International Urogynecology Journal

, Volume 30, Issue 11, pp 1903–1909 | Cite as

Pelvic floor muscle knowledge and relationship with muscle strength in Brazilian women: a cross-sectional study

  • Leticia Maciel de Freitas
  • Kari Bø
  • Ana Carolina Nociti Lopes Fernandes
  • Natalia Uechi
  • Thaiana Bezerra Duarte
  • Cristine Homsi Jorge FerreiraEmail author
Original Article


Introduction and hypothesis

There seems to be little knowledge about pelvic floor muscles (PFMs) in the general population; however, literature confirming this assertion is scarce, especially in developing countries. The present study hypothesized a low level of knowledge about PFMs in a sample of Brazilian women and a positive relationship between that knowledge and the ability to contract the PFMs, strength, and urinary continence.


This was a cross-sectional study including 133 women. A questionnaire assessing knowledge about PFMs and the International Consultation on Incontinence Questionnaire-Short Form (ICIQ-UI-SF) were applied. Vaginal palpation and manometry were used to assess PFM condition. Pearson’s correlation coefficient was used to test the association between PFM knowledge and continuous variables, and Fisher’s exact test was used to compare the women’s PFM knowledge with the categorical variables.


A low level of PFM knowledge was observed in this sample, with a mean total score of 0.48 (±0.97). Vaginal manometry peak, mean, and duration values were 39.1 cmH2O (±23.7), 25.5 cmH2O (±16.1), and 21.1 s (±20.8) respectively. The ICIQ-UI-SF mean score was 7.1 (± 6.8). There were weak correlations between PFM knowledge and age (r −0.2044/ p = 0.01), and parity (r −0.19568/p = 0.02). PFM knowledge was higher among women with higher education levels (p = 0.0012) and those who had previously performed PFM training (p <0.001).


The participants showed a low level of PFM knowledge. No relationship between PFM knowledge and ability to contract or prevalence of UI was observed.


Pelvic floor Muscle function Urinary incontinence 


Compliance with ethical standards

Conflicts of interest



  1. 1.
    Neels H, Wyndaele JJ, Tjalma WA, De Wachter S, Wyndaele M, Vermandel A. Knowledge of the pelvic floor in nulliparous women. J Phys Ther Sci. 2016;28(5):1524–33.CrossRefGoogle Scholar
  2. 2.
    Neels H, Tjalma WA, Wyndaele JJ, De Wachter S, Wyndaele M, Vermandel A. Knowledge of the pelvic floor in menopausal women and in peripartum women. J Phys Ther Sci. 2016;28(11):3020–9.CrossRefGoogle Scholar
  3. 3.
    Liao YM, Dougherty MC, Liou YS, Tseng J. Pelvic floor muscle training effect on urinary incontinence knowledge, attitudes, and severity: an experimental study. Int J Nurs Stud. 2006;43(1):29–37.CrossRefGoogle Scholar
  4. 4.
    Berzuk K, Shay B. Effect of increasing awareness of pelvic floor muscle function on pelvic floor dysfunction: a randomized controlled trial. Int Urogynecol J. 2015;26(6):837–44.CrossRefGoogle Scholar
  5. 5.
    Shah AD, Massagli MP, Kohli N, Rajan SS, Braaten KP, Hoyte L. A reliable, valid instrument to assess patient knowledge about urinary incontinence and pelvic organ prolapse. Int Urogynecol J. 2008;19(9):1283.CrossRefGoogle Scholar
  6. 6.
    Kiyosaki K, Ackerman AL, Histed S, Sevilla C, Eilber K, Maliski S, et al. Patient understanding of pelvic floor disorders: what women want to know. Female Pelvic Med Reconstr Surg. 2012;18(3):137.CrossRefGoogle Scholar
  7. 7.
    Almousa S, Van Loon AB. The prevalence of urinary incontinence in nulliparous adolescent and middle-aged women and the associated risk factors: a systematic review. Maturitas. 2018;107:78–83.CrossRefGoogle Scholar
  8. 8.
    Dumoulin C, Hay-Smith J, Habée-Séguin GM, Mercier J. Pelvic floor muscle training versus no treatment, or inactive control treatments, for urinary incontinence in women: a short version Cochrane systematic review with meta-analysis. Neurourol Urodyn. 2015;34(4):300–8.CrossRefGoogle Scholar
  9. 9.
    O’Neill AT, Hockey J, O’Brien P, et al. Knowledge of pelvic floor problems: a study of third trimester, primiparous women. Int Urogynecol J. 2017;28(1):125–9.CrossRefGoogle Scholar
  10. 10.
    Woodley SJ, Boyle R, Cody JD, Mørkved S, Hay-Smith EJC. Pelvic floor muscle training for prevention and treatment of urinary and faecal incontinence in antenatal and postnatal women. Cochrane Database Syst Rev. 2017;10:CD007471.Google Scholar
  11. 11.
    Smith AL, Nissim HA, Le TX, et al. Misconceptions and miscommunication among aging women with overactive bladder symptoms. Urology. 2011;77(1):55–9.CrossRefGoogle Scholar
  12. 12.
    Doshani A, Pitchforth E, Mayne CJ, Tincello DG. Culturally sensitive continence care: a qualitative study among south Asian Indian women in Leicester. Fam Pract. 2007;24(6):585–93.CrossRefGoogle Scholar
  13. 13.
    Hay-Smith J, Herderschee R, Dumoulin C, Herbison P. Comparisons of approaches to pelvic floor muscle training for urinary incontinence in women: an abridged Cochrane systematic review. Eur J Phys Rehabil Med. 2012;48(4)689–705.PubMedGoogle Scholar
  14. 14.
    Bø K, Frawley HC, Haylen BT, et al. An International Urogynecological Association (IUGA)/International Continence Society (ICS) joint report on the terminology for the conservative and nonpharmacological management of female pelvic floor dysfunction. Int Urogynecol J. 2017;28(2):191–213.CrossRefGoogle Scholar
  15. 15.
    De Andrade RL, Bø K, Antonio FI et al. An education program about pelvic floor muscles improved women’s knowledge but not pelvic floor muscle function, urinary incontinence or sexual function: a randomised trial. J Physiother. 2018;64(2):91–6.CrossRefGoogle Scholar
  16. 16.
    Tamanini JTN, Almeida FG, Girotti ME, et al. The Portuguese validation of the International Consultation on Incontinence Questionnaire—Vaginal Symptoms (ICIQ-VS) for Brazilian women with pelvic organ prolapse. Int Urogynecol J. 2008;19(10):1385–91.CrossRefGoogle Scholar
  17. 17.
    Laycock J, Jerwood D. Pelvic floor muscle assessment: the PERFECT scheme. Physiotherapy. 2001;87(12):631–42.CrossRefGoogle Scholar
  18. 18.
    Frawley HC, Galea MP, Phillips BA, Sherburn M, Bø K. Reliability of pelvic floor muscle strength assessment using different test positions and tools. Neurourol Urodyn. 2006;25(3):236–42.CrossRefGoogle Scholar
  19. 19.
    Navarro Brazález B, Torres Lacomba M, de la Villa P, et al. The evaluation of pelvic floor muscle strength in women with pelvic floor dysfunction: a reliability and correlation study. Neurourol Urodyn. 2008;37(1):269–77.CrossRefGoogle Scholar
  20. 20.
    Bø K, Kvarstein B, Hagen RR, Larsen S. Pelvic floor muscle exercise for the treatment of female stress urinary incontinence. II. Validity of vaginal pressure measurements of pelvic floor muscle strength and the necessity of supplementary methods for control of correct contraction. Neurourol Urodyn. 1990;9(5):479–87.CrossRefGoogle Scholar
  21. 21.
    Hill AM, McPhail SM, Wilson JM, Berlach RG. Pregnant women’s awareness, knowledge and beliefs about pelvic floor muscles: a cross-sectional survey. Int Urogynecol J. 2017;28(10):1557–65.CrossRefGoogle Scholar
  22. 22.
    Dunivan GC, Komesu YM, Cichowski SB, Lowery C, Anger JT, Rogers RG. Elder American Indian women’s knowledge of pelvic floor disorders and barriers to seeking care. Female Pelvic Med Reconstr Surg. 2015;21(1):34.CrossRefGoogle Scholar
  23. 23.
    Jackson E, Hernandez L, Mallett VT, Montoya TI. Knowledge, perceptions, and attitudes toward pelvic organ prolapse and urinary incontinence in Spanish-speaking Latinas. Female Pelvic Med Reconstr Surg. 2017;23(5):324–8.CrossRefGoogle Scholar
  24. 24.
    AlGhamdi KM, Almohedib MA. Internet use by dermatology outpatients to search for health information. Int J Dermatol. 2011;50(3):292–9.CrossRefGoogle Scholar
  25. 25.
    Instituto brasileiro de geografia e estatística–IBGE. Atlas do censo demográfico 2010. Rio de Janeiro: IBGE; 2013.Google Scholar

Copyright information

© The International Urogynecological Association 2018

Authors and Affiliations

  1. 1.Postgraduate Program in Rehabilitation and Functional Performance, Department of Health Science, Ribeirão Preto Medical SchoolUniversity of São PauloRibeirão PretoBrazil
  2. 2.Department of Sports Medicine and Akershus University HospitalNorwegian School of Sport SciencesLørenskogNorway
  3. 3.Universidade de São PauloRibeirão PretoBrazil

Personalised recommendations