PELVIC FLOOR DYSFUNCTION IN CARDIOPULMONARY DISEASES: MECHANISMS, EVIDENCE, AND CLINICAL APPROACHES

Öz

Cardiopulmonary diseases are chronic conditions affecting heart and lung function and are associated with high morbidity and mortality worldwide. Common symptoms, such as chronic cough, dyspnea, and respiratory muscle dysfunction, not only compromise respiratory capacity but also impact the thoracic, abdominal, and pelvic musculo-fascial chain, leading to functional impairments and movement limitations. Pelvic floor dysfunction may develop through multidimensional mechanisms, including increased intra-abdominal pressure, diaphragmatic dysfunction, abdomino-pelvic dyssynergy, and impaired core stability. Additionally, disruptions in the gut-lung axis can affect gastrointestinal motility and excretory function, increasing the load on the pelvic floor. While cardiopulmonary diseases alone negatively affect quality of life, coexisting pelvic floor dysfunction can impose an additional burden. This review aims to systematically examine the relationships between cardiopulmonary diseases and pelvic floor dysfunction, elucidate potential pathophysiological mechanisms, and highlight the importance of clinical assessment and comprehensive rehabilitation strategies. Early diagnosis and appropriate interventions may therefore help preserve both pelvic floor and respiratory functions and improve patients’ quality of life.

Anahtar Kelimeler

• Pelvic floor
• Cardiac diseases
• Pulmonary diseases
• Quality of life
• Physiotherapy and rehabilitation

KARDİYOPULMONER HASTALIKLARDA PELVİK TABAN DİSFONKSİYONU: MEKANİZMALAR, KANITLAR VE KLİNİK YAKLAŞIMLAR

Öz

Kardiyopulmoner hastalıklar, kalp ve akciğer fonksiyonlarını etkileyen ve dünya genelinde yüksek morbidite ile mortaliteye yol açan kronik sağlık sorunlarıdır. Bu hastalıklarda sık görülen kronik öksürük, dispne ve solunum kas disfonksiyonu gibi semptomlar yalnızca solunum kapasitesini etkilemekle kalmaz; torakal, abdominal ve pelvik kas‑fasya zincirinin bütününü de etkileyerek fonksiyonel bozulmalara ve hareket kısıtlılıklarına yol açabilir. Pelvik taban disfonksiyonları; artmış intraabdominal basınç, diyafram disfonksiyonu, abdomino‑pelvik dissinerji ve kor stabilitedeki bozulmalar gibi çok boyutlu mekanizmalar aracılığıyla ortaya çıkabilir. Ayrıca bağırsak‑akciğer aksındaki işlev bozuklukları, gastrointestinal motiliteyi ve boşaltım fonksiyonlarını etkileyerek pelvik taban üzerindeki yükü artırabilir. Kardiyopulmoner hastalıklar bireylerin yaşam kalitesini tek başına olumsuz etkilerken, bu hastalığa eşlik edebilen pelvik taban disfonksiyonları yaşam kalitesi üzerinde ek bir yük oluşturabilir. Bu derlemenin amacı, kardiyopulmoner hastalıklar ile pelvik taban disfonksiyonu arasındaki ilişkileri mevcut literatür ışığında sistematik biçimde incelemek, olası patofizyolojik mekanizmaları açıklamak ve klinik değerlendirme ile bütüncül rehabilitasyon stratejilerinin önemini vurgulamaktır. Böylece, erken tanı ve uygun müdahalelerin, hem pelvik taban hem de solunum fonksiyonlarının korunmasına ve hastaların yaşam kalitesinin artırılmasına katkı sağlayabileceği ortaya koymaktadır.

Anahtar Kelimeler

• Pelvik taban
• Kardiyak hastalıklar
• Pulmoner hastalıklar
• Yaşam kalitesi
• Fizyoterapi ve rehabilitasyon

Kaynakça

1. Global Burden of Cardiovascular Diseases and Risks 2023 Collaborators. Global, regional, and national burden of cardiovascular diseases and risk factors in 204 countries and territories, 1990–2023. J Am Coll Cardiol. 2025;86(22):2167–2243. https://doi.org/10.1016/j.jacc.2025.08.015
2. Geltser BI, Kurpatov IG, Dej AA, Kozhanov AG. Respiratory muscles dysfunction and respiratory diseases. Ter Arkh. 2019;91(3):93–100. https://doi.org/10.26442/00403660.2019.03.000108
3. Yang X, Wang H, Liu A, Ni Y, Wang J, Han Y, Xie B, Geng J, Ren Y, Zhang R, Liu M, Dai H. Evaluation of respiratory muscle dysfunction in patients with idiopathic pulmonary fibrosis: a prospective observational study with magnetic resonance imaging. BMC Pulm Med. 2025;;25(1):118. https://doi.org/10.1186/s12890-025-03572-6
4. Hodges PW, Sapsford R, Pengel LH. Postural and respiratory functions of the pelvic floor muscles. Neurourol Urodyn. 2007;26(3):362–71. https://doi.org/10.1002/nau.20232
5. Kawabata M, Shima N. Interaction of breathing pattern and posture on abdominal muscle activation and intra-abdominal pressure in healthy individuals: a comparative cross-sectional study. Sci Rep. 2023;13(1):11338. https://doi.org/10.1038/s41598-023-37629-5
6. Button BM, Holland AE, Sherburn MS, Chase J, Wilson JW, Burge AT. Prevalence, impact and specialised treatment of urinary incontinence in women with chronic lung disease. Physiotherapy. 2019;105(1):114–119. https://doi.org/10.1016/j.physio.2018.07.006
7. Yang C, Feng Z, Chen Z, Xu D, Li Y, Lai K, Yi F. The risk factors for urinary incontinence in female adults with chronic cough. BMC Pulm Med. 2022;22(1):276.https://doi.org/10.1186/s12890-022-02069-w
8. Burge AT, Lee AL, Kein C, Button BM, Sherburn MS, Miller B, Holland AE. Prevalence and impact of urinary incontinence in men with chronic obstructive pulmonary disease: a questionnaire survey. Physiotherapy. 2017;103(1):53–58. https://doi.org/10.1016/j.physio.2015.11.004

9. Chen W, Gong J, Liu M, Cai YC. Long-term health outcomes and quality of life in women with untreated pelvic floor dysfunction: a single-center cohort study. Front Public Health. 2025;12:1495679. https://doi.org/10.3389/fpubh.2024.1495679
10. Moradi M, Daneshi F, Behzadmehr R, Rafiemanesh H, Bouya S, Raeisi M. Quality of life of chronic heart failure patients: a systematic review and meta-analysis. Heart Fail Rev. 2020;25(6):993–1006. https://doi.org/10.1007/s10741-019-09890-2
11. Alrajhi NS, Albarrati A, Aldhahi MI, Gwada RFM. Influence of urinary incontinence related factors on health-related quality of life in patients with chronic obstructive pulmonary disease: a cross-sectional study. Int J Chron Obstruct Pulmon Dis. 2025;20:1881–92. https://doi.org/10.2147/COPD.S515494
12. National Guideline Alliance (UK). Co-existing long-term conditions and pelvic floor dysfunction: Pelvic floor dysfunction: prevention and non-surgical management: Evidence review C. London: National Institute for Health and Care Excellence (NICE); 2021. (NICE Guideline, No. 210.) Available from: https://www.ncbi.nlm.nih.gov/books/NBK579550/
13. Cholewicki J, Juluru K, McGill SM. Intra-abdominal pressure mechanism for stabilizing the lumbar spine. J Biomech. 1999;32(1):13–7. https://doi.org/10.1016/s0021-9290(98)00129-8
14. Liu X, Rong Q, Liu Y, Wang J, Xie B, Ren S. Relationship between high intra-abdominal pressure and compliance of the pelvic floor support system in women without pelvic organ prolapse: a finite element analysis. Front Med (Lausanne). 2022;9:820016. https://doi.org/10.3389/fmed.2022.820016
15. Simpson S, Deeble M, Thompson J, Andrews A, Briffa K. Should women with incontinence and prolapse do abdominal curls? Int Urogynecol J. 2016;27(10):1507–12. https://doi.org/10.1007/s00192-016-3005-9
16. Yamasato KS, Oyama IA, Kaneshiro B. Intraabdominal pressure with pelvic floor dysfunction: do postoperative restrictions make sense? J Reprod Med. 2014;59(7-8):409–13.
17. Haukeland-Parker S, Frisk B, Spruit MA, Stafne SN, Johannessen HH. Treatment of urinary incontinence in women with chronic obstructive pulmonary disease—a randomised controlled study. Trials. 2021;22(1):900. https://doi.org/10.1186/s13063-021-05816-2
18. Muro S, Akita K. Pelvic floor and perineal muscles: a dynamic coordination between skeletal and smooth muscles on pelvic floor stabilization. Anat Sci Int. 2023;98(3):407–425. https://doi.org/10.1007/s12565-023-00717-7
19. Sicilia-Gomez C, Fernández-Carnero S, Martin-Perez A, Cuenca-Zaldívar N, Naranjo-Cinto F, Pecos-Martín D, Cervera-Cano M, Nunez-Nagy S. Abdominal and pelvic floor activity related to respiratory diaphragmatic activity in subjects with and without non-specific low back pain. Diagnostics (Basel). 2022;12(10):2530. https://doi.org/10.3390/diagnostics12102530
20. Park H, Han D. The effect of the correlation between the contraction of the pelvic floor muscles and diaphragmatic motion during breathing. J Phys Ther Sci. 2015;27(7):2113–5. https://doi.org/10.1589/jpts.27.2113
21. Golec J, Gamrot S, Michalik M, Sulowska-Daszyk I, Nowak M, Balicka-Bom J. Effects of diaphragmatic therapy on pelvic floor muscle activity, stress levels, and sexual life satisfaction in Polish women. Appl Sci. 2025;15:12055. https://doi.org/10.3390/app152212055
22. Ottenheijm CA, Heunks LM, Sieck GC, Zhan WZ, Jansen SM, Degens H, de Boo T, Dekhuijzen PN. Diaphragm dysfunction in chronic obstructive pulmonary disease. Am J Respir Crit Care Med. 2005;172(2):200–5. https://doi.org/10.1164/rccm.200502-262OC
23. Korkmaz Dayican D, Keser I, Celiker Tosun O, Yavuz O, Tosun G, Kurt S, Baser Secer M. Exercise position to improve synergy between the diaphragm and pelvic floor muscles in women with pelvic floor dysfunction: a cross-sectional study. J Manipulative Physiol Ther. 2023;46(4):201–211. https://doi.org/10.1016/j.jmpt.2024.02.005
24. Talasz H, Kremser C, Talasz HJ, Kofler M, Rudisch A. Breathing, (S)Training and the pelvic floor—a basic concept. Healthcare (Basel). 2022;10(6):1035. https://doi.org/10.3390/healthcare10061035
25. Seo H, Jeong G, Chun B. Impact of diaphragm-strengthening core training on postural stability in high-intensity squats. Life (Basel). 2024;14(12):1612. https://doi.org/10.3390/life14121612
26. Song X, Dou X, Chang J, Zeng X, Xu Q, Xu C. The role and mechanism of gut-lung axis mediated bidirectional communication in the occurrence and development of chronic obstructive pulmonary disease. Gut Microbes. 2024;16(1):2414805. https://doi.org/10.1080/19490976.2024.2414805
27. Wang L, Cai Y, Garssen J, Henricks PAJ, Folkerts G, Braber S. The bidirectional gut-lung axis in chronic obstructive pulmonary disease. Am J Respir Crit Care Med. 2023;207(9):1145–1160. https://doi.org/10.1164/rccm.202206-1066TR
28. Chiu YC, Lee SW, Liu CW, Lan TY, Wu LS. Relationship between gut microbiota and lung function decline in patients with chronic obstructive pulmonary disease: a 1-year follow-up study. Respir Res. 2022;23(1):10. https://doi.org/10.1186/s12931-022-01928-8
29. Aigon A, Billecocq S. Prevalence and impact on quality of life of urinary incontinence in an adult population with chronic obstructive pulmonary diseases: a literature review [originally published in French]. Prog Urol. 2018;28(17):962–972. https://doi.org/10.1016/j.purol.2018.08.016
30. Abrams P, Avery K, Gardener N, Donovan J; ICIQ Advisory Board. The International Consultation on Incontinence Modular Questionnaire: www.iciq.net. J Urol. 2006;175(3 Pt 1), 1063–1066. https://doi.org/10.1016/S0022-5347(05)00348-4
31. Barber MD, Walters MD, Bump RC. Short forms of two condition-specific quality-of-life questionnaires for women with pelvic floor disorders (PFDI-20 and PFIQ-7). Am J Obstet Gynecol. 2005;193(1):103–13. https://doi.org/10.1016/j.ajog.2004.12.025
32. Frank L, Kleinman L, Farup C, Taylor L, Miner P Jr. Psychometric validation of a constipation symptom assessment questionnaire. Scand J Gastroenterol. 1999;34(9):870–7. https://doi.org/10.1080/003655299750025327
33. Hunt CW, Cavallaro PM, Bordeianou LG. Metrics used to quantify fecal incontinence and constipation. Clin Colon Rectal Surg. 2021;34(1):5–14. https://doi.org/10.1055/s-0040-1714245
34. Yakıt Yeşilyurt S, Şahiner Pıçak G, Başol Göksülük M, Balıkoğlu M, Özengin N. Investigating the effectiveness of pelvic floor muscle training, including sensor-based diaphragm exercises in women with stress urinary incontinence: a randomized controlled study. Arch Phys Med Rehabil. 2025;S0003-9993(25)00796-8.https://doi.org/10.1016/j.apmr.2025.06.019
35. Parra NS, Jaramillo AP, Zambrano J, Segovia D, Castells J, Revilla JC. The effectiveness of pelvic floor muscle exercise in urinary incontinence: a systematic literature review and meta-analysis. Cureus. 2023;15(9):e45011. https://doi.org/10.7759/cureus.45011
36. Gerlegiz ENA, Akbayrak T, Gürşen C, Yazici MS, Bolat NM, Akdoğan B, Nakip G, Özgül S. Lifestyle recommendations and pelvic floor muscle training with Knack maneuver for post-prostatectomy urinary incontinence: a randomized controlled trial. Support Care Cancer. 2025;33(2):132. https://doi.org/10.1007/s00520-025-09197-z
37. Toprak N, Sen S, Varhan B. The role of diaphragmatic breathing exercise on urinary incontinence treatment: a pilot study. J Bodyw Mov Ther. 2022;29:146–53. https://doi.org/10.1016/j.jbmt.2021.10.002
38. Yagli MD, Capan N, Cakmak ET, Ugurlucan FG, Yasa C, Karan A. Efficacy of core stabilization exercises in women with stress and stress-dominant mixed urinary incontinence: a prospective, randomized controlled study. Int Urogynecol J. 2025;36(11):2191–2201. https://doi.org/10.1007/s00192-025-06115-z
39. Nipa SI, Sriboonreung T, Paungmali A, Phongnarisorn C. The effects of pelvic floor muscle exercise combined with core stability exercise on women with stress urinary incontinence following the treatment of nonspecific chronic low back pain. Adv Urol. 2022;2051374. https://doi.org/10.1155/2022/2051374
40. Celenay ST, Korkut Z, Bulbul SB, Altay H, Oskay K. Effects of spinal stabilization exercises focusing on the pelvic floor in women with overactive bladder. Int Urogynecol J. 2023;34(12):2959–2967. https://doi.org/10.1007/s00192-023-05638-7
41. Sundus H, Khan N, Mohammad N. Rehabilitation strategies for managing urinary incontinence in COPD: a review of literature. Bull Fac Phys Ther. 2023;28:49. https://doi.org/10.1186/s43161-023-00160-9
42. Adis Medical Writers. Manage urinary incontinence in COPD depending on whether it is stress, urge or mixed. Drugs Ther Perspect. 2020;36:230–33. https://doi.org/10.1007/s40267-020-00735-9
43. Sun Y, Zheng F, Li Y, Wu R, Liu Y, Liu M, Zhang J, Gao K. Correlation between lower gastrointestinal tract symptoms and quality of life in patients with stable chronic obstructive pulmonary disease. J Tradit Chin Med. 2013;33(5):608–14. https://doi.org/10.1016/s0254-6272(14)60029-7
44. Ishida T, Kawada K, Jobu K, Hamada T, Kubo T, Okazaki M, Kawai K, Nakaoka Y, Yabe T, Furuno T, Yamada E, Kitaoka H, Hamada Y. Impact of comorbid constipation on the survival of patients with heart failure: a multicenter, prospective cohort study conducted in Japan. Front Cardiovasc Med. 2025;11:1470216. https://doi.org/10.3389/fcvm.2024.1470216
45. Namiuchi S, Tanita A, Sunamura S, Onodera K, Ogata T, Noda K, Takii T, Nitta Y, Yoshida S. Effect of constipation on readmission for heart failure in patients with acute heart failure. ESC Heart Fail. 2024;11(2):819–825. https://doi.org/10.1002/ehf2.14650
46. Isogai T, Morita K, Okada A, Michihata N, Matsui H, Miyawaki A, Yasunaga H. Association between coexisting constipation and heart failure readmission in patients with heart failure: a nationwide database study. Circ Rep. 2024;6(11):529–35. https://doi.org/10.1253/circrep.CR-24-0060
47. Zhu M, Sim J, Okada C, Kim J, Abraham N. Association between respiratory disease and stress urinary incontinence: an analysis of the 2015–2020 National Health and Nutrition Examination Survey. Neurourol Urodyn. 2023;42(6):1280–1289. https://doi.org/10.1002/nau.25217
48. Külekçi Y, Barğı G, Yıldız S. Urinary incontinence in individuals with asthma. Izmir Democracy Univ Health Sci J. 2025;8(1):38–47. https://doi.org/10.52538/iduhes.1606370
49. Azevedo IG, Sousa SLO, Viana ESR, Dantas DS, Maciel ÁCC, Da Câmara SMA. Relationship between symptomatic pelvic organ prolapse and respiratory muscle strength in middle-aged and older women in Northeast Brazil: a cross-sectional study. Physiother Theory Pract. 2021;37(6):755–61. https://doi.org/10.1080/09593985.2019.1642428
50. Yüksel F, Guzel NA, Taspinar B, Balaban A. Relationship between trunk muscle endurance, pulmonary function, and respiratory muscle strength in healthy individuals. Turk Fizyoter Rehabil Derg. 2020;31(3):255–62. https://doi.org/10.21653/tjpr.642915
51. Carrasco Garrido P, de Miguel Díez J, Rejas Gutiérrez J, Centeno AM, Gobartt Vázquez E, Gil de Miguel A, García Carballo M, Jiménez García R. Negative impact of chronic obstructive pulmonary disease on the health-related quality of life of patients: results of the EPIDEPOC study. Health Qual Life Outcomes. 2006;4:31. https://doi.org/10.1186/1477-7525-4-31
52. Karapolat H, Eyigor S, Atasever A, Zoghi M, Nalbantgil S, Durmaz B. Effect of dyspnea and clinical variables on the quality of life and functional capacity in patients with chronic obstructive pulmonary disease and congestive heart failure. Chin Med J (Engl). 2008;121(7):592–96.