Today marks the 1st of September which means not only is it the first day of Spring here in AUS but it is also a day for highlighting some cool research around women’s health.
Last month I shared with you a paper highlighting the relationship between the hip and the pelvic floor and I hope you have been investigating your ‘hip clients’ a bit further since reading about it.
If you missed the email I chatted about the hip and the pelvic floor in an episode on my podcast which you can listen to HERE.
Today I would like to share with you a paper that is super relevant for you if you do not have access to internal pelvic floor assessments and want to understand what the likelihood of a verbal pelvic floor cue has on successful contraction of the pelvic floor.
Henderson W, Wang S, Masters M, Nygaard I. Can women correctly contract their pelvic floor muscles without formal instruction. Female Pelvic Med Reconstr Surg 2013;19 (8-12) LINK – Can women correctly contract their pelvic floor muscles without formal instruction? – PubMed (nih.gov)
Here we have a Coss-sectional study with a goal of identifying the amount of women who can contract pelvic floor correctly on first cue, and if they incorrectly contracted could they relearn with a second different cue.
779 women were included in the study and were selected based on being asked to be part of the study as they attended an annual checkup. They were given a brief pelvic exam to determine which of the following groups they would be placed in:
-
- Pelvic organ prolapse with no stress incontinence (POP) – 166 out of 779
- Stress incontinence and no pelvic organ prolapse (SUI) – 133 out of 779
- Both pelvic organ prolapse and stress urinary incontinence (BOTH) – 35 out of 779
When initially assessed they were given the verbal cue of ‘now please squeeze the muscles in the vagina and hold like you are holding urine’. A correct activation was determined by inward pressure or upward traction felt on the examiners finger as well as no accompanying contracting through the glutes or with valsalva.
Let’s take a look at the results from the initial assessment:
-
- 85.5% of the POP group were successful
- 83.4% of the SUI group were successful
- 68.6% of the BOTH group were successful
- 85.8% of the NEITHER group were successful
Not a bad outcome for the majority but not a great start for those who have POP and SUI.
A total of 120 women were unsuccessful at correctly contracting the pelvic floor with that verbal cue. So they reassessed by this time instructions were ‘please real, now I want you to use your vaginal muscles instead of your bottom muscles’. This cue alone resulted in 94 out of the 120 women correctly contracted the pelvic floor after this instruction.
The women with POP were the least likely group of women to improve their ability to correctly contract their pelvic floor than the women who did not have POP or SUI.
The discussion around the findings was that there is a solid chance women who do not want to seek professional guidance have a pretty good chance of correctly contracting the pelvic floor without professional guidance. However those with POP may need more professional support especially seeing as though even on second cue could not master correct contraction.
The study accounted for many other variable such as age, BMI, ethnicity, education level, parity, type of delivery, menopausal status, HRT use, chronic cough history, smoking status, caffeine intake, previous hysterectomy and health status and the only associations between incorrect PFM contraction were increasing vaginal deliveries AND decreasing caffeine intake! So basically those who consumed more caffeine were less likely to incorrectly contract the pelvic floor. It was hypothesized that those who drink caffeinated beverages have trained themselves to engage their pelvic floor muscles through the diuretic effect of these drinks and therefore conditioned themselves to correctly utilize their pelvic floor. Now I don’t know how I feel about this hypothesis, but maybe our interventions should include ‘drink more coffee and hold in your poop?’
Key Takeaways and clinical application:
-
- Exercise Physiologists (or any health and fitness professional) can verbally cue clients to contract the pelvic floor and there is a good chance your client is doing it correctly. How you instruct will require refining how you cue your clients as well as being able to educate your clients on what incorrect contraction might feel like for them.
- There are often other strategies that indicate poor pelvic floor contracting – like glute contractions and breath holding. There are many more but we won’t dive into those in this email. But if you see these happening it’s a big sign they are not doing it very well.
- Those who have prolapse and stress urinary incontinence may struggle to learn correct pelvic floor contraction and will more than likely need a lot more cueing and support. Be ready to potentially refer out if they have not already seen someone for an internal examination.
- Those with multiple vaginal deliveries (and less caffeine intake… which still blows my mind) are also more likely to struggle with initially pelvic floor contraction.
This paper is quite comforting for me, especially seeing as I run a fully online clinic where cueing is absolutely crucial for the first phase of pelvic floor rehab. I hope this also gives you some relief knowing that you might not have to always refer for an internal pelvic floor exam just because you can’t tell exactly what is going on.
So there you have it… The monthly research spotlight straight to your inbox. Until next month… practice your pelvic floor cueing and see where it takes you.
And if you have absolutely no idea about pelvic floor cueing or the treatment process and want to dive deep into pelvic health join the waitlist for my 2024 mentorship intake. It will open for registration in December and kick off in January for only 10 people so don’t miss out… you’ll learn absolutely everything there is to know about the pelvic floor across the female lifecycle and feel like an absolutely boss practitioner by the end.
Have a good one!