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Pelvic Floor Muscle Contraction During a Cough and Decreased Vesical Neck Mobility

From the Departments of Obstetrics and Gynecology, Mechanical Engineering, and Biomedical Engineering, the Institute of Gerontology, and the School of Nursing, University of Michigan, Ann Arbor, Michigan, and the Universitaetsspital Zurich, Zurich, Switzerland.

Address reprint requests to: James Ashton-Miller, PhD, GG Brown Laboratories, Room 3208 University of Michigan Ann Arbor, MI 48109-2125 E-mail: jaam{at}umich.edu

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.