Skip to main content

Advertisement

SpringerLink
Log in

Ability to contract the pelvic floor muscles and association with muscle function in incontinent women

  • Original Article
  • Published:
International Urogynecology Journal Aims and scope Submit manuscript

Abstract

Introduction and hypothesis

Many women with pelvic floor dysfunction are unable to perform pelvic floor muscle (PFM) contraction. We aimed to assess the ability to contract the PFM and to evaluate the association with muscle function in Brazilian women with urinary incontinence.

Methods

We conducted a retrospective cross-sectional study including incontinent women over the age of 18. The assessment of PFM contraction was carried out by bidigital palpation via the PERFECT scheme. We categorized our population as: group absent: women not able to contract the PFM with verbal instructions; group 1 (1st command): women able to contract their PFM after verbal instructions; group 2 (2nd command): women who needed additional training on PFM anatomy and functioning to contract them. We compared the groups regarding their PFM functionality. We used ANOVA for demographic data and Mann-Whitney test for association analyses and P value < 0.05 for statistical significance.

Results

Among 139 women included, 21 (15.1%) were not able to perform the contraction of the PFM. Sixty-five (46.7%) contracted their PFM voluntarily at the first command and 53 (38.1%) at the second command. There was a significant reduction in the PFM function in group 2 in terms of power (p < 0.001), endurance (p < 0.001) and fast contraction (p < 0.001) compared to group 1.

Conclusion

A high percentage (53.2%) of women were not able to contract their PFM voluntarily without training in PFM anatomy and functioning. Those women had impaired muscle function compared to women able to perform PFM after receiving exclusively oral instructions.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

Abbreviations

ANOVA:

analysis of variance model

BMI:

body mass index

ES:

electrical stimulation

ICS:

International Continence Society

IUGA:

International Urogynecological Association

MUI:

mixed urinary incontinence

OAB:

Overactive bladder

PFM:

pelvic floor muscle

PFMT:

pelvic floor muscle training

PT:

physical therapist

SUI:

stress urinary incontinence

UUI:

urgency urinary incontinence

References

  1. Fultz NH, Herzog AR. Epidemiology of urinary symptoms in the geriatric population. Urol Clin North Am. 1996;23(01):1–10. https://doi.org/10.1016/s0094-0143(05)70288-3.

    Article  CAS  PubMed  Google Scholar 

  2. 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;28:125–9. https://doi.org/10.1007/s00192-016-3087-4.

    Article  PubMed  Google Scholar 

  3. 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;28:1524–33. https://doi.org/10.1589/jpts.28.1524.

    Article  PubMed  PubMed Central  Google Scholar 

  4. 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. https://doi.org/10.1589/jpts.28.3020.

    Article  PubMed  PubMed Central  Google Scholar 

  5. Fante JF, Silva TD, Mateus-Vasconcelos ECL, Ferreira CHJ, Brito LGO. Do women have adequate knowledge about pelvic floor dysfunctions? A systematic review. Rev Bras Ginecol Obstet. 2019;41:508–19. https://doi.org/10.1055/s-0039-1695002.

    Article  PubMed  Google Scholar 

  6. Freitas LM, Bø K, Fernandes ACNL, Uechi N, Duarte TB, Ferreira CHJ. Pelvic floor muscle knowledge and relationship with muscle strength in Brazilian women: a cross-sectional study. Int Urogynecol J. 2019;30(11):1903–9. https://doi.org/10.1007/s00192-018-3824-y.

    Article  PubMed  Google Scholar 

  7. 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;26:837–44. https://doi.org/10.1007/s00192-014-2599-z.

    Article  PubMed  Google Scholar 

  8. Dumoulin C, Cacciari LP, Hay-Smith EJC. Pelvic floor muscle training versus no treatment, or inactive control treatments, for urinary incontinence in women. Cochrane Database Syst Rev. 2018;10(10):CD005654. https://doi.org/10.1002/14651858.CD005654.pub4.

    Article  PubMed  Google Scholar 

  9. Kegel AH. Stress incontinence and genital relaxation. Clin Symp. 1952;4(2):35–51.

    CAS  Google Scholar 

  10. Talasz H, Himmer-Perschak G, Marth E, Fischer-Colbrie J, Hoefner E, Lechleitner M. Evaluation of pelvic floor muscle function in a random group of adult women in Austria. Int Urogynecol J Pelvic Floor Dysfunct. 2008;19(1):131–5. https://doi.org/10.1007/s00192-007-0404-y.

    Article  CAS  PubMed  Google Scholar 

  11. Talasz H, Gosch M, Enzelsberger H, Rhomberg HP. Female geriatric patients with urinary incontinence symptoms and their control over pelvic floor muscles. Z Gerontol Geriatr. 2005;38(6):424–30. https://doi.org/10.1007/s00391-005-0301-2.

    Article  CAS  PubMed  Google Scholar 

  12. Bø K, Mørkved S. Motor learning. In: Bø K, Berghmans B, Mørkved S, Van Kampen M, editors. Evidence-based physical therapy for the pelvic floor. Edinburgh: Elsevier; 2015. p. 111–7.

    Google Scholar 

  13. Laycock J, Jerwood D. Pelvic floor muscle assessment: the PERFECT scheme. Physiotherapy. 2001;87(12):631–42. https://doi.org/10.1016/S0031-9406(05)61108-X.

    Article  Google Scholar 

  14. Messelink B, Benson T, Berghmans B, et al. Standardization of terminology of pelvic floor muscle function and dysfunction: report from the pelvic floor clinical assessment group of the International Continence Society. Neurourol Urodyn. 2005;24(4):374–80. https://doi.org/10.1002/nau.20144.

    Article  PubMed  Google Scholar 

  15. Haylen BT, de Ridder D, Freeman RM, Swift SE, Berghmans B, et al. An International Urogynecological Association (IUGA)/International Continence Society (ICS) joint report on the terminology for female pelvic floor dysfunction. Int Urogynecol J. 2010;21:5–26. https://doi.org/10.1007/s00192-009-0976-9.

    Article  PubMed  Google Scholar 

  16. Peschers UM, Voduŝek DB, Fanger G, Schaer GN, DeLancey JO, Schuessler B. Pelvic muscle activity in nulliparous volunteers. Neurourol Urodyn. 2001;20(3):269–75. https://doi.org/10.1002/nau.1004.

    Article  CAS  PubMed  Google Scholar 

  17. Devreese A, Staes F, Weerdt W, et al. Clinical evaluation of pelvic floor muscle function in continent and incontinent women. Neurourol Urodyn. 2004;23(3):190–7. https://doi.org/10.1002/nau.20018.

    Article  PubMed  Google Scholar 

  18. Constantinou CE, Hvistendahl G, Ryhammer A, et al. Determining the displacement of the pelvic floor and pelvic organs during voluntary contractions using magnetic resonance imaging in younger and older women. BJU Int. 2002;90:408–14. https://doi.org/10.1046/j.1464-410x.2002.02907.x.

    Article  CAS  PubMed  Google Scholar 

  19. Bump RC, Hurt WG, Fantl JA, Wyman JF. Assessment of Kegel pelvic muscle exercise performance after brief verbal instruction. Am J Obstet Gynecol. 1991;165(2):322–7. https://doi.org/10.1016/0002-9378(91)90085-6.

    Article  CAS  PubMed  Google Scholar 

  20. Faulkner JA, Larkin LM, Claflin DR, Brooks SV. Age-related changes in the structure and function of skeletal muscles. Clin Exp Pharmacol Physiol. 2007;34(11):1091–6. https://doi.org/10.1111/j.1440-1681.2007.04752.x.

    Article  CAS  PubMed  Google Scholar 

  21. Koelbl H, Strassegger H, Riss PA, et al. Morphologic and functional aspects of pelvic floor muscles in patients with pelvic relaxation and genuine stress incontinence. Obstet Gynecol. 1989;74(5):789–95.

    CAS  PubMed  Google Scholar 

  22. Smith AR, Hosker GL, Warrell DW. The role of partial denervation of the pelvic floor in the aetiology of genitourinary prolapse and stress incontinence of urine. A neurophysiological study. Br J Obstet Gynaecol. 1989;96(1):24–8. https://doi.org/10.1111/j.1471-0528.1989.tb01571.x.

    Article  CAS  PubMed  Google Scholar 

  23. Bø K, Larsen S, Oseid S, et al. Knowledge about and ability to correct pelvic floor muscle exercises in women with stress urinary incontinence. Neurourol Urodyn. 1988;7(3):261–2.

    Google Scholar 

  24. Dietz HP, Wilson PD, Clarke B. The use of perineal ultrasound to quantify levator activity and teach pelvic floor muscle exercises. Int Urogynecol J Pelvic Floor Dysfunct. 2001;12(3):166–8. https://doi.org/10.1007/s001920170059.

    Article  CAS  PubMed  Google Scholar 

  25. Thompson JA, O’Sullivan PB, Briffa NK, Neumann P. Assessment of voluntary pelvic floor muscle contraction in continent and incontinent women using transperineal ultrasound, manual muscle testing and vaginal squeeze pressure measurements. Int Urogynecol J Pelvic Floor Dysfunct. 2006;17(6):624–30. https://doi.org/10.1007/s00192-006-0081-2.

    Article  PubMed  Google Scholar 

  26. Fall M, Lindström S. Electrical stimulation: a physiologic approach to the treatment of urinary incontinence. Urol Clin North Am. 1991;18:393–407.

    CAS  PubMed  Google Scholar 

  27. Stewart F, Berghmans B, Bø K, Glazener CMA. Electrical stimulation with non-implanted devices for stress urinary incontinence in women. Cochrane Database Syst Rev. 2017;12(12):CD012390. https://doi.org/10.1002/14651858.CD012390.pub2.

    Article  PubMed  Google Scholar 

  28. Wilson PD, Al Samarrai T, Deakin M, Kolbe E, Brown AD. An objective assessment of physiotherapy for female genuine stress incontinence. Br J Obstet Gynaecol. 1987;94(6):575–82. https://doi.org/10.1111/j.1471-0528.1987.tb03153.x.

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Gynaecology, Federal University of São Paulo, Rua Napoleão de Barros, 608 – Vila Clementino, São Paulo, SP, CEP 04024-002, Brazil

    Fátima Faní Fitz, Letícia Missen Paladini, Letícia de Azevedo Ferreira, Márcia Maria Gimenez, Maria Augusta Tezelli Bortolini & Rodrigo Aquino Castro

Authors
  1. Fátima Faní Fitz
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Letícia Missen Paladini
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Letícia de Azevedo Ferreira
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Márcia Maria Gimenez
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Maria Augusta Tezelli Bortolini
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Rodrigo Aquino Castro
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

Fátima Faní Fitz: Concept idea, research design, article writing, data collection, project management.

Letícia Missen Paladini: Concept idea, research design, article writing, data collection.

Letícia de Azevedo Ferreira: Concept idea, research design, data analysis, article writing.

Márcia Maria Gimenez: Concept idea, research design, article writing.

Maria Augusta Tezelli Bortolini: Concept idea, research design, article writing, manuscript review.

Rodrigo Aquino Castro: Concept idea, research design, article writing, manuscript review.

Corresponding author

Correspondence to Fátima Faní Fitz.

Ethics declarations

Ethical approval

The study was approved by the Review Board Committee of this institution, paper no. 3.762.856.

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Fitz, F.F., Paladini, L.M., Ferreira, L.d. et al. Ability to contract the pelvic floor muscles and association with muscle function in incontinent women. Int Urogynecol J 31, 2337–2344 (2020). https://doi.org/10.1007/s00192-020-04469-0

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00192-020-04469-0

Keywords

Search

Navigation