Investigation of optimal cues to instruction for pelvic floor muscle contraction: A pilot study using 2D ultrasound imaging in pre‐menopausal, nulliparous, continent women

Abstract

AUI was significantly more acute/optimal when PFMC instruction included a posterior cue. This may be due to optimal recruitment of puborectalis and other posterior regional muscles which may be sub-maximally recruited with anterior cue. Investigation of the potential impact of these findings and possible usefulness of standardized instructions in PFM training is required.

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

“…The methods employed in various studies as to which verbal cues to use, differ from each other as well. Henderson et al used an invasive technique of finger palpation into the vagina; Crotty et al used perineal ultrasound images while Bo et al, Kelly et al, and our study used abdominal ultrasound. It was previously established by Bo et al that ultrasound is a more valid method than palpation or clinical observation to assess PFM function.…”

“…Bo et al proved that an instruction to contract the PFMs produces a significantly more effective PFMC than an instruction to perform a transversus abdominis (TrA) contraction. Crotty et al performed a pilot study ( n = 17) on continent women who were taught selective PFMC using different cues: anterior (urine), posterior (anus), and anterior and posterior, combined. Similar to our findings, their results suggest that a posterior cue produces a better contraction.…”

“…Bo et al 5 proved that an instruction to contract the PFMs produces a significantly more effective PFMC than an instruction to perform a transversus abdominis (TrA) contraction. Crotty et al 15 ultrasound is a more valid method than palpation or clinical observation to assess PFM function. The abdominal ultrasound is a noninvasive method enabling the participants to be more relaxed during the examination and thus, greater cooperation can be established.…”

“…Diverse verbal instructions as to how to correctly contract PFMs may influence the displacement of the pelvic floor. However, it is still being debated in the literature as to which recruitment strategy optimizes the displacement of the pelvic floor . For example, should all regions of the pelvic floor musculature around the urethra, vagina, and rectum be mentioned in the instruction; should only one region that is, the anus or the urethra be mentioned or should the transversus abdominis and correct breathing also be utilized?…”

Is there correlation between electromyography and digital palpation as means of measuring pelvic floor muscle contractility in nulliparous, pregnant, and postpartum women?

“…The International Continence Society (ICS) recommends that the functional evaluation of the PFM, the tone at rest and the voluntary strength or reflex contraction of these muscles must be classified by visual inspection, digital palpation, electromyography, or perineometry 2. Other methods, such as dynamometry, ultrasound, and magnetic resonance imaging have also been suggested 3–6. Currently, there is not a gold standard for the assessment of women's PFM function,7 which turns any comparison between the results more difficult and imprecise.…”