The effects of different relaxation positions on muscle functions in women with urinary incontinence

Objective: The pelvic floor muscles have four main functions: opening (relaxation), closing (contraction), supporting and sexual functions. Various positions for relaxation of pelvic floor muscles are routinely recommended in physiotherapy clinics. It is not known whether there is real relaxation in these positions, or what position is the most effective relaxation. Therefore, the aim of our study is to examine the effects of different relaxation positions on muscle functions in women with urinary incontinence. Method: The study was carried out with 67 individuals who applied to Dokuz Eylül University Medical Faculty Hospital, Department of Obstetrics and Gynecology and were diagnosed with incontinence by a specialist. The International Incontinence Questionnaire Short Form (ICIQ-SF) and bladder diary were used to inquire about the type, frequency, amount and effects of urinary incontinence on daily life. Electromyographic activities of the pelvic floor muscles and abdominal muscles (rectus abdominus-RA, transversus abdominus-TA, internal oblique abdominals-İO, external oblique abdominals-EO) were evaluated using a superficial EMG. Evaluations were made in three different relaxation positions (P1: supine hook position, P2: crawling position, P3: squatting position). Friedman Variance Analysis was used to determine whether there was a statistically significant difference between positions, and Bonferroni corrected Wilcoxon analysis was used to determine where the difference originated. Results: The position where the pelvic floor muscles relaxed the most was found in P1 and the highest functional activity was found in P2 (p<0.001). During the relaxation of the pelvic floor muscles, the lowest mean activities of RA, TA, IO, EO muscles were seen in P1 (p<0.001). During the contraction of the pelvic floor muscles, the mean activities of the RA and EO muscles were highest in P2 (p<0.001), the mean activity of the TA muscle in P1 (p>0.05), the mean activity of the IO muscles in P3 (p>0.05). Conclusion: The amount of relaxation and functional activity of the pelvic floor and abdominal muscles are affected by positions. In physiotherapy clinics, effective relaxation can be achieved in the positions given for the relaxation of the pelvic floor muscles. The positions chosen are important to create the most effective pelvic floor muscles training protocols and more research is needed on this subject. Key Words: Urinary incontinence, pelvic floor muscles, abdominal muscles, superficial electromyography.