C0091 Dynamic transabdominal ultrasound: assessing the reduction of the pelvic floor displacement during the cough

Background The knack manoeuvre or counterbracing refers to the pelvic floor muscles (PFM) contraction against intra-abdominal increased pressures. This manoeuvre seems to be effective in the prevention and resolution of pelvic floor dysfunction symptoms such as urinary leakage. In an attempt to understand the behaviour of PFM during the knack manoeuvre, a real time ultrasound cross-sectional study was designed. Methods The PFM caudal displacement was measured during the cough in fifteen women using transabdominal ultrasonography. Prior to entering the study, all the women were digitally assessed and showed a PFM strength higher than 3 in the levator ani testing. A 3.5 MHz curved linear array ultrasound transducer (Model C5–2 s, Mindray, Shenzen, China) was placed immediately above the pubis bone angled at 10–30 degrees from the vertical. The assessment was performed in supine position in the midtransversal and midsagittal planes. Firstly, the participants were encouraged to cough following a deep inspiration reaching the inspiratory reserve volume values. Secondly, the women tried to reproduce the same manoeuvre adding a maximum PFM contraction before and during the cough (knack manoeuvre). Results The mean (standard deviation) age of the participants was 42.86 (±10.15) with a BMI of 23.89 (±3.56). Four women were menopausal and four were nulliparous. Ten presented stress urinary incontinence and nine received a previous pelvic-perineal physiotherapy treatment. The median (interquartile range) of caudal displacement during cough in the transversal plane was 3.13 (±1.06) cm, whereas the shift produced during cough with the manoeuvre was 1.86 (±0.61) cm. In sagittal plane, similar differences were found. The PFM descent during the cough was 3.33 (±1.35) cm and 1.95 (±1.01) cm during a cough associated with the knack. A Wilcoxon signed-rank test showed that, according to the statistics, the PFM caudal displacement was significantly minor during a cough with a simultaneous PFM contraction than in a cough alone (p=0.001). Conclusions Transabdominal ultrasound assessment demonstrated that the knack manoeuvre minimised the impact of cough to PFM. Women should be instructed and trained in the knack manoeuvre in order to achieve its automation.