Characterisation of the Vaginal Pressure Profile (femfit®) During Exercise

Abstract

Pelvic floor disorders (PFD)s such as urinary incontinence (UI) and pelvic organ prolapse (POP), affect up to 47% of the population, with one in five women requiring surgery. The significant physical, emotional, social and financial burden of these disorders means understanding modifiable risk factors is very important for establishing prevention and management strategies. It is suggested that excessive or repetitive increases in intra-abdominal pressure (IAP), specifically high impact exercise (HIE), may promote the development of pelvic floor dysfunction. Research assessing IAP generation during different exercises has reported wide variations amongst individuals and there remains no established threshold of maximal IAP to guide activity restrictions. It is well recognised that alterations in pelvic floor muscle (PFM) function contribute to the pathophysiology of PFDs. The PFMs respond to IAP changes to ensure urinary and faecal control as well as pelvic organ support. Thus, the contribution of the PFMs to a woman’s ability to tolerate increases in IAP during exercise needs to be considered to advance our understanding of HIE as a potential risk factor. Real time transperineal ultrasound (TPUS) is a current tool used to provide physical imaging of the PFMs, however, the positioning of the probe provides substantial constraints on use during dynamic exercising. The femfit® is an intra-vaginal pressure array that measures the vaginal pressure profile and overcomes the physical constraints of ultrasound. The design of the femfit® allows dynamic measurement of a pressure profile by virtue of its size, the materials used, and the presence of eight independent pressure sensors along the length of the device. This enables simultaneous measurement of IAP and PFM activation. This project investigated if an array of pressure measurements can be interpreted to derive similar information to TPUS in terms of anatomical changes to the PFMs. This was assessed by comparing the vaginal pressure profile observed during a series of exercises with changes in the PFMs as measured by TPUS measurements. Eighteen women were included in this observational study that involved concurrent femfit® and TPUS measurements of the PFMs during a series of lying and standing tasks. These measurements were then compared to assess the accuracy of femfit® pressures for describing changes in PFM geometry. The results of this study suggest that the femfit® is very good at assessing a meaningful shortening of the PFMs in the presence of low IAP for all participants across all the tasks. However, disagreement was observed in 25% of participants with high IAP during straining manoeuvre. Overall, the femfit® demonstrated a good ability to describe changes in the geometry of the PFM during dynamic activity. This is promising because use of the femfit®, compared to TPUS, can be used in a much wider variety of exercise types, is much easier to use, and is much more accessible. Future studies will be required to explore the utility of the femfit to safely guide women on HIE participation.