Do differences in abdominal movement patterns during coughing and forced expiration affect cranioventral bladder neck displacement in healthy nulliparous subjects?

de Jong, Jacqueline; Dumoulin, Chantale; Junginger, Baerbel; Zwahlen, Marcel; Bloch, Konrad; Burkhard, Fiona (2023). Do differences in abdominal movement patterns during coughing and forced expiration affect cranioventral bladder neck displacement in healthy nulliparous subjects? Continence, 5, p. 100576. Elsevier 10.1016/j.cont.2023.100576

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Aims: Abdominal movement patterns during coughing and forced expiration (FE) fall into two categories: abdominal inward movement (AIM) and abdominal outward movement (AOM). These abdominal movement patterns are thought to affect cranioventral (CV) bladder neck displacement differently. However, many studies have described an absent or altered PFM response during coughing, assuming PFM dysfunction, without considering the impact of abdominal movement pattern differences. The aim of this study was to observe abdominal movement patterns during coughing and FE and compare the associated (CV) bladder neck displacement patterns.

Method: Participants performed three maximal expulsive coughs, followed by three FEs, during which the respiratory inductive plethysmography (RIP) method was used to identify abdominal movement patterns. Concurrently, perineal 2D ultrasound was applied to assess CV bladder neck displacement. All measurements were done in the standing and crook lying position. Descriptive statistics were computed for abdominal movement patterns and bladder neck displacement. Chi-squared tests were used to compare abdominal movement patterns and CV bladder neck displacement.

Results: One hundred and forty-nine healthy nulliparous women without PFM dysfunction participated in the study. During both coughing and FE in the standing position, women who displayed an AIM pattern had a significantly higher occurrence of CV bladder neck displacement compared to those presenting AOM. In the crook lying position, there was a significantly higher occurrence of bladder neck displacement during coughing in subjects showing AIM compared to those with AOM.

Conclusion: Significant differences were found in abdominal movement patterns during coughing and FE in healthy nulliparous subjects in standing and crook lying positions. Most of the subjects showed AOM during coughing or FE in both standing and lying positions. This is contrary to the existing literature and needs further investigation. Abdominal movement patterns impacted CV bladder neck displacement during coughing and FE while standing and during coughing in the crook lying position. Clinicians should be aware of different abdominal movement patterns, which should be considered for diagnosis and treatment.

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