Pelvic floor muscle contraction during a cough and decreased vesical neck mobility

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Abstract
Objective: To test the hypothesis that a voluntary pelvic muscle contraction initiated in preparation for a cough, a maneuver we call the Knack, significantly reduces vesical neck displacement. Methods: A convenience sample of 22 women consisted of 11 young, continent nulliparas (mean age [± standard deviation] 24.8 ± 7.0 years) and 11 older, incontinent paras (mean age [±SD] 66.9 ± 3.9 years). With the use of perineal ultrasound, we quantified vesical neck displacement at rest and during coughs using caliper tracing and a coordinate system. The subjects coughed with and without voluntary pelvic floor muscle contraction. Results: Vesical neck mobility during coughs was significantly decreased when voluntary contraction was used: from a median (range) of 5.4 (20.0) mm without volitional contraction to 2.9 (18.3) mm with volitional contraction (P < .001). The younger women demonstrated a median (range) decrease in excursion from 4.6 (19.5) to 0.0 (17.0) mm (P = .007), and the older incontinent women demonstrated a median (range) decrease from 6.2 (10.0) to 3.5 (15.4) mm (P = .003). At rest, the median vesical neck position in the group of older incontinent women was significantly further dorsocaudal (P = .001) than in the younger women. Conclusion: A pelvic floor muscle contraction in preparation for, and throughout, a cough can augment proximal urethra support during stress, thereby reducing the amount of dorsocaudal displacement.