obstet Gynecol. 2004:171–175.

    Google Scholar 

  45. Hoyte L, Jakab M, Warfield SK, et al. Levator ani thickness variations in symptomatic and asymptomatic women using magnetic resonance-based 3-dimensional color mapping. Am J Obstet and Gynecol. 2004;191:856–861.

    Article  Google Scholar 

  46. Bo K, Sherburn M, Allen T. Transabdominal ultrasound measurement of pelvic floor muscle activity when activated directly or via a transversus abdominis muscle contraction. Neururol Urodyn. 2003; 22:582–588.

    Article  Google Scholar 

  47. Bernstein IT. The pelvic floor muscles: muscle thickness in healthy and urinary-incontinent women measured by perineal ultrasonography with reference to the effect of pelvic floor training. Estrogen receptor studies. Neururol Urodyn. 1997;16:237–275.

    Article  CAS  Google Scholar 

  48. Miller JM, Perucchini D, Carchidi LT, et al. Pelvic floor muscle contraction during a cough and decreased vesical neck mobility. Obstet Gynecol. 2001;97:255–260.

    Article  CAS  PubMed  Google Scholar 

  49. Peschers U, Schaer G, Anthuber C, et al. Changes in vesical neck mobility following vaginal delivery. Obstet Gynecol. 2001;88:1001–1006.

    Article  Google Scholar 

  50. Haderer JM, Pannu HK, Genadry R, et al. Controversies in female urethral anatomy and their significance for understanding urinary continence: observations and literature review. Int Urogynecol J. 2002;13:236–252.

    Article  CAS  Google Scholar 

  51. Gunnarsson M. Pelvic floor dysfunction: a vaginal surface EMG study in healthy and incontinent women. Lund, Sweden: Lund University; 2002.

    Google Scholar 

  52. Hahn I, Milsom I, Ohlson BL, et al. Comparative assessment of pelvic floor function using vaginal cones, vaginal digital palpation and vaginal pressure measurement. Gynecol Obstetric Invest. 1996; 41:269–274.

    CAS  Google Scholar 

  53. Morkved S, Salvesen K, Bo K, et al. Pelvic floor muscle strength and thickness in continent and incontinent nulliparous women. Neurourol Urodyn. 2002;21:358–359.

    Google Scholar 

  54. Bo K, Stien R, Kulseng-Hanssen S, et al. Clinical and urodynamic assessment of nulliparous young women with and without stress incontinence symptoms: a case-control study. Obstet Gynecol. 1994;84:1028–1032.

    CAS  PubMed  Google Scholar 

  55. Benvenuti F, Caputo GM, Bandinelli S, et al. Reeducative treatment of female genuine stress incontinence. Am J of Phys Med. 1987;66:155–168.

    CAS  Google Scholar 

  56. Bo K, Larsen S, Oseid S, et al. Knowledge about the ability to correct pelvic floor muscle exercises in women with urinary stress incontinence. Neurourol Urodyn. 1988;7:261–262.

    Google Scholar 

  57. Hesse U, Schussler B, Frimberger J, et al. Effectiveness of a three step pelvic floor reeducation in the treatment of stress urinary incontinence: a clinical assessment. Neurourol Urodyn. 1990;9:397–398.

    Google Scholar 

  58. Kegel AH. Stress incontinence and genital relaxation. Ciba Clin Sympos. 1952;2:35–51.

    Google Scholar 

  59. Morkved S, Bo K, Schei B, et al. Pelvic floor muscle training during pregnancy to prevent urinary incontinence: a single-blind randomized controlled trial. Obstet Gynecol. 2003;101:313–319.

    Article  PubMed  Google Scholar 

  60. Reilly ET, Freeman RM, Waterfield MR, et al. Prevention of postpartum stress incontinence in primigravidae with increased bladder neck mobility: a randomised controlled trial of antenatal pelvic floor exercises. BJOG. 2002;109:68–76.

    Article  CAS  PubMed  Google Scholar 

  61. Sampselle CM, DeLancey JO. The urine stream interruption test and pelvic muscle function. Nurs Res. 1992;41:73–77.

    CAS  PubMed  Google Scholar 

  62. Salvesen KA, Morkved S. Randomised controlled trial of pelvic floor muscle training during pregnancy. BMJ. 2004;329:378–380.

    Article  PubMed  Google Scholar 

  63. Kegel AH. Progressive resistance exercise in the functional restoration of the perineal muscles. Am J Obstet Gynecol. 1948;56:238–249.

    CAS  PubMed  Google Scholar 

  64. Hay-Smith E, Bo K, Berghmans L, et al. Pelvic floor muscle training for urinary incontinence in women. Available in the Cochrane Library [data-base on disk and CD ROM]. Updated quarterly. The Cochrane Collaboration, 2001.

    Google Scholar 

  65. Miller JM, Ashton-Miller JA, DeLancey JO. A pelvic muscle precontraction can reduce cough-related urine loss in selected women with mild SUI. J Am Geriatr Soc. 1998;46:870–874.

    CAS  PubMed  Google Scholar 

  66. Herbison P, Plevnik S, Mantle J. Weighted vaginal cones for urinary incontinence. [update of Cochrane Database Syst Rev. 2000;(2):CD002114; PMID: 10796862]. Cochrane Database of Systematic Reviews, 2002;1.

    Google Scholar 

  67. Sapsford RR, Hodges PW. Contraction of the pelvic floor muscles during abdominal maneuvers. Archs Phys Med Rehab. 2001;82:1081–1088.

    Article  CAS  Google Scholar 

  68. Sapsford RR, Hodges PW, Richardson CA, et al. Co-activation of the abdominal and pelvic floor muscles during voluntary exercises. Neurourol Urodyn. 2001;20:31–42.

    Article  CAS  PubMed  Google Scholar 

  69. Neumann P, Gill V. Pelvic floor and abdominal muscle interaction: EMG activity and intraabdominal pressure. Int Urogynecol J. 2002;13:125–132.

    Article  CAS  Google Scholar 

  70. Brooks SV, Faulkner JA. Skeletal muscle weakness in old age: underlying mechanisms. Med Sci Sports Exerc. 1994;26:432–439.

    CAS  PubMed  Google Scholar 

  71. Goldspink G, Harridge SD. Growth factors and muscle ageing. Exp Gerontol. 2004;39:1433–1438.

    Article  CAS  PubMed  Google Scholar 

  72. Goldspink G. Age-related loss of skeletal muscle function; impairment of gene expression. J Musculoskelet Neuronal Interact. 2004;4:143–147.

    CAS  PubMed  Google Scholar 

  73. Bar-Shai M, Carmeli E, Coleman R, et al. The effect of hindlimb immobilization on acid phosphatase, metalloproteinases and nuclear factorkappaB in muscles of young and old rats. Mech Ageing Dev. 2005;126:289–297.

    Article  CAS  PubMed  Google Scholar 

  74. Conboy IM, Rando TA. Ageing, stem cells and tissue regeneration: lessons from muscle. Cell Cycle. 2005;4:407–410.

    CAS  PubMed  Google Scholar 

  75. Goldspink G, Harridge SD. Growth factors and muscle ageing. Exp Gerontol. 2004;39(10):1433–1438.

    Article  CAS  PubMed  Google Scholar 

  76. Machida S, Booth FW. Insulin-like growth factor 1 and muscle growth: implication for satellite cell proliferation. Proc Nutr Soc. 2004;63:337–340.

    Article  CAS  PubMed  Google Scholar 

  77. Bo 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;13:35–41.

    Article  CAS  PubMed  Google Scholar 

  78. Amarenco G, Ismael SS, Lagauche D, et al. Cough anal reflex: strict relationship between intravesical pressure and pelvic floor muscle electromyographic activity during cough. Urodynamic and electrophysiological study. J Urol. 2005;173:149–152.

    Article  PubMed  Google Scholar 

  79. Aukee P, Penttinen J, Airaksinen O. The effect of ageing on the electromyographic activity of pelvic floor muscles. A comparative study among stress incontinent patients and asymptomatic women. Maturitas. 2003;44:253–257.

    Article  PubMed  Google Scholar 

  80. Janda S, van der Helm FC, de Blok SB. Measuring morphological parameters of the pelvic floor for finite element modelling purposes. J Biomech. 2003;36:749–757.

    Article  PubMed  Google Scholar 

  81. Parikh M, Rasmussen M, Brubaker L, et al. Three dimensional virtual reality model of the normal female pelvic floor. Ann Biomed Eng. 2004;32: 292–296.

    Article  PubMed  Google Scholar 

  82. DeLancey JO, Sampselle CM, Punch MR. Kegel dyspareunia: levator ani myalgia caused by overexertion. Obstet Gynecol. 1993;82:658–659.

    Article  CAS  PubMed  Google Scholar 

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Russell, B., Brubaker, L. (2008). Muscle Function and Ageing. In: Baessler, K., Burgio, K.L., Norton, P.A., Schüssler, B., Moore, K.H., Stanton, S.L. (eds) Pelvic Floor Re-education. Springer, London. https://doi.org/10.1007/978-1-84628-505-9_4

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  • DOI: https://doi.org/10.1007/978-1-84628-505-9_4

  • Publisher Name: Springer, London

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  • Online ISBN: 978-1-84628-505-9

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