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


CONCLUSIONS
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.
Miller
J M
JM
Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, Michigan, USA. jaam@umich.edu
Perucchini
D
D
Carchidi
L T
LT
DeLancey
J O
JO
Ashton-Miller
J
J
D000328:Adult; D000368:Aged; D003371:Cough / Q000503:physiopathology*; D005260:Female; D006801:Humans; D007537:Isometric Contraction / Q000502:physiology*; D008875:Middle Aged; D017773:Pelvic Floor / Q000503:physiopathology; D012016:Reference Values; D001743:Urinary Bladder / Q000503:physiopathology*; D014550:Urinary Incontinence, Stress / Q000503:physiopathology*; D014563:Urodynamics / Q000502:physiology*