Differential effects of cough, Valsalva, and continence status on vesical neck movement

Objective: We tested the null hypothesis that vesical neck descent is the s ame during a cough and during a Valsalva maneuver. We also tested the secon dary null hypothesis that differences in vesical neck mobility would be ind ependent of parity and continence status. Methods: Three groups were included: 17 nulliparous continent (31.3 +/- 5.6 ; range 22-42 years), 18 primiparous continent (30.4 +/- 4.3; 24-43), and 2 3 primiparous stress-incontinent (31.9 +/- 3.9; 25-38) women. Measures of v esical neck position at rest and during displacement were obtained by ultra sound. Abdominal pressures were recorded simultaneously using an intravagin al microtransducer catheter. To control for differing abdominal pressures, the stiffness of the vesical neck support was calculated by dividing the pr essure exerted during a particular effort by the urethral descent during th at effort. Results: The primiparous stress-incontinent women displayed similar vesical neck mobility during a cough effort and during a Valsalva maneuver (13.8 m m compared with 14.8 mm; P = .49). The nulliparous continent women (8.2 mm compared with 12.4 mm; P = .001) and the primiparous continent women (9.9 m m compared with 14.5 mm; P = .002) displayed less mobility during a cough t han during a Valsalva maneuver despite greater abdominal pressure during co ugh. The nulliparas displayed greater pelvic floor stiffness during a cough compared with the continent and incontinent primiparas (22.7, 15.5, 12.2 c m H2O/mm, respectively; P = .001). Conclusion: There are quantifiable differences in vesical neck mobility dur ing a cough and Valsalva maneuver in continent women. This difference is lo st in the primiparous stress-incontinent women. (C) 2000 by The American Co llege of Obstetricians and Gynecologists.