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Sharon-Saban T1,2, Dar G1
1University of Haifa, Physiotherapy, Haifa, Israel, 2Clalit Health Services, Physiotherapy, Kiryat-Ata, Israel
Background: Pelvic floor muscles (PFM) training is the first line treatment for urinary stress incontinence. Nevertheless, some women are unable to contract the PFM voluntarily. The literature lacks evidence about the possible influence of repeating instructions to contract these muscles enhance awareness of the women and improve contraction ability and functionality of the PFM.
Purpose: To investigate if repeated instructions during exercise classes to contract the PFM can improve the awareness of women to their PFM, their contraction ability and their PFM functionality.
Methods: The study population included 49 women who participated in Pilate´s classes for at least 1 year. The study group included 23 volunteers who were repeatedly instructed to contract their PFM during the classes and a control group included 26 volunteers who were not so instructed.
The PFM contraction ability and function were evaluated by transabdominal ultrasound imaging under four conditions:
(a) rest;
(b) while voluntarily contracting the PFM following verbal instruction;
(c) while raising the right knee towards the chest, without any instruction regarding the PFM;
(d) while raising the right knee towards the chest with an instruction to contract the PFM.
The PFM awareness was assessed simultaneously, by asking the women about their personal evaluation of their PFM contraction during each of these conditions. The awareness was concluded as acceptable if their subjective report matched the objective examination.
Results: No significant differences were found between research groups regarding awareness, ability to contract or functioning of the PFM.
In both groups, the PFM awareness was acceptable in 80.4% women. Approximately one-fifth of the women were unable to contract their PFM at all, but none of them reversed the contraction and push down. Most of the women (91.3%) did not contract their PFM while raising their leg, even when this movement caused depression of the pelvic floor (at 30.4% of the cases). An explicit instruction to contract the PFM during this motion prevented the depression in two-thirds of the women who showed depression without this instruction.
A phenomenon of bracing the abdominal muscles was found among the control group compared with the study group when they instructed to contract the PFM while raising their knee (50% and 22.7% respectively, p=0.056).
Conclusion(s): Repeating instruction to contract the PFM does not improve the women´s awareness, contraction ability or function of the PFM. Nevertheless, it is still recommended to repeatedly remind women to contract their PFM while guiding exercises, because explicit instruction to contract the PFM can prevent depression of the pelvic floor, at least in some women. In addition, women who were repeatedly instructed to contract the PFM tended to control the contraction more easily, with less bracing of their abdominal muscles.
Additional studies are required to evaluate the influence of repeating reminder during exercise classes on urinary incontinence and/or pelvic organ prolapse.
Implications: Physiotherapists should repeatedly instruct their female patients to contract their PFM while guiding exercises, since such explicit instruction might prevent pelvic floor depression and hence might prevent future damage.
Keywords: Pelvic Floor Muscles, Urinary Incontinence, Women's Health
Funding acknowledgements: The work is unfunded
Purpose: To investigate if repeated instructions during exercise classes to contract the PFM can improve the awareness of women to their PFM, their contraction ability and their PFM functionality.
Methods: The study population included 49 women who participated in Pilate´s classes for at least 1 year. The study group included 23 volunteers who were repeatedly instructed to contract their PFM during the classes and a control group included 26 volunteers who were not so instructed.
The PFM contraction ability and function were evaluated by transabdominal ultrasound imaging under four conditions:
(a) rest;
(b) while voluntarily contracting the PFM following verbal instruction;
(c) while raising the right knee towards the chest, without any instruction regarding the PFM;
(d) while raising the right knee towards the chest with an instruction to contract the PFM.
The PFM awareness was assessed simultaneously, by asking the women about their personal evaluation of their PFM contraction during each of these conditions. The awareness was concluded as acceptable if their subjective report matched the objective examination.
Results: No significant differences were found between research groups regarding awareness, ability to contract or functioning of the PFM.
In both groups, the PFM awareness was acceptable in 80.4% women. Approximately one-fifth of the women were unable to contract their PFM at all, but none of them reversed the contraction and push down. Most of the women (91.3%) did not contract their PFM while raising their leg, even when this movement caused depression of the pelvic floor (at 30.4% of the cases). An explicit instruction to contract the PFM during this motion prevented the depression in two-thirds of the women who showed depression without this instruction.
A phenomenon of bracing the abdominal muscles was found among the control group compared with the study group when they instructed to contract the PFM while raising their knee (50% and 22.7% respectively, p=0.056).
Conclusion(s): Repeating instruction to contract the PFM does not improve the women´s awareness, contraction ability or function of the PFM. Nevertheless, it is still recommended to repeatedly remind women to contract their PFM while guiding exercises, because explicit instruction to contract the PFM can prevent depression of the pelvic floor, at least in some women. In addition, women who were repeatedly instructed to contract the PFM tended to control the contraction more easily, with less bracing of their abdominal muscles.
Additional studies are required to evaluate the influence of repeating reminder during exercise classes on urinary incontinence and/or pelvic organ prolapse.
Implications: Physiotherapists should repeatedly instruct their female patients to contract their PFM while guiding exercises, since such explicit instruction might prevent pelvic floor depression and hence might prevent future damage.
Keywords: Pelvic Floor Muscles, Urinary Incontinence, Women's Health
Funding acknowledgements: The work is unfunded
Topic: Women's & men's pelvic health
Ethics approval required: Yes
Institution: University of Haifa
Ethics committee: Institutional ethics board
Ethics number: approval no. 225/16
All authors, affiliations and abstracts have been published as submitted.
