What is the most effective verbal instruction for correctly contracting the pelvic floor muscles?

Ami, Noa Ben; Dar, Gali

doi:10.1002/nau.23810

Cited by 17 publications

(16 citation statements)

References 24 publications

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“…Correct PFMC must be assessed before PFMT because up to 30% of women cannot correctly complete the PFMC [ 23 – 25 ]. Several studies have shown that the pelvic floor muscles can be correctly contracted in 78%–90% of women after a brief verbal instruction [ 26 , 27 ], which is used most commonly. Henderson et al [ 27 ] have found that the pelvic floor muscles could not be correctly contracted in 31.4% of women with POP after a verbal instruction and that fewer women with POP could learn these movements than women without POP.…”

Section: Discussionmentioning

confidence: 99%

[Retracted] Effects of Adding Ultrasound Biofeedback to Individualized Pelvic Floor Muscle Training on Extensibility of the Pelvic Floor Muscle and Anterior Pelvic Organ Prolapse in Postmenopausal Women

Yang

Liu

et al. 2022

Contrast Media & Molecular Imaging

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The aim of the study was to determine effects of adding transperineal ultrasound (TPUS) biofeedback to individualized pelvic floor muscle training (PFMT) on extensibility of the pelvic floor muscle and anterior pelvic organ prolapse (POP) in postmenopausal women. A total of 77 patients with POP at stage I or stage II were admitted to Beijing Shijitan Hospital, China, from January 2017 to October 2018. They were randomly divided into a control group (CG) (n = 37) or a study group (SG) (n = 40). Both SG and CG received a 12-week PFMT including health education, verbal instruction, and home training. However, the SG, but not the CG, received additional TPUS biofeedback. Data of these patients were retrospectively reviewed. The distance from the lowest point of the bladder to the inferior-posterior margin of the symphysis pubis (BSP) and the levator hiatus area (LHA) were measured on maximal Valsalva via TPUS before and after the 12-week PFMT. Correct pelvic floor muscle contraction (PFMC) rates before and after PFMT were compared between the two groups. The correct PFMC rate was higher in the SG than that in the CG (92.5% vs. 73%; x2 = 5.223, p = 0.022 ). The BSP was increased but the LHA was reduced after the 12-week PFMT in both groups compared to those before PFMT (all p < 0.05 ). However, after the PFMT, the SG showed greater improvement than the CG for both BSP (0.77 ± 0.71 cm vs. 0.11 ± 0.66 cm, p < 0.05 ) and LHA (20.69 ± 2.77 cm2 vs. 22.85 ± 3.98 cm2, p < 0.05 ). TPUS might be an effective biofeedback tool for PFMT in clinical practice. Individualized PFMT with TPUS biofeedback could significantly attenuate POP severity and strengthen the extensibility of pelvic floor muscle in postmenopausal women when they are under increased intraabdominal pressure.

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Section: Discussionmentioning

confidence: 99%

[Retracted] Effects of Adding Ultrasound Biofeedback to Individualized Pelvic Floor Muscle Training on Extensibility of the Pelvic Floor Muscle and Anterior Pelvic Organ Prolapse in Postmenopausal Women

Yang

Liu

et al. 2022

Contrast Media & Molecular Imaging

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“…However, the majority of participants in this systematic review did not show symptoms of UI, and most of the included studies did not specify which verbal command they employed to ensure correct PFM contraction. Some studies that were not included in this review and evaluated the PFM contraction by ultrasound obtained better results with instructions related to the rectum, such as “squeeze the anus” [ 30 , 31 ]. This aspect should be studied in depth since finding the best verbal indications to ensure correct PFM contraction in different populations, including healthy women, would be useful to implement educational programmes and group interventions with effective, recognisable, and easy-to-remember verbal commands that help to improve the PFM condition and thus prevent or treat PFD symptoms.…”

Section: Discussionmentioning

confidence: 99%

Does the Contractile Capability of Pelvic Floor Muscles Improve with Knowledge Acquisition and Verbal Instructions in Healthy Women? A Systematic Review

Díaz-Álvarez

Lorenzo-Gallego

Romay‐Barrero

et al. 2022

IJERPH

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Seventy percent of women with pelvic floor dysfunctions (PFDs) are estimated to present deficient consciousness of their pelvic floor muscles (PFMs) and poor ability to contract them. Improving the proprioception of PFMs, defined as the capacity to know the status and position of each body part, and adequately contracting them could be a protective factor to prevent the appearance of PFDs in the general female population. This study aimed to identify the effectiveness of educational interventions and verbal instructions on how to contract and exercise the PFMs to improve the proprioception of the PFMs in women. A systematic search of studies published in the last 20 years until March 2022 was conducted in the PubMed, Cochrane Library, Web of Science, Scopus, PEDro, Lilacs, and Dialnet databases. A meta-analysis could not be performed due to the heterogeneity in the types of studies and included populations. This review followed the PRISMA guidelines for the design, search, and reporting of studies. The methodological quality was analysed via the PEDro and the Newcastle–Ottawa scales in the case of randomised clinical trials and non-randomised studies, respectively, while the quality of evidence was determined using the SIGN grading system for evidence-based guidelines. Descriptive and experimental studies published in English, Spanish, or Portuguese that evaluated the contractile capability of the PFMs in healthy women or women without a previous diagnosis of PFD were included. Seven articles that included a total of 2507 women were found, three of which were clinical trials with PEDro scores between 5 and 9 points out of 10 and four of which were non-randomised studies with NOS scores between 6 and 8 points out of 10. The outcomes were measured through vaginal palpation, visual observation, questionnaires for PFD symptoms, and self-perception reports. This review discriminated between two types of intervention, educational programmes and verbal instructions, and evaluated the changes observed in PFM strength and knowledgeability and the symptoms of PFDs. The findings showed that educational interventions and verbal instructions improve the proprioception of PFMs in women of all ages that are healthy or without a previous diagnosis of PFDs as well as their knowledge about the pelvic floor, healthy lifestyle habits, and symptoms that are potentially indicative of PFDs. Further high-quality randomised clinical trials are warranted to draw definitive conclusions about the effectiveness of educational interventions to improve the proprioception of the PFMs in women considered healthy or with mild symptoms that may be indicative of PFDs.

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“…The bladder base was marked on rest with the on-screen marker. The participant was asked to contract her PFM and the bladder base was marked again [ 24 , 25 ]. The direction of the bladder base displacement was recorded, as this indicated PFM function ( Figure 1 ).…”

Section: Methodsmentioning

confidence: 99%

The Perception of Pelvic Floor Muscle Function amongst Exercising Women Who Are Repeatedly Instructed to Contract Their Pelvic Floor Muscles

Dar

Saban

2022

Healthcare

Self Cite

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In this study, the self-perception of pelvic floor muscle (PFM) contractions amongst women receiving repeated verbal instructions during exercise classes was examined. The prevalence and severity of urinary stress incontinence were also assessed. This cross-sectional observational study included 46 women (mean age 48 (±8.6)), who regularly participated in Pilates classes where repeated instruction was given to contract PFM (“instruction group”; N = 22) or not (controls, N = 24). PFM function was evaluated using transabdominal ultrasound. Simultaneously, the participant described her personal evaluation of her PFM contraction ability. The International Consultation on Incontinence Questionnaire – Short Form was also utilized. Most women (80%) correctly contract PFM; however, 95% did not perform a voluntary contraction during leg movement, without differences observed between groups. A higher perception of PFM contraction was found in the “instruction group” when performing knee flexion towards the chest without specific verbal instruction. Women who were instructed to contract their PFM suffered less incontinence and had a lower degree of severity than the controls. Most women performing Pilates exercises correctly contracted their PFM. However, there was no PFM voluntary contraction during leg movement. Exposure to repeated verbal instructions to contract PFM, over time, might lead to an improvement in women’s perception of their ability to contract PFM. Verbal instructions for PFM contraction were found to be effective in reducing urinary incontinence.

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What is the most effective verbal instruction for correctly contracting the pelvic floor muscles?

Abstract: 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.

Cited by 17 publications

References 24 publications

[Retracted] Effects of Adding Ultrasound Biofeedback to Individualized Pelvic Floor Muscle Training on Extensibility of the Pelvic Floor Muscle and Anterior Pelvic Organ Prolapse in Postmenopausal Women

[Retracted] Effects of Adding Ultrasound Biofeedback to Individualized Pelvic Floor Muscle Training on Extensibility of the Pelvic Floor Muscle and Anterior Pelvic Organ Prolapse in Postmenopausal Women

Does the Contractile Capability of Pelvic Floor Muscles Improve with Knowledge Acquisition and Verbal Instructions in Healthy Women? A Systematic Review

The Perception of Pelvic Floor Muscle Function amongst Exercising Women Who Are Repeatedly Instructed to Contract Their Pelvic Floor Muscles

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