Prospective evaluation of the connected biofeedback EMY Kegel trainer in the management of stress urinary incontinence.

INTRODUCTION: The aim of this study was to evaluate changes in the quality of life with the connected biofeedback EMY Kegel trainer in patients suffering from stress urinary incontinence. Materiel and methods: This was a prospective, single-center, non-comparative study, which took place between September 2019 and October 2020, in the University Hospitals of Strasbourg. Eligible patients were instructed to use the EMY probe for a minimum of 10 min per day for five days per week. To assess quality of life and urinary symptoms, the Contilife and ICIQ-SF scores were completed each month until the final visit (M3). The PGI-I was also completed at 3 months to assess the benefit of the EMY Kegel Trainer. RESULTS: A total of 55 patients were included. At the inclusion visit (M0), the mean Contilife and ICIQ-SF scores were respectively at 6.6 ± 1.5 and 10.5 ± 3.0 points. At the final visit (M3), the mean Contilife score increased to 9.2 ± 1.0, indicating an improvement in quality of life. The mean ICIQ-SF score decreased to 4.2 ± 4.0, indicating an improvement in urinary symptoms. The PGI-I questionnaire identified a positive assessement of the EMY Kegel trainer. On the 55 patients included, 35 (64%) reported completing at least 36 sessions during the study, i.e. an average of 3 sessions per week. CONCLUSIONS: This study suggests that perineal rehabilitation by biofeedback using the EMY Kegel trainer might be beneficial.

Pelvic floor muscle activation in stress urinary incontinent women: Impact of a distraction task.

AIMS: Our purpose was to explore the involvement of cognition in voluntary and involuntary pelvic floor muscle (PFM) contraction in stress urinary incontinent women. METHODS: PFM contraction monitored by surface electromyography (EMG) was measured without a mental distraction task (DT), and with a DT called "paced auditory serial additional test" (PASAT). Forty stress incontinent women performed voluntary contractions of the external anal sphincter (EAS), and reflex EAS contractions induced by means of coughing were studied using the external intercostal muscle (EIC) EMG pattern. RESULTS: A DT altered PFM pre-activation when coughing: the reaction time between EIC muscle contraction and EAS contraction (called RT3) was respectively -54.94 ms (IQR -87.12; 3.12) without the PASAT and -3.99 ms (IQR: -47.92; 18.69) with a DT (P = 0.02, Wilcoxon's test). Concerning voluntary contraction, women activated their PFM sooner without than with a DT. CONCLUSION: The PASAT altered voluntary and reflex contractions of the PFM in stress urinary incontinent women. Our study suggests that cognition plays a role in urinary pathophysiology. Future studies should investigate rehabilitation programs that consider the role of cognition in stress urinary incontinent women.

Effect of body position on reflex and voluntary pelvic floor muscle contraction during a distraction task.

AIMS: To explore the impact of body position (sitting vs standing) on voluntary and reflex pelvic floor muscle (PFM) contraction during a mental distraction task (DT). METHODS: Informed consent was obtained from 19 healthy women. The electromyographic (EMG) activity of the external anal sphincter (EAS) was recorded during voluntary and reflex contraction. Reflex contraction of the EAS was induced by means of coughing. The trials were carried out with and without a mental DT (paced auditory serial additional test). PFM contraction was recorded in two different postures: standing and sitting. During voluntary PFM contraction, reaction time (RT1), defined as latency between the stimulus and the onset of EAS EMG activity, was measured. During reflex PFM contraction, latency between the onset of external intercostal (EIC) muscle EMG activity and EAS EMG activity was measured (RT3). RESULTS: Concerning voluntary pelvic floor muscle contraction, there was no difference between the two positions with and without DT, except for RT1 without DT. RT1 was shorter (353.99 mv/s; 263.89-425.03) in a standing position than in a sitting position (409.86 mv/s; 361.86-461.90) (ratio 0.86, P = 0.014). Concerning reflex PFM contraction, there was no difference between standing position RT3 (-96 ms; IQR: -114: -62) and sitting position RT3 (-80 ms; IQR: -100; -51) (ratio 1.2, P = 0.225) without DT. With DT, reflex PFM was also not different (-36 vs -34 ms, ratio 1.06, P = 0.86). CONCLUSIONS: Body position did not influence the timing of voluntary and reflex PFM contraction during DT.

Influence of a distraction task on the involuntary reflex contraction of the pelvic floor muscles following cough.

AIMS: To explore the involvement of a distraction task in involuntary reflex pelvic floor muscle contraction following cough. METHODS: Informed consent was obtained from 33 healthy volunteers. Involuntary contraction of the external anal sphincter (EAS) was induced by means of coughing. Cough efforts were elicited by electronic order. The electromyographic (EMG) activity of the EAS was recorded during involuntary contraction elicited by coughing. The trials were carried out twice: combined (or not) with a mental distraction task; the paced auditory serial additional test (PASAT). Reaction time (RT) defined as latency between the stimulus and maximum EAS EMG activity (RT1), latency between the stimulus and external intercostal (EIC) muscle EMG activity (RT2), latency between EIC EMG activity and EAS EMG activity (RT3), duration of the contraction, and the area under the EAS EMG activity curve (perineal contraction) were measured. RESULTS: The distraction task altered anticipation of the PFM contraction: RT3 was -80.00 ms (IQR -107; -56) without the PASAT versus -56.67 ms (IQR: -94; -2) with the distraction task (ratio 0.71, P = 0.0045, Wilcoxon test). RT2 was altered during the distraction task: 583.33 ms (IQR: 344-775) without PASAT versus 652.71 ms (503-790) during PASAT (ratio 1.12, P = 0.031, Wilcoxon test). Finally, when the two conditions (respectively with and without the mental distraction task) were compared, there was a significant difference between the area under the EAS EMG activity curve (0.0115 mv sec vs. 0.0103 mv sec, ratio 0.90, P = 0.023). CONCLUSIONS: The mental distraction task altered involuntary reflex contraction of the pelvic floor muscles. Neurourol. Urodynam. 36:160-165, 2017. © 2015 Wiley Periodicals, Inc.

Influence of cognitive rehabilitation on pelvic floor muscle contraction: A randomized controlled trial.

AIM: Distraction task (DT), which led to a modification of voluntary and involuntary reflex pelvic floor muscle (PFM) activation, might potentiate urinary incontinence, through an alteration of the temporal course between intra-abdominal pressure and PFM contraction. We evaluated whether cognitive rehabilitation (dual-task method) could prevent the effect of a mental distraction task on the reaction time of PFM contraction. METHODS: Thirty-nine healthy volunteers underwent two sessions of electromyographic (EMG) PFM recordings separated by a 2-week interval. We recorded external anal sphincter EMG activity during voluntary and involuntary PFM contraction with and without a DT (Paced Auditory Serial Addition Task). Two main parameters were recorded: RT1 (latency between an order for PFM contraction and the onset of the external anal sphincter EMG activation during voluntary PFM contraction) and RT3 (latency between the onset of the involuntary external anal sphincter EMG activation and the onset of the external intercostal muscle EMG activation during involuntary PFM contraction). Volunteers were randomized (ratio 1:2) in two groups: dual task cognitive (an attentional test, the n-back test, and PFM exercises) rehabilitation program (n = 13) and control group (n = 26). The control group had no specific instructions and did not have to do PFM exercises. RESULTS: Concerning voluntary PFM contraction, following a 2-week interval, in the study group RT1 in DT conditions decreased from 461.11 ms [357.14-557.41] to 290.74 ms [262.96-308.88] (ratio 0.63, P = 0.0063). In the control group, RT1 in DT conditions was not significantly different. Concerning involuntary PFM contraction, in the study group RT3 without a DT increased from -68.52 ms [-107.40; -40] to -127.78 ms [-163.06; -93.33] (ratio 1.86, P = 0.0327). In DT conditions, in the study group RT3 increased from -42.59 ms [-52.09; -6.66] to -59.25 ms [-119.44; -44.44] (ratio 1.39, P = 0.0478). CONCLUSION: The alteration of the reaction time of PFM provoked by a distraction task can be prevented by specific cognitive rehabilitation.

[Postpartum pelvic floor disorders]. / Troubles pelvi-périnéaux du post-partum. Fréquents et à rechercher systématiquement à l'interrogatoire.

Postpartum pelvic floor disorders. Postpartum pelvic floor disorders are frequent but most of the time, decrease spontaneously. Even if 40% of pregnant women suffer from urinary incontinence, 85% of them are cured 3 months after delivery. In case of persistent urinary incontinence, postpartum rehabilitation improves short-term urinary incontinence. Six weeks after delivery 4% to 39% women suffer from anal incontinence. Most of the time anal symptoms decrease spontaneously. Postpartum rehabilitation seems to improve short-term anal incontinence. 15 to 20% of pregnant women have a genital prolapse stage 2 during the third trimester and 20 to 50% in the immediate postpartum. Even if most of the women (90%) have genital prolapse (stage 1 for most of them) one year after delivery, only 10% are bothered. Expectative management with a clinical evaluation 12 months after delivery is sufficient. In case of persistent symptoms, pelvic floor rehabilitation can be proposed.

Troubles pelvi-périnéaux du post-partum. Les troubles pelvi-périnéaux du post-partum sont fréquents mais régressent spontanément la plupart du temps. L'incontinence urinaire dont la prévalence est proche de 40 % au cours de la grossesse régresse spontanément dans 85 % des cas à 3 mois du post-partum. En cas de persistance des symptômes, la rééducation périnéale semble améliorer les symptômes au moins à court terme. L'incontinence anale, dont la prévalence varie de 4 à 39 % à 6 semaines du post-partum régresse aussi spontanément la plupart du temps. La rééducation périnéale semble également être efficace à court mais pas à long terme. La prévalence des prolapsus de stade 2 est de 15 à 20 % au 3e trimestre de grossesse et elle varie de 20 à 50 % dans le post-partum immédiat. Même si la majorité des patientes (90 %) ont encore une petite composante de prolapsus à 1 an, seules 10 % en sont gênées. L'expectative avec une réévaluation de la gêne à 1 an du post-partum semble être préférable et, en cas de persistance des symptômes, une rééducation périnéale est alors préconisée.