title: Effect of pelvic-floor muscle strengthening on bladder neck mobility: a clinical trial.
abstract: BACKGROUND
  Pelvic-floor muscle (PFM) strengthening has been widely used to treat people with urinary incontinence (UI). However, its effect on bladder neck position and stiffness is unknown.
  
  
  OBJECTIVE
  The aim of the study was to investigate the effect of PFM strengthening on bladder neck mobility for women with stress UI (SUI) or mixed UI (MUI).
  
  
  METHODS
  This study was conducted as a single-group pretest-posttest design.
  
  
  METHODS
  This study was conducted mainly at the Life Quality & Health Promotion Laboratory at National Taiwan University and partly in the Ultrasonography Room of the Department of Obstetrics and Gynecology at National Taiwan University Hospital. Patients Twenty-three patients (mean age=51.9 years, SD=6.1) participated in the study.
  
  
  METHODS
  Each participant underwent a PFM strengthening program for 4 months. Bladder neck position at rest and during a cough, the Valsalva maneuver, and a PFM contraction was assessed by transperineal ultrasonography before and after the intervention. Severity Index score, self-reported improvement, PFM strength (force-generating capacity), and vaginal squeeze pressure were assessed for treatment effect.
  
  
  RESULTS
  The position of the bladder neck at PFM contraction and bladder neck mobility for maximal incursion from rest to PFM contraction were elevated, with effect sizes of 0.48 and 0.84, respectively. Bladder neck position and bladder neck mobility were not changed during a cough and the Valsalva maneuver. All participants reported diminution of incontinence, and PFM strength and maximal vaginal squeeze pressure were improved after the intervention. Limitations The limitations of the present trial included the pretest-posttest design and the absence of intra-abdominal pressure measuring and exercise adherence recording.
  
  
  CONCLUSIONS
  Four months of daily PFM strengthening can significantly improve the ability of the PFM to elevate the bladder neck voluntarily, but may not improve its stiffness during a cough and the Valsalva maneuver for women with SUI and MUI.
authors.affiliation: School and Graduate Institute of Physical Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan.
authors.forename: Hsiu-Chuan
authors.initials: HC
authors.lastname: Hung
authors.forename: Sheng-Mou
authors.initials: SM
authors.lastname: Hsiao
authors.forename: Shu-Yun
authors.initials: SY
authors.lastname: Chih
authors.forename: Ho-Hsiung
authors.initials: HH
authors.lastname: Lin
authors.forename: Jau-Yih
authors.initials: JY
authors.lastname: Tsauo
mesh_terms: D004548:Elasticity / Q000502:physiology; D005081:Exercise Therapy / Q000379:methods*; D005260:Female; D006801:Humans; D008875:Middle Aged; D009068:Movement / Q000502:physiology; D017773:Pelvic Floor / Q000502:physiology*; D012720:Severity of Illness Index; D016896:Treatment Outcome; D001743:Urinary Bladder / Q000503:physiopathology*; D014550:Urinary Incontinence, Stress / Q000628:therapy*