Le système pelvien féminin est un système complexe jouant un rôle primordial dans la miction, la défécation et la reproduction. Il comprend de nombreux organes, muscles et ligaments tous interconnectés. Malheureusement le système pelvien peut subir de nombreuses pathologies l’une d’entre elle étant le prolapsus, ou la descente d’organe, se définissant comme déplacement anormal d’un ou plusieurs organes génitaux. Le prolapsus est une pathologie très répandue au sein de la population féminine. 1 femme sur 3 serait concernée, 1 sur 10 subissant un traitement chirurgical au cours de sa vie. Cette pathologie a d’importantes conséquences sur la qualité de vie des patientes. Son traitement se fait principalement par voie chirurgicale, mais de gros progrès doivent être faits dans ce domaine. En effet, les taux de récidive post-traitement peuvent atteindre des valeurs de 60% dans la littérature.Malgré la nécessité d’une amélioration des techniques chirurgicales celle-ci ne pourra avoir lieu sans une meilleure compréhension du comportement mécanique global de cette région très complexe et encore assez mal connue. Une connaissance approfondie de la mobilité du système pelvien sain par rapport au pathologique permettrait le développement de nouvelles techniques plus à même de soigner efficacement les patientes.Malgré de nombreuses études, un manque de compréhension mécanique est à noter. En effet très peu de données provenant de patientes jeunes et saines sont disponibles. De plus la plupart des tests réalisés sont des tests de tractions uniaxiales, qui sont par essence limités. Un manque cruel de relation entre les modèles phénoménologiques et cliniques est également à regretter.Dans ce travail nous avons donc réalisés des tests uniaxiaux sur différents tissus de cadavres jeunes (<40 ans). Cela nous a permis de prouver l’hyper-élasticité et la grande déformabilité des tissus pelviens jeunes et de mieux comprendre les phénomènes de vieillissement et d’endommagements de ces tissus en les comparants aux nombreuses données de la littérature. Nous avons ainsi pu monter que les ligaments et le vagin subissaient un vieillissement de nature différente à la vessie et au rectum. Ce vieillissement que nous avons nommé « traumatique » entraine un allongement et un raidissement non réversible des tissus à niveau en rien comparable à un vieillissement « naturel ».Notre étude mécanique s’est également élargie en testant les accolements entre organes (vésico-vaginal et recto-vaginal) en les soumettant à une contrainte de cisaillement. Ce genre de tests est, à notre connaissance, une première pour les tissus mous biologiques. Nous avons ainsi pu montrer que le comportement mécanique de ces accolements était linéaire pour les petites déformations et bien que de rigidité faible par rapport aux tissus eux même, tout de même à prendre en compte dans de prochains modèle.Suite à cette étude purement mécanique nous avons tenté de mettre nos modèles phénoménologiques, dur d’accès aux professionnels de la santé, en relation avec des modèles cliniques, histologiques dans ce cas précis. Nous avons donc réalisé un modèle histologiquement fondée du comportement mécanique des tissus pelviens, mettant en relation les taux d’élastine et de collagène d’un tissu à son comportement mécanique. A l’aide de ce modèle, inspiré de la physique des élastomères à plusieurs phases, nous avons pu corréler les taux d’élastine et de collagène d’un tissu à sa rigidité et ainsi rendre plus accessible un modèle complexe.Nous avons ensuite voulu faire le bilan de nos connaissances sur la compréhension des prolapsus et dans quelle mesure notre étude nous a permis de l’approfondir. Nous nous sommes évidemment concentrés sur les modes d’endommagements et leurs conséquences d’un point de vue mécanique et histologique. Dans un but de clarté nous avons traités d’exemples précis afin d’illustrer nos propos, comme le vieillissement, l’accouchement par voie basse ou la cystocèle. / The pelvic floor is a complex anatomical system involved in urination, defecation and reproduction. It is composed of several organs, muscles and ligaments, all interconnected. Unfortunately the pelvic floor can suffer from several pathologies like prolapses. Prolapses are defined as an abnormal displacement of one or more pelvic organs. Prolapses are widespread in the woman population. One woman out of three would be affected, one out of ten undergoing a surgical treatment in her life. This pathology has tremendous consequences on the patient quality of life. Its treatment is mainly surgical, but big improvements are needed. Indeed, the recurrence rate could reach up to 60% in the literature.The improvement of surgical technics will only be possible with a better global mechanical understanding of the pelvic floor. A deep understanding of the healthy pelvic floor mobility compared to the pathological would allow for the development of technics to better treat patients.Even though several studies have been done, a lack of mechanical understanding is to be noted. Indeed very few data coming from healthy young patients are available. Moreover most tests are uniaxial testing, which are by essence quite limited. A lack of relationship between phenomenological and clinical models is also to be noted.Within our study we have then realized uniaxial testing of different tissues from young cadavers (<40 years old). That allowed us to prove the hyper-elasticity and the great deformability of young pelvic tissues. It also helped us to better understand the ageing and damaging processes of those tissues by comparing them to data available in the literature. We could should that the ligaments and the vagina undergo a different ageing process than the rectum and the bladder. That ageing that we defined as “traumatic” induces much stronger non-reversible stretching and stiffening of the tissues than a “natural” ageing.Our mechanical study broadened up by looking at bindings between organs (vesico-vaginal and recto-vaginal). Those bindings have been, for the first time to our knowledge, under shear conditions. We could then show that those binding have a linear mechanical behavior for small displacements and that their stiffness even though limited should be taken into account in numerical models.Following that purely mechanical study we tried to accommodate our models to a public of medical professionals, by linking our phenomenological models to clinical ones, histological in that case. We then realized a histologically based model of the mechanical behavior of pelvic tissues, linking the rate of collagen and elastin of a tissue to its mechanical behavior. Thanks to that model, inspired by the physics of polymers we could correlate the collagen and elastin rates of a tissue to its rigidity and therefore make a complex model more accessible.We then gathered our knowledge on the understanding of prolapses and observed how our study could deepen it. We focused on the ageing and damaging processes and their consequences from a mechanical and histological point of view. To help the understanding we looked at precise examples like ageing, vaginal delivery or cystocele.

Prior research on maternal postpartum care, the transition to motherhood, pelvic floor dysfunction, and pelvic floor muscle training (PFMT) has revealed that postpartum women are often denied the basic information, instruction, and preventive strategies necessary for optimal postbirth rehabilitation and psychological well-being. Employing a dual framework of self-determination theory and personal growth initiative (PGI) theory, this quantitative study utilized a cross-sectional design to investigate if autonomy, competence, and relatedness satisfaction predicted PGI in postpartum women. Differences in autonomy, competence, relatedness, and PGI between PFMT practicing and nonpracticing postpartum women were also examined. A web-based survey method was employed to collect data from 229 postpartum women, which consisted of 121 women not practicing PFMT and 108 women practicing PFMT. The Basic Psychological Need Satisfaction and Frustration Scale measured autonomy, competence, and relatedness. The PGI Scale-II measured PGI. Standard multiple regression and 4 independent-samples t tests were used to analyze the data. Results indicated that autonomy, competence, and relatedness predicted PGI. There were no significant mean differences between PFMT practicing and nonpracticing women. These findings have implications for positive social change such that the medical community and policy makers can utilize the fulfillment of postpartum women's needs for autonomy, competence, and relatedness to improve women's odds for optimal adjustment and adaptation to life after childbirth.

Tyrimo objektas. Moterų dubens dugno raumenų jėga ir jų treniravimo galimybės. Tyrimo problema. Dubens dugno raumenys vaidina svarbų vaidmenį šlapimo sulaikymui ir dubens organų palaikymui (Bo & Sherburn, 2005). Su amžiumi atrofuojasi (silpnėja ir nyksta) gleivinė, silpnėja dubens dugno raumenys, mažėja jungiamojo audinio, jis tampa ne toks elastingas, susilpnėja šlapimo pūslės sfinkteris (raumenų žiedas), pasikeičia šlapimo pūslės ir makšties anatomija (Thakar & Stanton, 2000). Kai sutrinka raumenų, laikančių uždarytą šlapimo pūslę, funkcija, gali atsirasti šlapimo nelaikymas. Ligoniai susiduria su daugybe socialinių ir psichologinių problemų, apribojamas žmogaus fizinis ir socialinis aktyvumas (Peeker et al., 2003). Tyrimo tikslas. Įvertinti dubens dugno raumenų treniravimo efektyvumą moterų šlapimo nelaikymo prevencijai. Tyrimo uždaviniai. 1. Įvertinti tiriamųjų dubens dugno raumenų jėgą prieš ir po kineziterapijos; 2. Įvertinti tiriamųjų dubens dugno raumenų pajėgumą amžiaus aspektu; 3. Nustatyti priklausomybę tarp dubens dugno raumenų pajėgumo, gimdymų skaičiaus ir gimdymo būdo; 4. Nustatyti ryšį tarp dubens dugno raumenų pajėgumo ir pilvo raumenų statinės ištvermės. Tyrimo metodika. Anketinės apklausos metu buvo išsiaiškintas tiriamųjų amžius, ūgis, svoris, gimdymų skaičius ir gimdymo būdas. Objektyvus dubens dugno raumenų jėgos testavimas buvo atliekamas penkiasdešimčiai moterų, naudojant dubens dugno raumenų treniruoklį bei dubens dugno raumenų funkcijos matavimo... [toliau žr. visą tekstą] / Object of research: Strength of women pelvic floor muscles and the possibilities of their training. Problem of research: Pelvic floor muscles play an important role in the urinary continence and support of pelvic organs (Bo & Sherburn, 2005). With age the mucous atrophies (weakens and wanes), the pelvic floor muscles weaken, connecting tissue diminishes, it becomes less elastic, sphincter (ring of muscles) of the bladder weakens, the anatomy of bladder and vagina changes (Thakar & Stanton, 2000). When the function of muscles that maintain the bladder closed disconcerts, the incontinence may manifest. Patients confront many social and psychological problems, physical and social activity of the person become limited (Peeker et al., 2003). Aim of research: Assess the effectiveness of pelvic floor muscle exercises to the prevention of incontinence of women. Goals of research: 1. Evaluate the strength of participants pelvic floor muscles before and after the physiotherapy; 2. Evaluate the strength of participants pelvic floor muscles with respect to the age; 3. Determine the relationship among the strength of pelvic floor muscles, number and ways of deliveries; 4. Determine the relationship between the strength of pelvic floor muscles and static endurance of abdominal muscles. Methods of research: With the help of questionnaire there were determined the age, height, weight, number of deliveries and ways of deliveries of participants. Pelvic floor muscle strength of fifty women was... [to full text]

Advanced prostate cancer (PCa) patients are offered androgen deprivation therapy (ADT) to control their cancer’s growth. ADT impairs sexual function and the sleep patterns of ADT patients. Since ADT deprives patients of estrogen, and supplemental estrogen reduces such problems in menopausal women, I studied whether administering estrogen reduces these problems for castrated male rats as a model for PCa patients on ADT. First, I tested how early versus late estradiol treatment after castration influenced rats’ sexual behaviour. Estradiol increases mounting behaviour to comparable levels regardless of when the treatment was started after castration, suggesting that estrogen’s ability to restore male sexual interest is insensitive to a delay since castration. Secondly, to understand the biological basis of these behavioural effects, I examined brain and muscle tissues from the same animals. Specifically, I compared changes in 1) estrogen receptors (ERs) and c-Fos protein (a neuronal activation marker) levels in brain areas controlling sex behavior; 2) ERs levels in pelvic floor muscles, important for erection; and 3) ERs levels in the hippocampus and prefrontal cortex. Prolonged castration increases ER? levels in the preoptic area (POA), a key brain area that regulates mating behaviour, and estradiol treatment reduced these effects. In the POA, mating-induced c-Fos expression was not affected by estradiol regardless of when the treatment began post-castration. Estrogen may upregulate ERs in pelvic floor muscles, and downregulate ERs in the hippocampus and prefrontal cortex, depending on administration time after castration. These findings suggest that mating activates POA neurons, and this activation induces mounting only in the presence of estrogen. Additionally, the duration after castration influences ER autoregulation in the pelvic floor muscles, hippocampus, and prefrontal cortex in response to estradiol. Lastly, I studied how estrogen modulates the sleep-wake behaviour of orchiectomized rats. Estradiol promotes baseline wakefulness during the dark period and prevents castration-induced impairment in sleep recovery after sleep deprivation. These findings suggest that estradiol may positively influence the sleep-wake behaviour of castrated males. Collectively, I demonstrate that estrogen administered to castrated rats improves sexual and sleep functions. It may similarly improve the quality of life of PCa patients on ADT.

Previous studies have suggested that protective responses in the pelvic floor muscles (PFMs), described in terms of hypertonicity and over-reactivity, are associated with and may worsen the symptoms of provoked vestibulodynia (PVD, i.e., chronic vulvar pain). A recent study reported that, upon manual palpation of the PFM, hypertonicity was consistently found in the superficial but not the deep PFM layers. The goals of this study were to compare superficial and deep PFM resting tone, protective response magnitude and onset timing to moderate perceived vulvar pain between women with and without PVD. Eleven women with PVD and eleven control women Tcompleted a gynecological examination and standardized PFM electromyography (EMG) testing. Three trials of sTurface EMG activity of the PFM were recorded while a pressure-pain stimulus (PPS) was applied to the vulvar vestibule. Increasing pressure was applied to achieve a perceived pain intensity rating of 6/10 using an 11-point numerical rating scale presented visually. The women with PVD had higher resting EMG activity in their superficial PFMs (p=0.04) as compared to the control group, while no difference was found at the level of the deep PFMs (p=0.12). Participants in both groups demonstrated contractile responses to the PPS in both the superficial and the deep PFM, and these responses were significantly higher (p=0.0001) in the superficial (50.06 vs 38.69 % maximal voluntary electrical activation [MVE]) as compared to the deep (24.88 vs 22.52 %MVE) PFM layers. Women with PVD had significantly higher PFM responses at the superficial layer as compared to the control women (p<0.0005). The onset of the superficial and deep EMG PFM responses followed the PPS application in both groups. No differences were found between the deep and superficial PFM onset latency to the timing of the PPS application.The results of this study suggest that women with PVD have superficial PFMs that are more responsive to vulvar pain than those in non-affected women. The findings also suggest that superficial PFM over-reactivity, rather than deep PFM over-reactivity, is part of the PFM dysfunction reported in women with PVD. / Thesis (Master, Rehabilitation Science) -- Queen's University, 2008-09-26 15:46:22.84

Introduction: The primary purpose of this research was to determine whether women with stress urinary incontinence (SUI) demonstrate pelvic floor muscle (PFM) strength or endurance deficits and/or changes in the motor control patterns used during maximum voluntary PFM contractions (PFM MVCs) and coughing. A secondary purpose was to determine the effect of age on these parameters. Methods: After first validating the use of vaginal pressure to study the functional output of the PFMs, three studies were carried out to address these objectives. In two studies vaginal pressure and PFM and abdominal muscle electromyography (EMG) data were recorded simultaneously during PFM MVCs and maximum effort coughs in continent women, women with mild SUI and women with moderate to severe SUI in both supine and standing. In the final study, the effect of continence status and age on PFM strength and endurance was measured with vaginal pressure. Results: Changes in vaginal pressure induced by PFM MVCs and coughing were found to reflect changes in urethral pressure. The women with SUI and the continent women were found to be equally able to produce peak PFM EMG and vaginal pressure amplitudes during PFM MVCs and coughs. Compared to the continent women, the women with SUI delayed activating their abdominal muscles during the PFM MVCs. During coughing, vaginal pressure and PFM EMG peaked simultaneously in the continent women, while in the women with SUI vaginal pressure peaked after PFM EMG. During both the PFM MVCs and the coughs, the EMG activity in all of the muscles tested was higher at the onset of vaginal pressure generation in the women with SUI compared to the continent women. No difference was found in PFM endurance between the women with and without SUI. The ability to generate peak vaginal pressure during coughing decreased with age. Conclusions: PFM weakness does not appear to play a significant role in SUI. Rather, the results of this research suggest that a combination of motor control deficits and delays in pressure transmission are associated with SUI in women. / Thesis (Ph.D, Rehabilitation Science) -- Queen's University, 2009-09-21 09:37:12.923

Purpose: Intravaginal probes used for recording electromyography (EMG) from the pelvic floor muscles (PFMs) likely record activity from nearby muscles (crosstalk), and move during functional tasks, causing motion artifact data contamination, threatening the validity of results obtained. This study investigated the test-retest reliability and validity of surface EMG recordings from the PFMs using a novel, theoretically superior electrode in comparison to a commercially available intravaginal probe, the FemiscanTM. Methods: Healthy subjects (n=20) performed tasks with each vaginal electrode in situ: i) PFM maximal voluntary contractions (MVC), ii) coughs, iii) unilateral hip adductor/external rotator contractions at 25%MVC, 50%MVC, and MVC while keeping the PFMs relaxed or maximally contracted, and iv) transversus abdominis contractions (TrA; recorded using fine-wires) at 25%MVC, 50%MVC, MVC. Analyses: i) Intraclass correlation coefficients (ICC), ii) t-tests of proportions (α=0.05), iii) repeated measures ANOVAs and Tukey’s post-hoc testing (α=0.05) and iv) cross-correlation functions between peaks of transversus abdominis and PFM activity were used to determine the between-trial and between-day reliability of each vaginal electrode, a difference in prevalence of motion artifact contamination between electrodes, and the presence of crosstalk from the hip and TrA, respectively. Results: Between-trial reliability of both vaginal electrodes was excellent (ICC(3,1)=0.943-0.974). Between-day reliability was less consistent (ICC(3,1)=0.788-0.924 and 0.648-0.715 for the FemiscanTM and novel electrode, respectively). No significant difference in the proportion of files contaminated with motion artifact using each electrode existed. At submaximal intensities of hip muscle contractions, the FemiscanTM recorded significantly higher EMG amplitudes compared to what it recorded when the hip was relaxed, whereas the novel electrode did not, indicating that the FemiscanTM recorded crosstalk from the hip musculature. Low cross-correlation coefficients (<0.90) and large time delays (≥ 0.5 milliseconds) between peaks of PFM and TrA activity indicated that neither vaginal electrode recorded crosstalk from the TrA. Conclusion: The novel electrode is a promising tool to record EMG from the PFMs, as it records less crosstalk from the hip musculature than current technology while maintaining a high degree of reliability when comparing results collected within the same session; however, this electrode should not be used to compare one’s muscle activity between days. / Thesis (Master, Rehabilitation Science) -- Queen's University, 2011-02-07 14:46:30.811

No description available.

The purpose of this thesis was to explore the relationships between pregnancy, childbirth and incontinence (both urinary and faecal) and the effect of preventive activities during pregnancy on continence. Two papers comprise this thesis. The first paper, a scoping review, focused on examination of how pregnancy and childbirth affect continence in nulliparous women. Several key considerations were identified from the published literature that we suggest are crucial to understanding these relationships. The second paper, a systematic review, is focused on the effect of preventive measures during pregnancy on continence. Pelvic floor muscle training was found to be effective in reducing the incidence of incontinence at 3 months postpartum. Few studies met our inclusion criteria thus limiting analysis of data. Based on these two papers, further prospective research is suggested. The final chapter of this thesis outlines a developing PhD project that addresses gaps identified through the scoping and systematic reviews.

The pelvic floor muscles (PFM) form the base of the abdominal canister, and like the other muscle groups around the canister, the abdominal muscles and the diaphragm, they contribute to and are affected by pressures within the canister. But they also have a role in organ support and continence. In urinary incontinence, clinical rehabilitation has targeted the PFM in isolation. It aims to build up strength and endurance of these muscles, but without consideration of the influence of intra-abdominal pressure, and therefore the co-ordination of muscles that generate that pressure, on PFM activity. Strengthening of the PFM has not resolved incontinence for all women, and the benefits are not sustained in the long term. Thus consideration of factors beyond the pelvic floor (PF) may lead to better outcomes for rehabilitation in both the short and long term. Thus these studies aimed to investigate the influences of abdominal muscle activity and spinal posture on the recruitment of the PFM. The studies firstly investigated the association between the abdominal and PFM during voluntary tasks. Further studies examined the effect of automatic recruitment of the PFM and the abdominal muscles with postural disturbances and changes in spinal posture, and whether there was a difference in recruitment between layers of the PFM complex during function. Electromyographic (EMG) studies, using fine wire and/or surface electrodes, were performed to record patterns of muscle activity, while, in selected studies, this was accompanied by pressures recorded within the stomach, urethra, bladder, vagina, anus and rectum, to monitor the effects of the striated muscle activity on intra-abdominal pressure and urethral function. When the PFM were voluntarily contracted in healthy women, there was a co-ordinated response in all the abdominal muscles, which varied with the position of the lumbar spine. Conversely, when the lower abdominal muscles were drawn in towards the spine there was an increase in IAP, urethral pressure and PFM EMG activity. Relaxation of the abdominal muscles and bulging of the relaxed abdominal wall decreased PFM activity and urethral pressure below their resting baselines. Thus, voluntary activation of the abdominal or PFM influences activity in the other muscle group. Other studies investigated the automatic responses of abdominal and PFM during breathing, postural perturbation, sitting and coughing. Quiet breathing was associated with modulation of PFM EMG with greater activity during expiration than inspiration, in association with variations in abdominal muscle activity. Hypercapnoea accentuated these results. Postural perturbations generated co-activation of the PF and abdominal muscles before the onset of deltoid activity with sustained activity through out repeated arm movements. Changes in spinal posture also affected PFM activity. Like the abdominal muscles, PFM were less active when sitting in a slumped position. Similar changes occurred in women with stress urinary incontinence but with lower pelvic floor muscle activity levels. Women with stress urinary incontinence also had less lordosis of the lumbar spine in upright sitting and a trend for greater superficial abdominal muscle activity than continent women. Activity of the superficial, but not deep, PFM during coughing, was affected by different sitting postures, with greater activity during coughing in slumped than in upright postures. Different breathing patterns and changes in posture also affected IAP and abdominal muscle recruitment patterns during coughing. Investigation of PFM activity during functional tasks indicates that factors beyond the PF influence its activity. The findings from these studies indicate that PFM activity is inter-related with spinal posture and abdominal muscle activity. While most of these studies were conducted in healthy women, there are a number of different types of PF problems in women, in which the mechanics of the dysfunction differ from stress urinary incontinence. PFM activity has not been investigated in all types of PF dysfunction. The findings of co-ordinated recruitment of the abdominal and PFM and the effect of spinal posture on PFM function provide some evidence that PFM rehabilitation should not be undertaken in isolation, and that there is a likely advantage from exercising with a neutral lumbar spine. There is a need for further investigation of this co-ordinated muscle recruitment in subjects with different types of dysfunction, not just stress urinary incontinence. Findings from such investigations could then point the way forward to improved rehabilitation methods for people with problems, and more suitable methods of maintaining pelvic floor health.