Exploring pelvic floor muscle function in men with and without pelvic floor symptoms: A population-based study

Françoise J M Notenboom-Nas, Grietje E Knol-de Vries, Lotte Beijer, Yme Tolsma, Marijke C Ph Slieker-Ten Hove, Janny H Dekker, Gommert A van Koeveringe, Marco H Blanker, Françoise J M Notenboom-Nas, Grietje E Knol-de Vries, Lotte Beijer, Yme Tolsma, Marijke C Ph Slieker-Ten Hove, Janny H Dekker, Gommert A van Koeveringe, Marco H Blanker

Abstract

Background: Pelvic floor symptoms (PFS), such as lower urinary tract symptoms, defecation disorders, sexual problems, and genital-pelvic pain, are prevalent in men. Thorough physical assessments of the external anal sphincter (EAS) and the puborectal muscle (PRM) are the keys to unraveling the role of muscle dysfunction.

Objectives: To explore associations within and between the EAS and PRM and between muscle (dys-) function and the number of male PFS.

Methods: This cross-sectional study purposively enrolled men aged ≥21 years with 0-4 symptoms from a larger study. After extensive external and internal digital pelvic floor assessment, we explored (1) agreement between muscle function of the EAS versus PRM (using cross tabulation), (2) associations within and between the EAS and PRM (using heatmaps), and (3) associations between muscle function and number of PFS (using a visual presentation [heatmaps] and χ2 tests).

Results: Overall, 42 out of 199 men (21%) had completely normal muscle function. Sixty-six (33.2%) had no symptoms, of which 53 (80%) had some degree of muscle dysfunction. No clear dose-response relationship existed between muscle (dys-) function and the number of symptoms. The PRM showed both more dysfunction and severer dysfunction than the EAS.

Conclusions: No clear association exists between muscle dysfunction and the number of symptoms, and the absence of PFS does not indicate normal muscle function for all men. Dysfunction levels are highest for the PRM. Further pelvic floor muscle research is warranted in men with PFS.

Trial registration: ClinicalTrials.gov NCT03558802.

Keywords: digital assessment; heatmap; male pelvic floor musculature; male pelvic floor symptoms.

Conflict of interest statement

MarijkeC.Ph. Slieker‐ten Hove: KOL Indiba (Indiba. com). She has an advising role for pelvic floor physical therapists who want to use Tecar therapy in pelvic floor dysfunction. The remaining authors declare no conflict of interest.

© 2022 The Authors. Neurourology and Urodynamics published by Wiley Periodicals LLC.

Figures

Figure 1
Figure 1
Participant flow chart. PFS, pelvic floor symptoms.
Figure 2
Figure 2
Comparison of EAS and PRM function. (A) EAS and PRM function. (B) Comparison of EAS and PRM function items. Data were sorted according to EAS dysfunction in the first columns with all other items for EAS and PRM; the green cells indicate normal function (at the top) and the red cells indicate dysfunction (at the bottom). Each line (row) includes the outcomes of an individual participant. Colors of cells: white (missing data), green (normal function), light orange (slight function decrease), orange (moderate function decrease), dark orange (strong function decrease), and red (very strong function decrease). For tone (both EAS and PRM), red represents an increase or decrease of tone; other red cells represent “no closure of EAS” and “no increase of anorectal angle,” as appropriate. EAS, external anal sphincter; max. vol., maximum voluntary; PRM, puborectal muscle.
Figure 3
Figure 3
Heatmap of EAS and PRM function items by the number of pelvic floor symptoms. Data were sorted according to EAS dysfunction in the first columns with all other items for EAS and PRM; the green cells indicate normal function (at the top) and the red cells indicate dysfunction (at the bottom). Each line (row) includes the outcomes of an individual participant. Colors of cells: white (missing data), green (normal function), light orange (slight function decrease), orange (moderate function decrease), dark orange (strong function decrease), and red (very strong function decrease). For tone (both EAS and PRM), red represents an increase or decrease of tone; other red cells represent “no closure of EAS” and “no increase of anorectal angle,” as appropriate. EAS, external anal sphincter; max. vol., maximum voluntary; PRM, puborectal muscle.

References

    1. Smith CP. Male chronic pelvic pain: an update. Indian J Urol. 2016;32(1):34‐39.
    1. Lakhoo J, Khatri G, Elsayed RF, et al. MRI of the male pelvic floor. Radiographics. 2019;39(7):2003‐2022.
    1. Rocca Rossetti S. Functional anatomy of pelvic floor. Arch Ital Urol Androl. 2016;88(1):28‐37.
    1. D'Ancona C, Haylen B, Oelke M, et al. The International Continence Society (ICS) report on the terminology for adult male lower urinary tract and pelvic floor symptoms and dysfunction. Neurourol Urodyn. 2019;38(2):433‐477.
    1. Frawley H, Shelly B, Morin M, et al. An International Continence Society (ICS) report on the terminology for pelvic floor muscle assessment. Neurourol Urodyn. 2021;40(5):1217‐1260.
    1. Huang W, Wang Q, Chen J, Wu P. Development and validation of the International Consultation on Incontinence Modular Questionnaire for Male Lower Urinary Tract Symptoms (ICIQ‐MLUTS) and the ICIQ‐MLUTS Long Form in Chinese population. Low Urin Tract Symptoms. 2019;11(4):189‐194.
    1. Meinds RJ, Timmerman MEW, van Meegdenburg MM, Trzpis M, Broens PMA. Reproducibility, feasibility and validity of the Groningen defecation and fecal continence questionnaires. Scand J Gastroenterol. 2018;53(7):790‐796.
    1. van Dongen H, van der Vaart H, Kluivers KB, Elzevier H, Roovers JP, Milani AL. Dutch translation and validation of the pelvic organ prolapse/incontinence sexual questionnaire‐IUGA revised (PISQ‐IR). Int Urogynecol J. 2019;30(1):107‐114.
    1. Seksuele gezondheid in Nederland . 2017. Accessed November 15, 2021.
    1. Slieker‐ten Hove MC, Pool‐Goudzwaard AL, Eijkemans MJ, Steegers‐Theunissen RP, Burger CW, Vierhout ME. Symptomatic pelvic organ prolapse and possible risk factors in a general population. Am J Obstet Gynecol. 2009;200(2):184.e1‐184.e7.
    1. Oike H, Ogawa Y, Oishi K. Simple and quick visualization of periodical data using microsoft excel. Methods Protoc. 2019;2(4):81. 10.3390/mps2040081
    1. Voorham‐van der Zalm PJ, Lycklama À, Nijeholt GAB, Elzevier HW, Putter H, Pelger RCM. “Diagnostic investigation of the pelvic floor”: a helpful tool in the approach in patients with complaints of micturition, defecation, and/or sexual dysfunction. J Sex Med. 2008;5(4):864‐871.
    1. Hodges PW, Stafford RE, Hall L, et al. Reconsideration of pelvic floor muscle training to prevent and treat incontinence after radical prostatectomy. Urol Oncol . 2020;(5):354‐371.
    1. Stoker J. Anorectal and pelvic floor anatomy. Best Pract Res Clin Gastroenterol. 2009;23(4):463‐475.
    1. Hetrick DC, Glazer H, Liu YW, Turner JA, Frest M, Berger RE. Pelvic floor electromyography in men with chronic pelvic pain syndrome: a case‐control study. Neurourol Urodyn. 2006;25(1):46‐49.
    1. Quaghebeur J, Petros P, Wyndaele JJ, De Wachter S. The innervation of the bladder, the pelvic floor, and emotion: a review. Auton Neurosci. 2021;2(35):102868.
    1. Butrick CW. Pathophysiology of pelvic floor hypertonic disorders. Obstet Gynecol Clin North Am. 2009;36(3):699‐705.
    1. Cohen D, Gonzalez J, Goldstein I. The role of pelvic floor muscles in male sexual dysfunction and pelvic pain. Sex Med Rev. 2016;4(1):53‐62.
    1. Armstrong AA, Nguyen MM, Wieslander CK, Tarnay CM. All levels of providers can effectively and efficiently teach pelvic floor strength assessment at time of pelvic examination. Female Pelvic Med Reconstr Surg. 2019;25(2):154‐156.
    1. Rociu E, Stoker J, Eijkemans MJ, Laméris JS. Normal anal sphincter anatomy and age‐ and sex‐related variations at high‐spatial‐resolution endoanal MR imaging. Radiology. 2000;217(2):395‐401.
    1. Bharucha AE. Pelvic floor: anatomy and function. Neurogastroenterol Motil. 2006;18(7):507‐519.
    1. Mateus‐Vasconcelos ECL, Ribeiro AM, Antônio FI, Brito LGO, Ferreira CHJ. Physiotherapy methods to facilitate pelvic floor muscle contraction: a systematic review. Physiother Theory Pract. 2018;34(6):420‐432.
    1. Davis KA, Knight RA. Childhood maltreatment experiences and problematic sexual outcomes in adult males who have sexually offended: further evidence of the potency of male caregiver psychological abuse. Child Abuse Negl. 2019;96:104097.
    1. Pena CC, Bø K, Ossa AMP, et al. Are visual inspection and digital palpation reliable methods to assess ability to perform a pelvic floor muscle contraction? An intra‐rater study. Neurourol Urodyn. 2021;40(2):680‐687.

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