European Journal of Applied Physiology

, Volume 118, Issue 8, pp 1661–1671 | Cite as

Clinical and MRI changes of puborectalis and iliococcygeus after a short period of intensive pelvic floor muscles training with or without instrumentation

A prospective randomized controlled trial
  • Frédéric Dierick
  • Ekaterina Galtsova
  • Clara Lauer
  • Fabien Buisseret
  • Anne-France Bouché
  • Laurent Martin
Original Article



This study evaluates the impact of a 3-week period of intensive pelvic floor muscles training (PFMT), with or without instrumentation, on clinical and static magnetic resonance imaging (MRI) changes of puborectalis (PR) and iliococcygeus (IL) muscles.


24 healthy young women were enrolled in the study and 17 achieved the 9 sessions of 30 min training exercises and conducted all assessments. Participants were randomly assigned in two training groups: voluntary contractions combined with hypopressive exercises (HYPO) or biofeedback exercises combined with transvaginal electrical stimulations (ELEC). Clinical and T2-weighted MRI assessments were realized before and after training.


Modified Oxford Grading System (MOGS) scores for left PR and perineal body significantly increased in the two groups (p = 0.039, p = 0.008), but MOGS score for right PR significantly increased only in HYPO (p = 0.020). Muscle volumes of right and left IL significantly decreased (p = 0.040, p = 0.045) after training as well as signal intensities of right and left PR (p = 0.040, p = 0.021) and thickness of right and left IL at mid-vagina location (p = 0.012, p = 0.011).


A short period of intensive PFMT induces clinical and morphological changes in PFMs at rest suggesting a decrease in IL volume and adipose content of PR. Although the results suggested that an intensive non-instrumented PFMT is as effective as an instrumented training, future controlled studies with greater sample sizes are needed to establish the relative and absolute effectiveness of each of the two interventions.


Anatomy Levator ani Transversus abdominis Strengthening Morphology Hypopressive Biofeedback Electrical stimulation 



Body mass index


Consolidated standards of reporting trials


Diaphragmatic aspiration


Diffusion tensor imaging


Biofeedback exercises and transvaginal electrical stimulations group


Voluntary contractions and hypopressive exercises group


Intraclass correlation coefficient




Levator ani


Modified Oxford grading system


Mid-pubic line


Magnetic resonance imaging


Obturator internus


Perineal body




Pubococcygeal line


Pelvic floor dysfunction


Pelvic floor distress inventory


Pelvic floor impact questionnaire


Pelvic floor muscle


Pelvic floor muscle training


Posterior levator plate






Repeated measures analysis of variance


Resting tone


Standard deviation


Translabial tomographic ultrasound imaging


Urinary incontinence



The authors would like to thank Caroline Lahaye and Jean-Louis Greffe for their assistance in the development of the protocol, and Jean-Claude Malherbe (Enraf-Nonius) for making the stimulation/biofeedback material available throughout the experiment. They also thank the financial support of Grand Hôpital de Charleroi (GHdC asbl), Philips SA, and the Haute Ecole Louvain en Hainaut for the MRI.

Author contributions

FD and AFB conceived and designed research. FD, EG, CL and LM conducted experiments. FD, EG and CL analyzed data. FD, EG, CL, FB, AFB and LM wrote the manuscript. All authors read and approved the manuscript.


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  • Frédéric Dierick
    • 1
  • Ekaterina Galtsova
    • 1
  • Clara Lauer
    • 1
  • Fabien Buisseret
    • 1
  • Anne-France Bouché
    • 2
  • Laurent Martin
    • 3
  1. 1.Forme and Fonctionnement Humain Lab, Department of Physical TherapyCERISIC, Haute Ecole Louvain en HainautMontignies-sur-SambreBelgium
  2. 2.Le RichemontBioulBelgium
  3. 3.Grand Hôpital de CharleroiGillyBelgium

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