Ben Ami N1, Dar G2,3
1Ariel University, Physiotherapy, Ariel, Israel, 2Haifa University, Physiotherapy, Haifa, Israel, 3Ribstein Center for Research and Sports Medicine, Wingate Institute, Physiotherapy, Netanya, Israel
Background: Urinary incontinence (UI) is a common problem affecting women of all ages and negatively affect their quality of life. High-quality evidence confirms that pelvic floor muscle (PFM) training reduces stress and mixed urinary incontinence. Teaching and assessing PFM contraction is a challenging task, for physiotherapists and patients, as these muscles, cannot be directly visualized and therapists cannot demonstrate their contraction. They are usually evaluated clinically via digital vaginal palpation. This procedure might not be appropriate for certain populations.
Transabdominal ultrasound is non-invasive and recommended as a valid instrument to measure the displacement of the bladder, thereby, the correctness of the PFM Contraction. One of the advantages of a transabdominal ultrasound is that a woman does not have to undress and the pelvic floor movement during contraction can be directly visualized and assessed. Our hypothesis was that the most effective verbal instruction would be to "squeeze the anus”.
Purpose: The main purpose of the present study was to compare the effectiveness of four different verbal instructions for correctly contracting the pelvic floor muscles (PFM), measured as a displacement of the pelvic floor when imaged on transabdominal ultrasound.
Methods: Fifty-six female undergraduate physiotherapy students, mean age 24.2± 2.5 years, participated in the study. A 6 MHz 35-mm curved linear array ultrasound transducer (Mindray M5) was placed in the transverse plane, suprapubically over the lower abdomen and angled at 15-30○ from the vertical plane. The participants were randomly divided into two groups: posterior and anterior. Each group received four different verbal instructions to contract the PFMs. Only one verbal instruction differed between the groups: "squeeze the anus" (posterior group) compared with "stop the flow of urine" (anterior group).
Results: In the posterior group, 27 participants (90%) performed a correct contraction compared with 17 participants (65%) in the anterior group, thus demonstrating a statistically significant difference in favor of the "anus" instruction (p=0.025). Forty-seven participants (84%) exhibited a downward movement during the verbal instruction combining transversus abdominis contractions with breathing, i.e. "take a moderate breath in, let the breath out then draw in and lift your pelvic floor".
Conclusion(s): Our findings suggest that the most effective verbal instruction for correctly contracting the PFMs among 56 physiotherapy students was the posterior instruction of "squeezing the anus”. The majority (90%) of participants succeeded in correctly contracting the PFMs. Using the abdominal muscle during contraction decreased correct contraction, displacement and endurance.
Our results should be confirmed using a larger sample comprised of older adults with various PFM disorders. Further studies are being conducted now on different patient´s populations.
Implications: Our study results can influence and assist women health. Many women perform exercises such as yoga, Pilates, etc to strengthen their PFMs, without the aid of a physiotherapist who would determine if the contraction is being executed correctly. Therefore, by using a simple verbal cue such as "squeeze your anus”, the likelihood of a correct contraction is increased.
Keywords: Pelvic floor muscle contraction, Transabdominal Ultrasound, Verbal instruction
Funding acknowledgements: None
Acknowledgments: We thank the physiotherapy students who participated in the study.
Transabdominal ultrasound is non-invasive and recommended as a valid instrument to measure the displacement of the bladder, thereby, the correctness of the PFM Contraction. One of the advantages of a transabdominal ultrasound is that a woman does not have to undress and the pelvic floor movement during contraction can be directly visualized and assessed. Our hypothesis was that the most effective verbal instruction would be to "squeeze the anus”.
Purpose: The main purpose of the present study was to compare the effectiveness of four different verbal instructions for correctly contracting the pelvic floor muscles (PFM), measured as a displacement of the pelvic floor when imaged on transabdominal ultrasound.
Methods: Fifty-six female undergraduate physiotherapy students, mean age 24.2± 2.5 years, participated in the study. A 6 MHz 35-mm curved linear array ultrasound transducer (Mindray M5) was placed in the transverse plane, suprapubically over the lower abdomen and angled at 15-30○ from the vertical plane. The participants were randomly divided into two groups: posterior and anterior. Each group received four different verbal instructions to contract the PFMs. Only one verbal instruction differed between the groups: "squeeze the anus" (posterior group) compared with "stop the flow of urine" (anterior group).
Results: In the posterior group, 27 participants (90%) performed a correct contraction compared with 17 participants (65%) in the anterior group, thus demonstrating a statistically significant difference in favor of the "anus" instruction (p=0.025). Forty-seven participants (84%) exhibited a downward movement during the verbal instruction combining transversus abdominis contractions with breathing, i.e. "take a moderate breath in, let the breath out then draw in and lift your pelvic floor".
Conclusion(s): Our findings suggest that the most effective verbal instruction for correctly contracting the PFMs among 56 physiotherapy students was the posterior instruction of "squeezing the anus”. The majority (90%) of participants succeeded in correctly contracting the PFMs. Using the abdominal muscle during contraction decreased correct contraction, displacement and endurance.
Our results should be confirmed using a larger sample comprised of older adults with various PFM disorders. Further studies are being conducted now on different patient´s populations.
Implications: Our study results can influence and assist women health. Many women perform exercises such as yoga, Pilates, etc to strengthen their PFMs, without the aid of a physiotherapist who would determine if the contraction is being executed correctly. Therefore, by using a simple verbal cue such as "squeeze your anus”, the likelihood of a correct contraction is increased.
Keywords: Pelvic floor muscle contraction, Transabdominal Ultrasound, Verbal instruction
Funding acknowledgements: None
Acknowledgments: We thank the physiotherapy students who participated in the study.
Topic: Women's & men's pelvic health
Ethics approval required: Yes
Institution: Ariel University, Israel
Ethics committee: ethics committee of Ariel University, Israel.
Ethics number: AU-NBA-20171221
All authors, affiliations and abstracts have been published as submitted.
