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


  • Linada Brubaker led the review process.

  • Conflicts of interest: none.



Optimal urethrovesical positioning (UVP) may be important for continence. Pelvic floor muscle contraction (PFMC) influences UVP. PFMC instruction cues vary and often encourage anterior PFM recruitment that may result in sub-maximal posterior facilitation. Study hypothesis: posterior or combined cues are more influential in optimizing UVP during PFMC following a brief practice period than anterior cue.


Seventeen pre-menopausal, nulliparous, continent women were taught selective PFMC using different cues: anterior; posterior; anterior and posterior combined. Perineal ultrasound images of three PFMC for each cue were captured in supine and standing twice, 5 min apart. For reliability two raters measured data using angle of urethral inclination (AUI). Data analysis was undertaken using a customized General Linear Model ANOVA testing for interactions between all variables; subject, cue, posture, and test. Post hoc Bonferroni correction was used with a significance level of 0.05.


The ANOVA showed significant differences between variables (P = 0.000). Post hoc analysis indicated significant differences between posterior and anterior cues 4.240° (P = 0.003); combined and anterior 3.756° (P = 0.009) but not between posterior and combined cues −0.484° (P = 1.00). Mean difference in AUI between supine and standing was 9.496° (P = 0.000); however, the interaction of cues and postures was not significant.


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. Neurourol. Urodynam. 30: 1620–1626, 2011. © 2011 Wiley Periodicals, Inc.