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

Objective: To test the hypothesis that a voluntary pelvic muscle contractio n initiated in preparation for a cough, a maneuver we call the Knack, signi ficantly 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 ol der, 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 wh en voluntary contraction was used: from a median (range) of 5.4 (20.0) mm w ithout volitional contraction to 2.9 (18.3) mm with volitional contraction (P <.001). The younger women demonstrated a median (range) decrease in excu rsion from 4.6 (19.5) to 0.0 117.0) 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 ol der incontinent women was significantly further dorso-caudal (P =.001) than in the younger women. Conclusion: A pelvic floor muscle contraction in preparation for, and throu ghout, a cough can augment proximal urethra support during stress, thereby reducing the amount of dorsocaudal displacement. (Obstet Gynecol 2001;97:25 5-60. (C) 2001 by The American College of Obstetricians and Gynecologists.) .