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 Table of Contents  
DPU: INTERDISCIPLINARY CONFERENCE
Year : 2020  |  Volume : 7  |  Issue : 5  |  Page : 72-75

Effect of yoga on pelvic floor muscle strength in menopausal females


Dr. D. Y. Patil College of Physiotherapy, Dr. D. Y. Patil Vidyapeeth, Pune, Maharashtra, India

Date of Web Publication26-Feb-2020

Correspondence Address:
Chaitanyaa Wani
Dr. D. Y. Patil College of Physiotherapy, Pimpri, Pune - 411 018, Maharashtra
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jdrr.jdrr_63_19

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  Abstract 


Background: By the age of 40–60 years, females achieve menopause. A lot of changes occur in the body because of menopause. It often accompanies alterations in the functioning of the female pelvic floor. Change in the routine with an improved diet and exercise cycle helps in the reduction of distresses related with menopause. Evidences recommend that yoga has an effect on core muscles and cardiovascular components. Objective: The aim of the study was to assess the effect of yoga on pelvic floor muscles' (PFMs) strength using perineometer and Brink score in females attaining menopause. Materials and Methods: A study was done on 17 menopausal females aging between 40 and 70 years. Participants were taught yoga exercises on day 1 and asked to do exercises at home for 5 days a week for 4 weeks. Primary outcome measures were PFM strength using perineometer and Brink score readings. Results: The patients showed no significant improvement in Brink score (P = 0.13) and no significant improvement in perineometer readings (P > 0.05). Postreadings of both outcome measures showed no significant improvement in PFM strength in patients. Conclusion: The study concluded that PFM strength did not show an increase after practicing yoga for a period of 4 weeks. This states that the effect of simple exercises cannot work on PFMs.

Keywords: Brink score, menopause, pelvic floor muscle strength, perineometer, yoga


How to cite this article:
Wani C, Rathi M, Madkar CS. Effect of yoga on pelvic floor muscle strength in menopausal females. J Dent Res Rev 2020;7, Suppl S2:72-5

How to cite this URL:
Wani C, Rathi M, Madkar CS. Effect of yoga on pelvic floor muscle strength in menopausal females. J Dent Res Rev [serial online] 2020 [cited 2020 Apr 4];7, Suppl S2:72-5. Available from: http://www.jdrr.org/text.asp?2020/7/5/72/278903

Editor: Dr. Pradnya Kakodkar





  Introduction Top


Growing age is an accepted and normal physiological phenomenon occurring in a female's lifecycle, which gets menopause in her midlife. All possible causes of menopause are not known completely to the humankind. They avoid conversation over this. WHO states, when the females menstrual blood loss stops for 1 year naturally or because of surgical or medical interventions are said to have reached the menopausal stage.[1] Many organs get affected because of menopause as they have association with the muscular structure of the pelvic floor.

Menopause results in a reduction in the working of ovaries, and there is slow termination of menstruation for 12 months. Menopause is a firm and regular progression. Ovaries produce progesterone as well as estrogen in females. Most females attain menopause naturally by the age of 40–60 years.[2]

Many fluctuation sensue in the body as a result of menopause, signs such as pain, disturbed sleep, and tiredness are some examples. The lack of estrogen subsequently tends to increase the cardiovascular complications.[3] Decline in circulating estrogen with respect to the aging process may result in urogynecological dysfunction for womankind.

Incontinence is a foremost problem at this phase. The symptoms which indicate whether a patient is suffering from menopausal incontinence include leakage of urine while coughing, sneezing, or exercise; inability to hold urine for a long time; waking up more than twice during night for voiding; and recurrent infections of the urinary tract. Causes for incontinence might be weak pelvic floor muscles (PFMs), prolapse, loss of bladder elasticity, estrogen diminution, or obesity, which are linked to menopause.

Menopause accompanies alterations in the functioning of the female pelvic floor. The prolapse of the pelvic organs is caused by the weakening of supporting structures. In this, tissues that support pelvic structures, that is, small bowel, uterus, bladder, rectum, urethra, and vagina are stretched and damaged and cause them to drop out of the place. This may compress the vagina wall causing a bulge in the vagina, which may protrude through the vaginal opening. There may be several causes for the prolapse of pelvic organs such as delivery, hysterectomy, and load lifting, but deficiency of estrogen in menopause is the most affecting factor. This leads to the thinning of the supporting structures along with tissue holding the pelvic organs in appropriate place and causes the organs to fall out of place.

A healthy lifestyle program set by a skilled medical squad will curtail the discomforts. The pelvic floor is a triangle-shaped structure. The diaphragm of the pelvic floor provides support to pelvic organs and helps in maintaining continence. If these muscles malform due to hormonal or added changes postmenopause, the body loosens. Muscles of the pelvic floor have a vibrant role in steadying of lumbar area and assist in unloading the spine.[4]

The contraction of transversus abdominis triggers the PFM. Transversus abdominis attaches with the coastal part of the diaphragm.[5]

Menopausal age brings alterations in the pelvic floor region. Aging and decline in the hormonal secretion can be said to be the chief reasons. This may develop certain complications, namely organ prolapse or incontinence. This will hamper the quality of life in old age.

A proper support system for the pelvic organs depends on strong PFMs. Muscles in the abdominal area and muscles of the pelvic floor work in tandem are correlated to each other.

Muscles in the abdomen belong to core muscles. Activation of muscles in the abdomen causes contraction movement in the pelvic area muscles. Stronger muscles in the abdominal region result in strengthened PFMs. So far, there is no direct evidence that yogic postures improve the strength of PFMs. Hence, this study aimed to find the correlation between yoga position and pelvic floor strength.


  Materials and Methods Top


The study was conducted in Dr. D. Y. Patil College of Physiotherapy in collaboration with the Obstetrics and Gynecology Department. The institutional ethics committee approved the project DPU/R and R (P) 540 (26)/18. This study was a pilot study. Participants who had attained menopause and willing to be a part of the study were included in the study. Written informed consent was taken from all the participants. Ladies having urinary tract infection, prolapse, incontinence, cancer of the cervix, unstable hypertension, or diabetes were excluded from the study. Participants were first evaluated and then taken into the study. Total patients screened were 22, of which 18 participants were eligible.

Baseline parameters were assessed. Pre- and post-assessment protocol was done. Privacy was maintained for each participant. For Brink scoring, three components were studied. The patient was made to lie in crook lying. Two methods were used to assess the pelvic strength. Bladder was emptied before the test. Therapist placed an index finger steeply into the vagina of the participant. They were asked to squeeze the fingers. Brink scoring was done.

The probe of perineometer was enclosed with a rubber sheath. The sensor was inserted into the vagina. The pressure of Sensor was raised till the maximum inflatory sensation of the sensor and was maintained by the closure of the pressure releasing knob. The patient was asked to squeeze the PFM. Three attempts were done; the highest reading was measured. The patients were asked to perform ten exercises for 5 days a week for 4 weeks. On day 1, patients were taught all the exercises and then asked to continue with the exercises at home. Naukasana, Bhujangasana, Setu Bandha Sarvangasana, Ardha Matsyendrasana, Veerbhadhrasana, Ushtrasana, Marjarasana, Gomukhasana, Utkatasana, and Paschimottasana were the exercises.

Two outcome measures, Brink score, and perineometer reading were used to assess the results. The differences between pre- and post-scores of both outcome measures were noted, and the statistical inference was derived.

Statistical analysis

Before and after treatment scores were matched. Paired t-test was used for comparing the data.


  Results Top


Of 18 participants, the study was completed with 17 participants with one loss to follow-up. The mean age of patients was 53.88 years. The mean body mass index (BMI) of patients was 26.93, and the mean number of menopausal years was 8.17 years. As mentioned in [Graph 1], the mean Brink score Pre intervention was 7.94, and post intervention, it was 7.65. The patients showed no significant improvement in Brink score as P = 0.14.



The mean perineometer reading preintervention was 4.11, and the postintervention was 3.8. The difference was not statistically significant (P > 0.05).

Postreadings of both outcome measures showed no significant improvement in PFM strength in patients.


  Discussion Top


There is no statistical improvement noted in the Brink score and perineometer reading. Brink score and perineometer reading are the indicators of PFM strength. Brink scale has greatest reliability of 94% agreement, overpressure.[6] Isherwood et al. stated a good agreement between perineometry and manual examination of PFM with a 0.73 kappa value showing considerable agreement between the two techniques.

Gynecological checkup assists to determine females' flaws in the pelvic region and those in the danger of prolapse.[6] Literature reports that yoga with controlled breathing boosts the receptors of the gastrointestinal, abdominal, and respiratory systems among females with prolapse.[7]

Hankyu Park et al. brought out the relationship between breathing and PFM movement. There is an example to justify this, when passage of urine is to be controlled for some reason, there is a contraction of PFM. Continence maintenance, as well as support to the organs in the abdomen, is an important function of PFM, it also assists in ventilation.[8]

The connection between PFM, abdominal muscles get activated, and the intravaginal pressure during PFM activity in normal women has been established by Madill and McLean. Effective contraction of PFM could not be attained while relaxing the deep abdominal muscles is also heightened by them.[9] Voluntary movement of muscles in the abdomen creates accelerated movement of PFM. Hence, patients were instructed to maintain an alert position of abdominal muscles while doing yoga because this may result in negative performance.[10]

Muscles of the pelvic region do not contract by themselves but move parallel with muscles surrounding the abdomen.[7] Breathing, speaking, and coughing cause rise in internal abdominal pressure, which is distributed throughout the relative organs. The organs are protected from this pressure by simultaneous contraction of abdominal muscles, PFM, and diaphragm.[7] The study by Hankyu Park et al. (2015) established that the contraction of the muscles of the pelvic floor is drawn into movement of the diaphragm and further affects the function of the pulmonary system. Thus, it can be safely said that breathing and movement of PFM are dependent on each other.[11]

The abdominal circumference was stable, as diaphragm and PFM restrict the contents of the stomach; the abdominal muscle estimated isometric activity and a slight hollowing occurred when hollowing of the lower abdomen was made.[12]

The back-bending position is a sign of strong core muscles. Usually, yogic postures are restricted by tightness of rectus abdominis (RA) muscle. Salem et al. researched regarding the activation of gastrocnemius, quadriceps, hamstrings, erector spinae (ES), and RA muscle in Virabhadrasana. They found that muscle activation pattern of RA is significantly increased in Virabhadrasana.[13]

Okubo et al. showed highest RA activation in Naukasana. Back muscles of the core embrace ES and multifidus, Bhujangasana strengthen these muscles.[14] The study by Ekstrom et al. stated the muscle activities of RA, external oblique, gluteus maximus (GM), gluteus medius, and hamstring in nine rehabilitation exercises and stated that activation pattern of GM had greater activation by Marjarasana and Setu Bandhasana.[15]

The lacunae of the study were that the sample size was small. They performed exercises without supervision at home, and the overall BMI was above normal which also can be a confounder in the study. Further, the group was not analyzed as per the grades of the PFM strength.

In the future, it is recommended that yoga should be combined with PFM contractions along with breathing exercises which can help in improving Brink and perineometer readings. In addition, the abdominal strength should also be checked, and an additional outcome assessor should be evaluated using the electromyography technique.


  Conclusion Top


The study concluded that PFM strength did not show an increase after practicing yoga for a period of 4 weeks.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Borker SA, Venugopalan PP, Bhat SN. Study of menopausal symptoms, and perceptions about menopause among women at a rural community in Kerala. J Midlife Health 2013;4:182-7.  Back to cited text no. 1
    
2.
Stages of Menopause-American College of Sports Medicine. Available from: www.acsm.org. [Last accessed on 2019 Aug 22].  Back to cited text no. 2
    
3.
Mishra N, Mishra VN, Devanshi. Exercise beyond menopause: Dos and Don'ts. J Midlife Health 2011;2:51-6.  Back to cited text no. 3
    
4.
Rathi M. Effect of pelvic floor muscle strengthening exercises in chronic low back pain. Indian J Physiother Occup Ther 2013;7:121-5.  Back to cited text no. 4
    
5.
Bordoni B, Zanier E. Anatomic connections of the diaphragm: Influence of respiration on the body system. J Multidiscip Healthc 2013;6:281-91.  Back to cited text no. 5
    
6.
Nayak R, Prakash S, Yadav RK, Dhungel KU. Kapalbhati changes cardiovascular parameters. Janaki Med Coll J Med Sci 2015;3:43-9.  Back to cited text no. 6
    
7.
Thangavel D, Gaur GS, Sharma VK, Bhavanani AB, Rajajeyakumar M, Syam SA. Effect of slow and fast pranayama training on handgrip strength and endurance in healthy volunteers. J Clin Diagn Res 2014;8:BC01-3.  Back to cited text no. 7
    
8.
Park H, Han D. The effect of the correlation between the contraction of the pelvic floor muscles and diaphragmatic motion during breathing. J Phys Ther Sci 2015;27:2113-5.  Back to cited text no. 8
    
9.
Capson AC, Nashed J, Mclean L. The role of lumbopelvic posture in pelvic floor muscle activation in continent women. J Electromyogr Kinesiol 2011;21:166-77.  Back to cited text no. 9
    
10.
Stüpp L, Resende AP, Petricelli CD, Nakamura MU, Alexandre SM, Zanetti MR. Pelvic floor muscle and transversus abdominis activation in abdominal hypopressive technique through surface electromyography. Neurourol Urodyn 2011;30:1518-21.  Back to cited text no. 10
    
11.
Kekan DR. Effect of kapalbhati pranayama on body mass index and abdominal skinfold thickness. Ind Med Gaz 2013;431;421-5.  Back to cited text no. 11
    
12.
Rocha S. Exercise and Sporting Activity during Pregnancy. Springer International Publishing AG, Springer Nature; 2019.  Back to cited text no. 12
    
13.
Salem GJ, Yu SS, Wang MY, Samarawickrame S, Hashish R, Azen SP, et al. Physical demand profiles of hatha yoga postures performed by older adults. Evid Based Complement Alternat Med 2013;2013:165763.  Back to cited text no. 13
    
14.
Okubo Y, Kaneoka K, Imai A, Shiina I, Tatsumura M, Izumi S, et al. Electromyographic analysis of transversus abdominis and lumbar multifidus using wire electrodes during lumbar stabilization exercises. J Orthop Sports Phys Ther 2010;40:743-50.  Back to cited text no. 14
    
15.
Ekstrom RA, Donatelli RA, Carp KC. Electromyographic analysis of core trunk, hip, and thigh muscles during 9 rehabilitation exercises. J Orthop Sports Phys Ther 2007;37:754-62.  Back to cited text no. 15
    




 

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Abstract
Introduction
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