Characterisation of Pelvic Floor Muscle Activation in Adults With Intellectual Disability Using Surface Electromyography: A Comparative Cross-Sectional Study.
Ana López-Lezcano, Manuel Rozalén-Bustín, Sara Cerrolaza-Tudanca and 5 others
PMID 42670647WHAT IT FOUND
Adults with intellectual disability produced significantly lower and more variable pelvic floor muscle contractions than matched controls, even without current incontinence.
After adjusting for age, sex, and body size, the difference remained, pointing to the disability itself as the factor.
Key findings
01The primary outcome — mean EMG activity during voluntary pelvic floor contraction — was significantly lower in the intellectual disability group than in the control group, with greater between-person variability in the ID group.
02In a multiple regression adjusting for age, sex, and BMI, intellectual disability was the only variable significantly associated with lower mean pelvic floor activation; age, sex, and BMI were not.
03No significant between-group differences were found in post-contraction signal reduction, resting signal variability, or relaxation time, suggesting the difference is concentrated in the active contraction phase rather than recovery.
STILL TO COME
How it was doneWhat they foundWhat it means for PTs
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What it does not show
Cross-sectional design: the study shows a difference at one time point, not a cause-and-effect relationship or a change over time. Convenience sampling from two specific centres in Spain; generalisability to other settings, severities of ID, or other populations is uncertain. Surface EMG over the external anal sphincter cannot isolate individual pelvic floor muscles (levator ani, bulbospongiosus, etc.) and does not measure force directly. No normalisation procedure was applied; values are in absolute microvolts, which limits comparison across individuals of different body sizes. The degree of disability, neurological comorbidities, and physical training history were not controlled for. Participants with ID varied in comprehension and collaboration, which may have affected task performance. Only voluntary contractions were assessed; reflex contractions (e.g., cough-induced) were not included, so automatic neuromuscular control is not characterised. Participants with current incontinence, prior pelvic floor dysfunction, pelvic surgery, or neuromuscular-affecting medication were excluded, so the findings describe people without a current continence diagnosis. The authors state this is, to their knowledge, the first study of its kind in this population; no prior data exist to benchmark the effect size.
Declared interests
The authors report no funding and declare no conflicts of interest.
The easy way to misread this
Do not read this as evidence that every adult with intellectual disability has a pelvic floor disorder or needs pelvic floor therapy. The study specifically excluded people with current incontinence, diagnosed pelvic floor dysfunction, or pelvic surgery, so it describes a different EMG activation pattern in people who do not have a current continence problem. It also measured only the external anal sphincter region with surface electrodes, not the full pelvic floor, and only voluntary contractions. Reflex responses during coughing or straining were not assessed. A single cross-sectional EMG reading in one person does not establish a clinical diagnosis or a treatment need.