Pelvic floor muscle training: mechanisms of action for the improvement of genitourinary syndrome of menopause

Abstract

Objective: This study aims to investigate the mechanism of action of pelvic floor muscle training (PFMT) for the improvement of the signs and symptoms of genitourinary syndrome of menopause (GSM) in postmenopausal women with GSM and urinary incontinence (UI).

Methods: Twenty-nine women were included in the secondary analysis of a single-arm feasibility study. Using color Doppler ultrasound, the peak systolic velocity, time-averaged maximum velocity, and pulsatility index of the internal pudendal and dorsal clitoral arteries were measured at rest and after a pelvic floor muscle (PFM) contraction task. PFM function was assessed by dynamometry, and vulvovaginal tissue elasticity was measured using the Vaginal Atrophy Index.

Results: PFMT significantly improved blood flow parameters in both arteries (p < 0.05) and significantly increased the speed of PFM relaxation after a contraction (p = 0.003). After the intervention, a marginally significant decrease in PFM tone was observed, as well as an increase in PFM strength (p = 0.060 and p = 0.051, respectively). Finally, improvements in skin elasticity and introitus width were observed as measured by the Vaginal Atrophy Index (p < 0.007).

Conclusion: Our findings suggest that PFMT improves blood flow in vulvovaginal tissues, PFM relaxation capacity, and vulvovaginal tissue elasticity in postmenopausal women with GSM and UI.

摘要

目的：本研究旨在探讨盆底肌训练（PFMT）改善绝经期泌尿生殖系统综合征（GSM）伴尿失禁（UI）女性体征和症状的作用机制。

方法：29名女性被纳入单臂可行性研究的二级分析。应用彩色多普勒超声检测静息状态和盆底肌（PFM）收缩后阴蒂内动脉和阴蒂背侧动脉的收缩期峰值流速、时均最大流速和搏动指数。肌力测定法评估PFM功能, 阴道萎缩指数测量外阴阴道组织弹性。

结果：PFMT可显著改善双侧动脉血流参数（p<0.05）, 显著加快收缩后PFM的松弛速度（p=0.003）。干预后, PFM张力略明显下降, 而PFM强度有所增加（分别p=0.060和p=0.051）。最后, 通过阴道萎缩指数来衡量皮肤弹性和阴道口宽度的改善（p<0.007）。

结论：我们的研究结果表明, PFMT改善了患有GSM和UI的绝经后女性的外阴阴道组织血流量、PFM松弛能力和外阴阴道组织弹性。

Keywords:

• Genitourinary syndrome of menopause
• pelvic floor muscle training
• postmenopausal women
• vulvovaginal blood flow
• pelvic floor muscle function
• vulvovaginal tissue elasticity

Potential conflict of interest

No potential conflict of interest was reported by the authors.

Additional information

Funding

This work was supported by the Quebec Network for Research on Aging and the Ordre professionnel de la physiothérapie du Québec. Joanie Mercier was supported by a research scholarship from the Fond de recherche du Québec – Santé (FRQS). Chantale Dumoulin was supported by a research grant from the Canadian Institutes of Health Research. Mélanie Morin received a salary award from the FRQS. An Tang was supported by a research scholarship from the FRQS and the Fondation de l’association des radiologistes du Québec Junior 2 Salary Award [FRQS-ARQ #34939].