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Pelvic-Floor Strength in Women With Incontinence as Assessed by the Brink Scale

MP FitzGerald, MD, is Associate Professor, Division of Female Pelvic Medicine and Reconstructive Pelvic Surgery, Loyola University Medical Center, 2160 S First Ave, Bldg 103, Room 1004, Maywood, IL 60153 (USA).
KL Burgio, MD, is Professor of Medicine, Division of Gerontology, Geriatrics, and Palliative Care, University of Alabama at Birmingham, Birmingham, Ala, and Associate Director for Research, Geriatric Research, Education, and Clinical Center, Department of Veterans Affairs, Birmingham, Ala.
DF Borello-France, PT, PhD, is Associate Professor, Department of Physical Therapy, Duquesne University, Pittsburgh, Pa.
SA Menefee, MD, is Associate Clinical Professor, Department of Reproductive Medicine, University of California–San Diego, San Diego, Calif, and Director, Division of Female Pelvic Medicine & Reconstructive Surgery, Kaiser Permanente, San Diego, Calif.
J Schaffer, MD, is Professor, Chief of Gynecology and Urogynecology, Department of Obstetrics/Gynecology, University of Texas Southwestern Medical Center, Dallas, Tex.
S Kraus, MD, is Assistant Professor, Department of Surgery, Division of Urology, and Head, Section of Female Urology, Neuro-Urology and Voiding Dysfunction, University of Texas Health Services Center at San Antonio, San Antonio, Tex.
VT Mallett, MD, is Professor and Chair, Department of Obstetrics and Gynecology, University of Tennessee Health Science Center, Memphis, Tenn.
Y Xu, MS, is Statistician, New England Research Institute, Watertown, Mass.

Mfitzg8{at}lumc.edu

Background and Purpose: The purpose of this study was to describe how clinical pelvic-floor muscle (PFM) strength (force-generating capacity) is related to patient characteristics, lower urinary tract symptoms, and fecal incontinence symptoms.

Subjects: Data were obtained from 643 women who were participating in a randomized surgical trial for treatment of stress urinary incontinence.

Methods: Patient demographic variables, baseline urinary and fecal incontinence symptom questionnaires, urodynamic data and urinary diary data, pad test results, and standardized assessment of pelvic organ support were compared with PFM strength as described by the Brink scoring system. Bivariate analysis of factors associated with the Brink scale score was done using analysis of variance and linear regression. Multivariate analysis included patient variables that were significant on bivariate analysis.

Results: The mean Brink scale score was 9 (SD=2) and did not vary widely in this large, but, highly select, patient sample. We found a weak, but statistically strong, relationship between age and Brink score. Brink scores were not related to diary and pad test measures of incontinence severity.

Discussion and Conclusion: Overall, PFM strength was good in this sample of women with stress incontinence. Scores tended to be similar, and it is possible that the Brink scale does not reflect real clinical differences in PFM strength.