Dynamics of the Female Pelvic Floor

Female urinary incontinence has been recently termed a “silent epidemic”, requiring systematic attention and a multidisciplinary approach towards economically ameliorating its impact. In this paper we examine the role of the pelvic floor (PF) in maintaining urinary continence by evaluating the dynamics produced during its voluntary and reflex activation. Analytical methods for the acquisition and subsequent ultrasound analysis of movement of PF structures during maneuvers that are associated with exercises are presented to enable the development of criteria and unique new parameters that define the kinematics of PF function. Principal among these parameters, are displacement, velocity, acceleration and the trajectory of pelvic floor landmarks facilitating functional and anatomical visualization. Different methods of movement detection, including motion tracking algorithms and segmentation algorithms were developed to acquire new dynamic parameters of Pelvic structures during different maneuvers. 2D animation was applied to enhance the ultrasound imaging and highlight the timing of the movement and deformation to fast and stressful maneuvers, which are important for understanding the neuromuscular control mechanisms in urinary continence. Using these visualization technologies changes in linear strain produced as a result of a cough was computed. Parameters were derived from image processing of noninvasive trans-perineal scanning from asymptomatic volunteers as well as patients presenting with relevant pathology. Observations suggest that the timing of response are a significant factors separating the continent from the incontinent subjects in terms of absolute measured parameters as well as computed parameters of linear strain.