Pelvic Floor Muscle Contraction During Hypopressive Exercise in Women With Pelvic Floor Dysfunction

Effects of Voluntary Pelvic Floor Muscle Contraction During Different Modalities of Hypopressive Exercise in Women With Pelvic Floor Dysfunction: A Randomized Controlled Trial

The purpose of this randomized controlled trial is to compare the effectiveness of different modalities of hypopressive exercise in women with pelvic floor dysfunction. The study evaluates the effects of performing the hypopressive manoeuvre with or without the specific postural programme traditionally used in hypopressive exercise and with or without the addition of voluntary pelvic floor muscle contraction. Transabdominal ultrasound biofeedback is incorporated into the groups performing the hypopressive manoeuvre without the specific postural programme.

This is a four-arm, parallel-group randomized controlled trial conducted in women with pelvic floor dysfunction. Participants are randomly allocated to one of four intervention groups combining different components of hypopressive exercise: the hypopressive manoeuvre performed within the specific postural programme traditionally used in hypopressive exercise, with or without voluntary pelvic floor muscle contraction; or the hypopressive manoeuvre performed without the specific postural programme, with or without voluntary pelvic floor muscle contraction.

All interventions are delivered individually under physiotherapist supervision and include an educational component addressing the anatomy and physiology of the abdominopelvic cavity and pelvic floor, together with hygienic and behavioural recommendations for the prevention and management of pelvic floor dysfunction.

The hypopressive manoeuvre consists of expiration followed by expiratory apnoea and active rib-cage expansion without inhalation, accompanied by inward and cranial displacement of the abdominal wall. In the groups using the specific hypopressive postural programme, the manoeuvre is incorporated into a sequence of postures performed in different body positions according to the principles of Hypopressive Abdominal Gymnastics.

In the groups performing the hypopressive manoeuvre without the specific postural programme, real-time transabdominal ultrasound imaging is used as visual biofeedback to facilitate motor learning and contraction of the transversus abdominis muscle during performance of the manoeuvre.

Interventions are performed twice weekly in individually supervised 45-minute sessions. Participants following the specific hypopressive postural programme receive 16 sessions over 8 weeks, whereas participants performing the hypopressive manoeuvre without the specific postural programme receive 12 sessions over 6 weeks.

Inclusion Criteria:

• Women diagnosed with pelvic floor dysfunction by their doctor.
• With minimum strength of the pelvic floor muscles of 3 according to Modified Oxford Score

Exclusion Criteria:

• Women who are pregnant or women who have had a vaginal or caesarean birth in the past six months.
• Women whose PFD is severe and the first indication is surgical (POP-Q grade III-IV prolapses).
• Women with only urinary incontinence or fecal urgency.
• Women with pain in the pelvic-perineal region of 3 cm in the visual analog scale, where a score of 0 cm means no pain, and a score of 10cm, the maximum pain that the participant can imagine.
• Women who have received pelvic floor physiotherapy treatment in the last 12 months.
• Women who are unable to voluntarily contract the pelvic floor muscles, quantified by the Modified Oxford Score by a score less than or equal to 2.
• Women with any pathology that may affect the treatment (neurological, gynecological or urological), or with recurrent urinary infection or hematuria.
• Women with cognitive limitations to understand the information, answer the questionnaires, consent and / or participate in the study.