title: Proof of concept: differential effects of Valsalva and straining maneuvers on the pelvic floor.
abstract: OBJECTIVE
  To prove a basic physiological principle in healthy women, demonstrating different movement patterns of diaphragm, pelvic floor, and muscular wall surrounding the abdominal cavity during a Valsalva maneuver as opposed to a straining maneuver, by means of real-time dynamic magnetic resonance imaging (MRI).
  
  
  METHODS
  The study was performed at Hochzirl Hospital, Austria and Department of Radiology, Medical University Innsbruck, Austria. Four healthy women underwent MRI measurements in a 1.5-T whole body MR-scanner. Coronal, sagittal, and axial slices were acquired simultaneously and a dynamic MRI sequence was used to assess cranio-caudal movements of the diaphragm and pelvic floor and of concomitant changes in anterolateral abdominal muscle thickness and abdominal diameter at the umbilical level.
  
  
  RESULTS
  Both the Valsalva maneuver and the straining maneuver began with deep inspiration and downward movement of the diaphragm. During the exertion phase of both maneuvers, abdominal muscle thickness increased and abdominal diameter decreased. During the Valsalva maneuver, the pelvic floor moved cranially parallel to the diaphragm, whereas during the straining maneuver, the pelvic floor was markedly displaced caudally.
  
  
  CONCLUSIONS
  The Valsalva maneuver reflects an expiratory pattern with diaphragm and pelvic floor elevation, whereas during straining the pelvic floor descends.
authors: Department of Internal Medicine, Hochzirl Hospital, 6170 Zirl, Austria. helena.talasz@tilak.at
authors: Helena
authors: H
authors: Talasz
authors: Christian
authors: C
authors: Kremser
authors: Markus
authors: M
authors: Kofler
authors: Elisabeth
authors: E
authors: Kalchschmid
authors: Monika
authors: M
authors: Lechleitner
authors: Ansgar
authors: A
authors: Rudisch
mesh_terms: D000009:Abdominal Muscles / Q000033:anatomy & histology / Q000502:physiology; D000328:Adult; D003964:Diaphragm / Q000033:anatomy & histology / Q000502:physiology; D045853:Exhalation; D005260:Female; D006801:Humans; D001239:Inhalation; D008279:Magnetic Resonance Imaging; D008875:Middle Aged; D009119:Muscle Contraction; D017773:Pelvic Floor / Q000033:anatomy & histology / Q000502:physiology*; D056887:Pelvic Organ Prolapse / Q000175:diagnosis; D005082:Physical Exertion; D014550:Urinary Incontinence, Stress / Q000175:diagnosis; D014636:Valsalva Maneuver