The ability of the pelvic floor muscles to perform adequate contraction and relaxation functions is closely related to the muscle strength of the hip muscles and femoral anteversion (1), but no study has been found examining the relationship between the amount of pelvic floor activation and hip muscle strength and femoral anteversion in children with bladder bowel dysfunction (BBD). Our hypothesis is, "As pelvic floor muscle activation decreases in children diagnosed with BBD, the femoral anteversion angle and hip agonist-antagonist force ratios increase in favor of internal rotators, extensors, and adductors."

This is a prospective, cross-sectional study conducted on children aged 5-12 years who were diagnosed with BBD by a pediatric urologist in 2022 and 2023. Before starting the study, ethics committee approval was obtained, and clinical trial registration was completed (NCT05182671). Demographic evaluations of the children, pelvic floor EMG measurements, femoral anteversion, hip internal rotation (IR), external rotation (ER), abduction, adduction, flexion, and extension muscle strength measurements were completed on the same day by the same physiotherapist. Pelvic floor muscle activity (work and rest minimum, work and rest average, work and rest deviation, work and rest maximum voluntary contraction), femoral anteversion, and hip strength measurement were assessed with relatively, the NeuroTrac Myoplus4 Pro device, Craig test, and MicroFET hand dynamometer. All data were analyzed with the SPSS software program (IBM, SPSS version 25, Chicago, IL, USA). Correlation analysis was done with the Pearson test.

50 children (female=27, male=23) with a mean age of 9.12±2.67 years and a BMI of 18.18±4.03 kg/m2 were included in the study (Table 1). Work minimum, rest average, and rest minimum values (r=0.36, p=0.013; r=0.32 p=0.026; r=0.43, p=0.003, respectively), and extension/flexion strength ratio were positively correlated. Rest average and rest average deviation values (r=0.3, p=0.031; r=0.30, p=0.039, respectively) and IR/ER force ratio were positively correlated. Work minimum value and femoral anteversion angle were negatively correlated (r=-0.32, p=0.031) (Table 2).

Hip extensor-flexor strength imbalance increases the minimum amount of contraction required for pelvic floor muscle contraction to occur, the average resting basal tone of the pelvic floor, and the minimum activation value required for relaxation of the pelvic floor. Hip IR and ER force imbalance increases the pelvic floor contraction tone at rest. As the femoral anteversion angle decreases, the minimum contraction amount required for pelvic floor muscle contraction increases.

There is a need for further studies examining lower extremity anatomical angles and proximal muscle force imbalance in children with BBD according to age and gender categories.

Snijders, C. J., Vleeming, A., & Stoeckart, R. (1993). Transfer of lumbosacral load to iliac bones and legs Part 1: Biomechanics of self-bracing of the sacroiliac joints and its significance for treatment and exercise. Clin Biomech (Bristol, Avon), 8(6), 285-294. doi:10.1016/0268-0033(93)90002-y