Pelvic Floor Function in the Female


Pelvic Floor (PF) disorders, such as urinary incontinence and prolapse accounted for over 400,000 operations in the USA in 1987 [1], and nearly a third of these were re-operations. It is estimated that 30% - 50% of women in Europe and the USA are affected by Urinary incontinence [2]. Stress Urinary Incontinence (SUI), the involuntary leakage of urine on coughing, sneezing, exertion or effort, is the most common form of urinary incontinence in women. The scientific understanding of normal PF function is limited and consequently treatment of these prevalent, disabling conditions is, at best, inefficient.


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Constantinou, C. (2014) Pelvic Floor Function in the Female. Open Journal of Obstetrics and Gynecology, 4, 826-831. doi: 10.4236/ojog.2014.414115.

Conflicts of Interest

The authors declare no conflicts of interest.


[1] DeLancey, J.O. (2005) The Hidden Epidemic of Pelvic Floor Dysfunction: Achievable Goals for Improved Prevention and Treatment. American Journal of Obstetrics & Gynecology, 192, 1488-1495.
[2] Buchsbaum, G.M., Duecy, E.E., et al. (2005) Urinary Incontinence in Nulliparous Women and Their Parous Sisters. Obstetrics Gynecology, 106, 1253-1258.
[3] DeLancey, J.O., Strohbehn, K., et al. (1998) Comparison of Ureteral and Cervical Descents during Vaginal Hysterectomy for Uterine Prolapse. American Journal of Obstetrics & Gynecology, 179, 1405-1410.
[4] Abitbol, M.M. (1988) Evolution of the Ischial Spine and of the Pelvic Floor in the Hominoidea. American Journal of Physical Anthropology, 75, 53-67.
[5] Bo, K. and Sherburn, M. (2005) Evaluation of Female Pelvic-Floor Muscle Function and Strength. Physical Therapy, 85, 269-282.
[6] Morin, M., Bourbonnais, D., et al. (2004) Pelvic Floor Muscle Function in Continent and Stress Urinary Incontinent Women Using Dynamometric Measurements. Neurourology and Urodynamics, 23, 668-674.
[7] Kessler, R. and Constantinou, C.E. (1986) Internal Urethrotomy in Girls and Its Impact on the Urethral Intrinsic and Extrinsic Continence Mechanisms. The Journal of Urology, 136, 1248-1253.
[8] Theofrastous, J.P., Wyman, J.F., et al. (2002) Effects of Pelvic Floor Muscle Training on Strength and Predictors of Response in the Treatment of Urinary Incontinence. Neurourology and Urodynamics, 21, 486-490.
[9] Nygaard, I. (2004) Physiologic Outcome Measures for Urinary Incontinence. Gastroenterology, 126, S99-S105.
[10] Costantini, S., Esposito, F., et al. (2006) Ultrasound Imaging of the Female Perineum: The Effect of Vaginal Delivery on Pelvic Floor Dynamics. Ultrasound in Obstetrics Gynecology, 27, 183-187.
[11] Miller, J.M., Perucchini, D., et al. (2001) Pelvic Floor Muscle Contraction during a Cough and Decreased Vesical Neck Mobility. Obstetrics Gynecology, 97, 255-260.
[12] Constantinou, C.E., Hvistendahl, G., et al. (2002) Determining the Displacement of the Pelvic Floor and Pelvic Organs during Voluntary Contractions Using Magnetic Resonance Imaging in Younger and Older Women. BJU International, 90, 408-414.
[13] Dietz, H.P. (2004) Ultrasound Imaging of the Pelvic Floor. Part II: Three-Dimensional or Volume Imaging. Ultrasound in Obstetrics Gynecology, 23, 615-625.
[14] Bump, R.C., Hurt, W.G., et al. (1991) Assessment of Kegel Pelvic Muscle Exercise Performance after Brief Verbal Instruction. American Journal of Obstetrics Gynecology, 165, 322-329.
[15] Deindl, F.M., Vodusek, D.B., et al. (1993) Activity Patterns of Pubococcygeal Muscles in Nulliparous Continent Women. British Journal of Urology, 72, 46-51.
[16] Constantinou, C.E. and Govan, D.E. (1982) Spatial Distribution and Timing of Transmitted and Reflexly Generated Urethral Pressures in Healthy Women. Journal of Urology, 127, 964-969.
[17] Deindl, F.M., Vodusek, D.B., et al. (1994) Pelvic Floor Activity Patterns: Comparison of Nulliparous Continent and Parous Urinary Stress Incontinent Women. A Kinesiological EMG Study. British Journal of Urology, 73, 413-417.
[18] Smith, M.D., Russell, A., et al. (2006) Disorders of Breathing and Continence Have a Stronger Association with Back Pain than Obesity and Physical Activity. Australian Journal of Physiotherapy, 52, 11-16.
[19] Hodges, P.W. and Richardson, C.A. (1999) Altered Trunk Muscle Recruitment in People with Low Back Pain with Upper Limb Movement at Different Speeds. Archives of Physical Medicine and Rehabilitation, 80, 1005-1012.
[20] Ferreira, P.H., Ferreira, M.L., et al. (2004) Changes in Recruitment of the Abdominal Muscles in People with Low Back Pain: Ultrasound Measurement of Muscle Activity. Spine, 29, 2560-2566.
[21] Sapsford, R.R., Hodges, P.W., et al. (2001) Co-Activation of the Abdominal and Pelvic Floor Muscles during Voluntary Exercises. Neurourology and Urodynamics, 20, 31-42.<31::AID-NAU5>3.0.CO;2-P
[22] Neumann, P. and Gill, V. (2002) Pelvic Floor and Abdominal Muscle Interaction: EMG Activity and Intra-Abdominal Pressure. International Urogynecology Journal and Pelvic Floor Dysfunction, 13, 125-132.
[23] Laycock, J., Brown, J., et al. (2001) Pelvic Floor Reeducation for Stress Incontinence: Comparing Three Methods. British Journal of Community Nursing, 6, 230-237.
[24] Bo, K., Lilleas, F., et al. (2001) Dynamic MRI of the Pelvic Floor Muscles in an Upright Sitting Position. Neurourology and Urodynamics, 20, 167-174.<167::AID-NAU19>3.0.CO;2-4
[25] Barbic, M., Kralj, B., et al. (2003) Compliance of the Bladder Neck Supporting Structures: Importance of Activity Pattern of Levator Ani Muscle and Content of Elastic Fibers of Endopelvic Fascia. Neurourology and Urodynamics, 22, 269-276.
[26] Klutke, C., Golomb, J., et al. (1990) The Anatomy of Stress Incontinence: Magnetic Resonance Imaging of the Female Bladder Neck and Urethra. Journal of Urology, 143, 563-566.
[27] Yang, A., Mostwin, J.L., et al. (1991) Pelvic Floor Descent in Women: Dynamic Evaluation with Fast MR Imaging and Cinematic Display. Radiology, 179, 25-33.
[28] Christensen, L.L., Djurhuus, J.C., et al. (1995) Imaging of Pelvic Floor Contractions Using MRI. Neurourology and Urodynamics, 14, 209-216.
[29] Stoker, J., Halligan, S., et al. (2001) Pelvic Floor Imaging. Radiology, 218, 621-641.
[30] Comiter, C.V., Vasavada, S.P., et al. (1999) Grading Pelvic Prolapse and Pelvic Floor Relaxation Using Dynamic Magnetic Resonance Imaging. Urology, 54, 454-457.
[31] Goh, V., Halligan, S., et al. (2000) Dynamic MR Imaging of the Pelvic Floor in Asymptomatic Subjects. American Journal of Roentgenology, 174, 661-666.
[32] Gousse, A.E., Barbaric, Z.L., et al. (2000) Dynamic Half Fourier Acquisition, Single Shot Turbo Spin-Echo Magnetic Resonance Imaging for Evaluating the Female Pelvis. Journal of Urology, 164, 1606-1613.
[33] Athanasiou, S., Khullar, V., et al. (1999) Imaging the Urethral Sphincter with Three-Dimensional Ultrasound. Obstetrics Gynecology, 94, 295-301.
[34] Fielding, J.R., Dumanli, H., et al. (2000) MR-Based Three-Dimensional Modeling of the Normal Pelvic Floor in Women: Quantification of Muscle Mass. American Journal of Roentgenology, 174, 657-660.
[35] Schaer, G.N., Perucchini, D., et al. (1999) Sonographic Evaluation of the Bladder Neck in Continent and Stress-Incontinent Women. Obstetrics Gynecology, 93, 412-416.
[36] Howard, D., Miller, J.M., et al. (2000) Differential Effects of Cough, Valsalva and Continence Status on Vesical Neck Movement. Obstetrics Gynecology, 95, 535-540.
[37] Dietz, H.P., Jarvis, S.K., et al. (2002) The Assessment of Levator Muscle Strength: A Validation of Three Ultrasound Techniques. International Urogynecology Journal and Pelvic Floor Dysfunction, 13, 156-159.
[38] Pregazzi, R., Sartore, A., et al. (2002) Perineal Ultrasound Evaluation of Urethral Angle and Bladder Neck Mobility in Women with Stress Urinary Incontinence. BJOG, 109, 821-827.
[39] Reddy, A.P., DeLancey, J.O., et al. (2001) On-Screen Vector-Based Ultrasound Assessment of Vesical Neck Movement. American Journal of Obstetrics Gynecology, 185, 65-70.

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