Dynamic Ultrasound Imaging in Women’s Health

Physiotherapy assessment and treatment techniques for pelvic floor dysfunction have changed little in the past 10 years apart from the introduction of computerised surface electromyography (sEMG) and manometry (pressure testing).  Standard treatment techniques consist of strengthening the pelvic floor muscles, improving endurance so that the muscles do not fatigue quickly on repeated activity, improving response times, and encouraging bracing of the pelvic floor muscles prior to any increase in intra-abdominal pressure.

‘Progressive resistance exercise in the functional restoration of perineal muscles’ as described by Kegel (1948), and pelvic floor muscle training, is now widely accepted as the first line of treatment in the conservative management of patients with pelvic floor dysfunction.  Until recently, the only reliable method for assessing dysfunction was digital vaginal / digital anal examination.  Not only is this invasive, but also contraindicated in certain groups of patients.

In recent years, dynamic ultrasound imaging has been used by gynaecologists and urologists to diagnose and evaluate paravaginal defects in females attending gynaecology clinics, and recent studies have been carried out to determine pelvic floor muscle strength and quantify pelvic floor muscle activity using transperineal / translabial ultrasound, and to teach pelvic floor muscle exercises.

The use of dynamic ultrasound imaging to support current assessment and treatment methodologies is a relatively new development in the field of Women’s Health physiotherapy.  Teaching accurate activation of the pelvic floor and core stabilising muscles; transversus abdominis, internal and external obliques, and multifidus, using real-time ultrasound for biofeedback purposes, adds a powerful dimension to existing treatment modalities.  For assessment purposes, dynamic imaging can identify clearly, the functional aspect of pelvic floor muscle activation.  Any inaccuracies of function can be instantly analysed and evaluated.

On a more fundamental note, the Women’s Health physiotherapist can also use dynamic imaging to carry out pre and post void bladder scanning to determine post-void residual urine volumes.

Dynamic imaging is changing the way physiotherapists are evaluating, analysing, and treating pelvic floor dysfunction, and it is hoped that current, ongoing research will identify more robust treatment protocols for the assessment and conservative management of this group of patients.

Jane Dixon