Pelvic floor dysfunction. A vaginal surface EMG study in healthy and incontinent women

Sammanfattning: Dysfunction of the pelvic floor can lead to incontinence and different forms of lower urinary tract symptoms (LUTS). Urinary incontinence is a common problem and about 500 000 persons in Sweden, mostly (2/3) women, suffering from incontinence. The general aim of this thesis was to characterize the function and dysfunction of the pelvic floor muscles in healthy and incontinent women. Vaginal EMG, pressure measurement and palpation were the main methods used for investigation. The results revealed a decreased function of the pelvic floor muscles in stress, urge and mixed incontinent women and also increasing loss of activity with increasing age compared to healthy women. These findings indicate a chronic and progressive pelvic floor neuromuscular disorder in women with different types of incontinence. The same pattern with decreased pelvic floor function was found in incontinent women, who had not yet asked for treatment. A successive normalization of vaginal EMG, pressure and palpation was seen during four month of pelvic floor training. Women, who were responders to pelvic floor exercises, had a higher probability of response to cortical magnetic stimulation and a tendency of higher amplitudes than non-responders and healthy women. A higher degree of corticofugal control was thus found in women successfully alleviated by pelvic floor exercises. Traumatic delivery, with also grade 2 rupture included, was found to be a risk factor for development of dysfunction in the pelvic floor muscles. The risk for LUTS was more than two-fold increased for primiparous women with traumatic delivery over 30 years of age. These studies demonstrate the neuromuscular disorder in women with incontinence or traumatic delivery in correlation to healthy women and the results of treatment in terms of structure and function of the pelvic floor muscles.