The aim of this study was to observe the abdominal and pelvic floor muscle reaction to an increase in intra-abdominal pressure in both continent and incontinent women. We performed a case control study using a convenience sample of 100 women, seen at two sites. Forty-eight were taken from a group of women with urinary incontinence seen at a tertiary care center, and 52 were studied during a routine gynecologic evaluation at a primary care center. The examination consisted of observation and palpation of the pelvic floor and abdomen during the command to cough and tighten the perineal muscles. The majority of incontinent (93%) and continent (92%) women allowed their perineum to bulge during a cough. The women (88% incontinent and 95% continent) also demonstrated a simultaneous bulging of their abdominal wall during coughing. Continent women exhibited statistically greater perineal strength than the incontinent women (p<0.001). The majority of women bulge their pelvic floor during the increased intra-abdominal pressure of a cough.
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McIntosh, L.J., Mallett, V.T., Frahm, J.D. et al. Abdominal and perineal muscle reaction to an increase in intra-abdominal pressure. Int Urogynecol J 5, 90–93 (1994). https://doi.org/10.1007/BF00375818