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Review of pelvic and perineal neuromuscular fatigue : Evaluation and impact on
therapeutic strategies

Pelvic floor fatigue is known by its clinical consequences (fecal
incontinence, stress urinary incontinence, pelvic organ prolapse), but there are
still few studies on the subject. OBJECTIVE: This article presents an overview of
the current knowledge of pelvic and perineal fatigue, focusing on its assessment
and consequences in terms of evaluation and therapeutic strategies, to propose an
evaluation that could be routinely performed. METHODS:
We performed a systematic
review of the literature in MEDLINE via PubMed and Cochrane Library databases by
using the keywords pelvic floor, muscular fatigue, physiopathology, stress
urinary incontinence, pelvic organ prolapse, fecal incontinence, physical
activity, and pelvic rehabilitation. We included reports of systematic reviews
and retrospective and prospective studies on adult humans and animals in English
or French published up to April 2018 with no restriction on start date. RESULTS:
We selected 59 articles by keyword search, 18 by hand-search and 3 specific
guidelines (including the 2009 International Continence Society recommendations);
finally 45 articles were included; 14 are described in the Results section (2
reviews of 6 and 20 studies, and 12 prospective observational or cross-over
studies of 5 to 317 patients including 1 of animals). Perineal fatigue can be
assessed by direct assessment, electromyography and spectral analysis and during
urodynamics. Because pelvic floor fatigue assessments are not evaluated
routinely, this fatigability is not always identified and is often falsely
considered an exclusive pelvic floor weakness, as suggested by some
rehabilitation methods that also weaken the pelvic floor instead of enhancing it.
CONCLUSION: Pelvic floor fatigue is not evaluated enough on a routine basis and
the assessment is heterogeneous. A better knowledge of pelvic floor fatigue by standardized routine evaluation could lead to targeted therapeutic strategies.
CI - Copyright (c) 2018 Elsevier Masson SAS. All rights reserved.

Langue : ANGLAIS

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