The aim of the study was to identify the relationship between the symptoms of stress urinary incontinence, pelvic floor muscle function and morphometry after pelvic floor muscle training (PFMT) with stabilization exercises for 12 weeks.

Patients with urinary incontinence from regional gynaecological clinics were recommended for PFMT. The diagnosis of urinary incontinence (UI) was made by a gynaecologist based on a standard examination. Patients signed informed consent and were enrolled in the study of an independent researcher. All patients had a medical history obtained through a structured interview to obtain urological and gynaecological data. The pelvic floor and PFMT were then examined by an experienced physiotherapist blinded to the SUI condition. A total of 86 patients were enrolled in the study. Based on entry and exclusion criteria, 71 patients were included in the study. Three women did not complete the study due to low adherence. The final sample consisted of 68 women. We used a power analysis to determine an appropriate sample size (power 0.80 and alpha 0.05 (type I error)), which was a total of 68 women.We expected a 20% loss, so we enrolled a total of 86 women. According to the sample selection, we expected a decrease in the incidence of SUI after the intervention from 25% to 10%. The success of our treatment was the reduction of difficulties by more than 50%. The International Consultation on Incontinence Questionnaire-Short Form (ICIQ-UI SF) was used for SUI evaluation. Pelvic floor muscle function was evaluated by maximum voluntary contraction (MvC, in cm H2O), and its duration was measured by a perineometer.. PERFECT scheme-power of MvC, endurance of MvC, repetition of MvC for 3 seconds, fast MvC for 1 second by perineometer.  Pelvic floor muscle morphometry was evaluated with 3D/4D transperineal ultrasound during rest, contraction and the Valsalva manoeuvre (in cm2).  The intervention was PFMT with stabilization exercises for 12 weeks, on average three times a week for 20 minutes a day. PFMT consisted of: 1. education of the proband on the anatomy, physiology, and function of the pelvic floor muscles,  as well as the correct attitude to understand the exercise; 2. training of pelvic floor muscles in various positions—lying on back, abdomen, side, kneeling, sitting, standing, and walking; and 3. diaphragmatic breathing and activation of the musculus transversus abdominis. Strength and endurance of the pelvic floor muscles during the bridge, diagonal stabilization, various forms of push ups, various forms of squats and during the side bridge. Inclusion criteria were as follows: willingness to provide written informed consent, over 18 years of age and experiencing uncomplicated SUI, score of ≥ 6 points on the ICIQ-UI SF, symptoms of urinary incontinence for at least 3 consecutive months, degree of pelvic organ prolapse stage ≤ 2 and willingness to accept the randomization process and fully participate in tests. Exclusion criteria were as follows: history of anti-incontinence surgery in the past 12 months; history of pelvic prolapse repair or urethral surgery in the past 12 months; history of PFMT in the past 12 months; history of interstitial cystitis or bladder-related pain; chronic severe constipation; clinically significant renal or hepatic impairment; clinically significant heart impairment; pregnant, lactating or actively trying to become pregnant; presence of a urinary tract infection; use of rehabilitation aids (pessary, urethral plugs, vaginal beads, etc.); insufficient understanding of pelvic floor exercises and/or omitting exercises; incomplete questionnaire; or refusal to participate in the study.

The sample consisted of 68 women. Three women did not complete the study due to low adherence. The mean age of the women was 40.4 ± 9.1 years, and the duration of SUI was 23.5 ± 22.8 months. The average number of childbirths was 1.7 ± 0.7. The mean child weight was 3620.6 ± 550.3 g. The number of incontinence episodes/week was 8.7± 6.1. The average number of pads per day was 1.2 ± 1.3, and the average ICIQ-UI SF score was 9.8 ± 3.1 points. Muscle tone was normal. Pelvic organ prolapse was not present. 
The correlation between the ICIQ-UI SF score and pelvic floor muscle function by the MvC (r=-0.236) or duration of contraction (-0.326) according to the perineometer was mild. The correlation between the ICIQ-UI SF score and the PERFECT scheme was statistically significant (p < 0.01). A mild to moderate negative correlation was achieved in the performance (r = -0.237), endurance (r = -0.370), number of MvC repetitions (r = -0.406) and the number of fast MvCs (r = -0.338). 
Mean correlation was achieved for the ICIQ-UI SF score and pelvic floor muscle morphometry according to 3D/4D ultrasound. The statistically significant (p < 0.01) moderate correlation was for the urogenital hiatal area during rest (r = 0.453), contraction (r = 0.533) and the Valsalva manoeuvre (r = 0.442).(Tab1)

There are several studies that have evaluated pelvic floor muscle morphometry in relation to physiotherapy (1). Correlations revealed that the reduction in SUI symptoms after PFMT is due to improved PERFECT scheme parameters (power, endurance, number of repetitions of MvC, and number of fast MvCs). The stronger the MvC (in cm H2O) and the longer its duration (in seconds) was, the more visible the reduction of hiatal area during rest, contraction and the Valsalva manoeuvre (in cm2). The data support the significant efficacy of PFMT with stabilization exercises due to confirmation of significant correlations between the reduction of SUI symptoms by ICIQ-UI SF and improvement of pelvic floor muscle function through a perineometer and PERFECT scheme and pelvic floor muscle morphometry through 3D/4D transperineal ultrasound.

PFMT with stabilization exercises for 12 weeks confirmed a significant correlation between reduction of SUI symptoms and improvement of both pelvic floor muscle function and pelvic floor muscle morphometry.

Cyr MP, Dumoulin C, Bessette P, Pina A, Gotlieb WH, Lapointe-Milot K, et al. Characterizing pelvic floor muscle function and morphometry in survivors of gynecological cancer who have dyspareunia. Phys Ther. 2021;101(4):pzab042.