Abstract
Background The aims of physiotherapy in stress incontinent women are to improve pelvic floor
function and the continence mechanism including bladder neck support and urethral
closure pressure. In Germany, traditional conservative treatment often includes gymnastic
exercises with unclear effects on the bladder neck. The aim of this study was to sonographically
assess bladder neck movements during selected exercises.
Methods Fifteen healthy, continent women without previous vaginal births, who were able to
voluntarily contract their pelvic floor muscels performed the shoulder bridge, the
abdominal press, tiptoe and the Pilates clam exercises. The first set was performed
without any additional instructions. During the second set directions were given to
activate the pelvic floor before beginning each exercise and to maintain the contraction
throughout the exercise. Bladder neck movement was measured on perineal ultrasound
using a validated method with the pubic symphysis as a reference point.
Results The median age of participants was 32 years, median BMI was 23. Eight women were
nulliparous and seven had given birth to 1 – 2 children via caesarean section. When
exercises were performed without voluntary pelvic floor contraction the bladder neck
descended on average between 2.3 and 4.4 mm, and with pelvic floor contraction prior
to the exercise only between 0.5 and 2.1 mm (p > 0.05 except for abdominal press p = 0.007).
The Pilates clam exercise and toe stand stabilised the bladder neck most effectively.
Discussion Bladder neck descent often occurs during pelvic floor gymnastic exercises as traditionally
performed in Germany, and a voluntary pelvic floor contraction during the exercises
does not necessarily prevent this.
Key words
pelvic floor training - pelvic floor rehabilitation - bladder neck - perineal ultrasound
- pelvic floor contraction
