title: Pelvic floor dynamics during high-impact athletic activities: A computational modeling study.
abstract: BACKGROUND
  Stress urinary incontinence is a significant problem in young female athletes, but the pathophysiology remains unclear because of the limited knowledge of the pelvic floor support function and limited capability of currently available assessment tools. The aim of our study is to develop an advanced computer modeling tool to better understand the dynamics of the internal pelvic floor during highly transient athletic activities.
  
  
  METHODS
  Apelvic model was developed based on high-resolution MRI scans of a healthy nulliparous young female. A jump-landing process was simulated using realistic boundary conditions captured from jumping experiments. Hypothesized alterations of the function of pelvic floor muscles were simulated by weakening or strengthening the levator ani muscle stiffness at different levels. Intra-abdominal pressures and corresponding deformations of pelvic floor structures were monitored at different levels of weakness or enhancement.
  
  
  RESULTS
  Results show that pelvic floor deformations generated during a jump-landing process differed greatly from those seen in a Valsalva maneuver which is commonly used for diagnosis in clinic. The urethral mobility was only slightly influenced by the alterations of the levator ani muscle stiffness. Implications for risk factors and treatment strategies were also discussed.
  
  
  CONCLUSIONS
  Results suggest that clinical diagnosis should make allowances for observed differences in pelvic floor deformations between a Valsalva maneuver and a jump-landing process to ensure accuracy. Urethral hypermobility may be a less contributing factor than the intrinsic sphincteric closure system to the incontinence of young female athletes.
authors.affiliation: Department of Biomedical Engineering, University of Houston, 360 HBS Building, 4811 Calhoun Rd., Houston, TX 77004, USA. Electronic address: ncdias@uh.edu.
authors.forename: Nicholas
authors.initials: N
authors.lastname: Dias
authors.affiliation: Department of Biomedical Engineering, University of Houston, 360 HBS Building, 4811 Calhoun Rd., Houston, TX 77004, USA. Electronic address: ypeng@uh.edu.
authors.forename: Yun
authors.initials: Y
authors.lastname: Peng
authors.affiliation: Department of Urology, Houston Methodist Hospital and Research Institute, 6565 Fannin St, Suite 2100, Houston, TX 77030-2703, USA. Electronic address: rkhavari@houstonmethodist.org.
authors.forename: Rose
authors.initials: R
authors.lastname: Khavari
authors.affiliation: Department of Urology, University of Minnesota, 420 Delaware St. SE MMC 394, Minneapolis, MN 55455-0341, USA. Electronic address: naki0003@umn.edu.
authors.forename: Nissrine A
authors.initials: NA
authors.lastname: Nakib
authors.affiliation: Department of Urology, University of Minnesota, 420 Delaware St. SE MMC 394, Minneapolis, MN 55455-0341, USA. Electronic address: rsweet@umn.edu.
authors.forename: Robert M
authors.initials: RM
authors.lastname: Sweet
authors.affiliation: Department of Urology, University of Minnesota, 420 Delaware St. SE MMC 394, Minneapolis, MN 55455-0341, USA. Electronic address: timmx025@umn.edu.
authors.forename: Gerald W
authors.initials: GW
authors.lastname: Timm
authors.affiliation: Department of Mechanical Engineering, University of Minnesota, 111 Church Street SE, Minneapolis, MN 55455-0341, USA. Electronic address: agerdman@umn.edu.
authors.forename: Arthur G
authors.initials: AG
authors.lastname: Erdman
authors.affiliation: Department of Urology, Houston Methodist Hospital and Research Institute, 6565 Fannin St, Suite 2100, Houston, TX 77030-2703, USA. Electronic address: TBoone3@houstonmethodist.org.
authors.forename: Timothy B
authors.initials: TB
authors.lastname: Boone
authors.affiliation: Department of Biomedical Engineering, University of Houston, 360 HBS Building, 4811 Calhoun Rd., Houston, TX 77004, USA. Electronic address: yzhang94@uh.edu.
authors.forename: Yingchun
authors.initials: Y
authors.lastname: Zhang
mesh_terms: D003198:Computer Simulation; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D018482:Muscle, Skeletal / Q000502:physiology; D017773:Pelvic Floor / Q000000981:diagnostic imaging / Q000502:physiology*; D059385:Plyometric Exercise; D013177:Sports / Q000502:physiology*; D014521:Urethra / Q000502:physiology; D014550:Urinary Incontinence, Stress / Q000503:physiopathology; D055815:Young Adult
keywords: Female athletes; Finite element method; Pelvic floor muscle; Stress urinary incontinence; Urethral hypermobility