Cough anal reflex: strict relationship between intravesical pressure and pelvic floor muscle electromyographic activity during cough. Urodynamic and electrophysiological study
| Autor: | Philippe Thoumie, Patrick Raibaut, Nicolas Wolff, Gérard Amarenco, Denis Lagauche, Patrick Rene-Corail, Samer Sheikh Ismael, François Haab |
|---|---|
| Přispěvatelé: | Physiologie et physiopathologie de la motricité chez l'homme, Université Pierre et Marie Curie - Paris 6 (UPMC)-IFR70-Institut National de la Santé et de la Recherche Médicale (INSERM) |
| Jazyk: | angličtina |
| Rok vydání: | 2005 |
| Předmět: |
Adult
medicine.medical_specialty Urology Urinary Incontinence Stress MESH: Muscle Contraction Urinary Bladder Anal Canal Urinary incontinence Electromyography Perineal Muscle MESH: Urinary Incontinence Stress Pelvic Floor Muscle MESH: Electromyography MESH: Urinary Bladder Pressure MESH: Cough Medicine Humans MESH: Urodynamics Pelvic floor MESH: Humans MESH: Middle Aged [SDV.BA.MVSA]Life Sciences [q-bio]/Animal biology/Veterinary medicine and animal Health medicine.diagnostic_test business.industry MESH: Anal Canal Anal wink MESH: Adult Pelvic Floor Middle Aged respiratory tract diseases Urodynamics medicine.anatomical_structure Cough MESH: Pelvic Floor Reflex Sphincter Female medicine.symptom business MESH: Pressure MESH: Female Muscle Contraction |
| Zdroj: | Journal of Urology Journal of Urology, 2005, 173 (1), pp.149-52. ⟨10.1097/01.ju.0000147305.00443.df⟩ |
| ISSN: | 0022-5347 |
| DOI: | 10.1097/01.ju.0000147305.00443.df⟩ |
| Popis: | International audience; PURPOSE: Cough and more generally abdominal strain determine a pelvic floor contraction which allows an increase in sphincter pressure to prevent leakage during stress. Many electrophysiological studies have demonstrated this reflex (formally cough anal reflex). We postulated that the perineal muscle contraction following cough is not a simple binary response but proportional to the intensity of the cough. MATERIALS AND METHODS: A total of 16 women (mean age 52 years) without neurological disease or stress urinary incontinence, referred for frequency and urgency without urge incontinence, underwent urodynamic investigation. Vesical pressure was compared to electromyographic activity of the anal sphincter during 4 successive coughs of different intensity, namely gentle, moderate, strong and very strong efforts. These 4 graded coughs were repeated at 0, 100, 200, 300 and 400 ml of filling during cystometry. RESULTS: All patients were able to determine a graded cough at each level of filling. In all patients and at each level of filling a strict relationship between intravesical pressure (intensity of cough) and integrated electromyographic value was demonstrated. The greater the intensity of the cough the greater the electromyographic response of the anal sphincter. There is a strict correlation between vesical pressure and integrated electromyographic value at rest at O (R2 = 0.983) or at 100 ml (R2 = 0.970), 200 (R2 = 0.918) or 300 ml (R2 = 0.960). Bladder filling does not modify the responses. CONCLUSIONS: Pelvic floor muscle contraction increases with the importance of intra-abdominal pressure generated during stress. This gradual adaptation of pelvic floor muscles is probably 1 of the main factors which contributes to stress urinary and fecal continence in women. It must be preprogrammed by the central nervous system to maintain continence during various stresses. |
| Databáze: | OpenAIRE |
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