Professional Documents
Culture Documents
Standarization
Standarization
STANDARDIZATION muscle function and dysfunction, and not on pelvic £oor dis-
orders. It contains no terminology on pelvic organ prolapse,
This report presents a standardization of terminology of
urinary, or fecal incontinence. Other reports refer to these
pelvic £oor muscle function and dysfunction. No earlier docu-
subjects [Bump, 1996; Weber et al., 2001; Abrams et al.,
ments contained de¢nitions on this terminology. These de¢ni-
2002a]. This report on terminology of the pelvic £oor muscles
tions are descriptive and do not imply underlying assumptions
is written for use, in daily clinical practice, by every health
that may later prove to be incorrect or incomplete. By follow-
care provider working with patients who have pelvic £oor
ing this principle, the International Continence Society aims
muscle problems. It facilitates the communication between
to facilitate comparison of results and enable e¡ective com-
di¡erent carers in the ¢eld of pelvic £oor muscle pathology.
munication by investigators performing pelvic £oor muscle
Because it has been developed by a multidisciplinary group, it
studies.
It is suggested that acknowledgment of these de¢nitions in
Bert Messelink, Jacques Corcos, Peter Huat-Chye Lim, Guus Lycklama, and
written publications be indicated by a footnote to the section Philip Van Kerrebroeck are Urologists; Thomas Benson and Alex Wang are
‘‘Materials and Methods’’ or its equivalent, to read as follows: Urogynecologits; Bary Berghmans, Kari B!, and Jo Laycock are Physiothera-
‘‘Terminology used is conform the de¢nitions recommended pists; Clare Fowler is Neurologists; Rik van Lunsen is a Sexologist;
by the International Continence Society, except where speci- John Pemberton is a Colon and Rectal Surgeon; Alain Watier is a Gastro-
¢cally noted.’’ Enterologist.
*Correspondence to: Bert Messelink, Pelvic Care Center Prinsengracht,
Prinsengracht 769, 1017 JZ, Amsterdam, Holland.
MULTIDISCIPLINARY E-mail: e.j.messelink@olvg.nl
Received 10 April 2005; Accepted 26 April 2005
The pelvic £oor is related to more than one organ system. Published online 15 June 2005 inWiley InterScience
Dysfunction of the pelvic £oor therefore in£uences di¡er- (www.interscience.wiley.com)
ent functions at the same time. This report is on pelvic £oor DOI 10.1002/nau.20144
more selective and can also be used to assess neurological or perineum. The position of the bladder neck in relation to
conditions that may involve the pelvic £oor muscles. the symphisis pubis is an important landmark. During the
. Intra-vaginal or intra-anal EMG probes will give the same investigation, the patient can be asked to contract the pelvic
(functional) information as surface electrodes. 21 £oor muscles and this can be seen to result in an elevation of
. During a voluntary contraction of the pelvic £oor muscles, the bladder neck. Anal ultrasound is used to de¢ne struc-
the intensity of the EMG signal should increase. When the tural defects in the anal sphincter.
patient is asked to hold the contraction, a sustained high . Fluoroscopy is the oldest technique used to indirectly
intensity on the EMG can be observed. At the subsequent image the pelvic £oor and the pelvic organs. Filling of the
relaxation, the intensity will fall to or even below baseline. intestine, colon, rectum, and vagina with contrast medium
is known as evacuation proctography or defecography. A
Pressure measurements lateral projection is important to get the best information.
At rest the anatomical position of the pelvic organs and the
. Investigators reporting pelvic £oor muscle studies should pelvic £oor can be visualized. Subsequently the patient can
state the position of the patient and the type of transducers, be asked to strain and can be asked to contract the pelvic
balloons, and EMG was used. £oor muscles. The changes in the anatomical positions can
. Urodynamics can be done to obtain insight into the func- then be observed.
tion of the lower urinary tract. Special attention should be . Video-urodynamics combines the techniques of uro-
paid to the function of the pelvic £oor muscles in relation to dynamics and £uoroscopy. This will give extra insight into
the bladder. Simultaneous measurement of the pelvic £oor the relationships between pelvic £oor anatomy and func-
EMG, during the micturition phase can demonstrate the tion of the bladder and urethra.
mechanism of dysfunctional voiding. . MRI is the newest technique for imaging of the pelvic £oor.
. Anorectal manometry assesses continence mechanisms by The use of endoluminal coils is advised in order to obtain
determining: (a) rectal volume required for sensation of dis- adequate images of the pelvic £oor and the related struc-
tension and urgency to defecate, (b) rectal compliance, tures. Dynamic MRI can be used to observe the movement
(c) voluntary contractions of the external anal sphincter, of the pelvic £oor during Valsalva manoeuvre, a defecatory
and (d) the resting pressure in the anal canal.Water perfused e¡ort and during pelvic £oor muscles contraction. It can
and solid state pressure transducers are used in combina- also be used for the detection of pelvic organ prolapse.
tion with a balloon positioned in the anal canal. EMG of . Di¡erent imaging techniques are used for di¡erent
the anal canal can be added but should not be used alone. 22 indications. 24
Fucini C, Ronchi O, Elbetti C. 2001. Electromyography of the pelvic £oor Stoker J, Halligan S, Bartram CI. 2001. Pelvic £oor imaging. Radiology
musculature in the assessment of obstructed defecation symptoms. 218:621^ 41.
Dis Colon Rectum 44:1168 ^ 75. ThompsonWG, Longstreth GF, Drossman DA, et al. 1999. Functional bowel
Neumann P, Gill V. 2002. Pelvic £oor and abdominal muscle interac- disorders and functional abdominal pain. Gut 45:1143 ^ 47.
tion: EMG activity and intra-abdominal pressure. Int Urogynecol J Weber AM, Abrams P, Brubaker L, et al. 2001. The standardization of termi-
13:125 ^32. nology for researchers in female pelvic £oor disorders. Int Urogynecol J
Sapsford RR, Hodges PW, Richardson CA, et al. 2001. Co-activation of the Pelvic Floor Dysfunct 12:178 ^ 86.
abdominal and pelvic £oor muscles during voluntary exercises. Neurourol Whitehead WE,Wald A, Diamant NE, et al. 1999. Functional disorders of the
Urodyn 20:31^ 42. anus and rectum. Gut 45:1155 ^59.