Pelvic floor muscle training (PFMT) lies within the recommended treatment approach for overactive bladder, a syndrome characterized by urinary urgency, frequency and nocturia, with or without urge incontinence. PFMT has long included the use of voluntary pelvic floor muscle (PFM) contractions as an urge suppression strategy; however, the relative effectiveness of different contraction types for urge suppression has not been established.

The aim of this pilot study was to compare the effects of maximal (M), submaximal(SM) and rapid successive (RS) PFM contractions on urinary urge in healthy women.  It also aimed to  identify which contraction type was perceived as the easiest to learn and which the most comfortable to perform.

Participants were trained to perform M, SM, and RS PFM contractions for this randomized, within-subject crossover pilot study.  After bladder-filling via fluid intake to a self-reported 'strong sensation to void', participants performed PFM contractions with pre-established contraction parameters.  Urge sensation was self-recorded immediately before and after each contraction session, and quantified on a 0-10 cm Visual Analogue Scale (VAS).  Contraction type was randomly sequenced, with the experiment performed by participants on three separate days, each with one of the three different contraction types.  Mixed model repeated-measures ANOVA was conducted to examine the changes in urinary urge levels, and the difference in change among the contraction types. The ease of learning the different contraction types and the relative comfort of the contractions during a strong sensation to void were assessed using subjective participant rankings on a scale of 1-3.

A statistically significant decrease in urinary urge sensation on the VAS was found following all three contraction types (p < 0.001). When comparing among contraction types, a non-significant difference was observed (p = 0.078).  Maximal contractions were most frequently ranked as easiest to learn, while the relative comfort of the contractions during a strong sensation of urge varied among individuals.

Consistent with the existing literature and convention, voluntary PFM contractions significantly reduced urinary urge in healthy young women. Although all three contraction types were effective, preliminary findings suggest potential differences in the magnitude of urge suppression between contraction strategies.

This pilot study indicates that the use of a pelvic floor muscle contraction as an urge-suppression strategy is valid.  Larger studies are required to determine whether meaningful differences exist between contraction types, to establish optimal contraction parameters and to determine whether these findings may be extrapolated to the management of urge and urgency symptoms in the clinical population.  This could improve specificity in PFMT according to the nature of the urinary dysfunction.

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Brown, C., Mailhot, S., Vo, J., Boudrias, M. (2024). Pelvic Floor Muscle Training Exercise Prescription Components Currently used for Overactive Bladder. ICS Madrid. DOI: 10.1016/j.cont.2024.101548