CC BY-NC-ND 4.0 · Geburtshilfe Frauenheilkd 2017; 77(07): 765-770
DOI: 10.1055/s-0043-103460
GebFra Science
Original Article/Originalarbeit
Georg Thieme Verlag KG Stuttgart · New York

Traditional Gymnastic Exercises for the Pelvic Floor Often Lead to Bladder Neck Descent – a Study Using Perineal Ultrasound

Article in several languages: English | deutsch
Kaven Baeßler
Campus Benjamin Franklin, Abt. für Gynäkologie, Beckenbodenzentrum Charité, Berlin, Germany
Bärbel Junginger
Campus Benjamin Franklin, Abt. für Gynäkologie, Beckenbodenzentrum Charité, Berlin, Germany
› Author Affiliations
Further Information

Publication History

received 30 November 2016
revised 07 February 2017

accepted 10 February 2017

Publication Date:
24 May 2017 (online)


Background The aims of physiotherapy in stress incontinent women are to improve pelvic floor function and the continence mechanism including bladder neck support and urethral closure pressure. In Germany, traditional conservative treatment often includes gymnastic exercises with unclear effects on the bladder neck. The aim of this study was to sonographically assess bladder neck movements during selected exercises.

Methods Fifteen healthy, continent women without previous vaginal births, who were able to voluntarily contract their pelvic floor muscels performed the shoulder bridge, the abdominal press, tiptoe and the Pilates clam exercises. The first set was performed without any additional instructions. During the second set directions were given to activate the pelvic floor before beginning each exercise and to maintain the contraction throughout the exercise. Bladder neck movement was measured on perineal ultrasound using a validated method with the pubic symphysis as a reference point.

Results The median age of participants was 32 years, median BMI was 23. Eight women were nulliparous and seven had given birth to 1 – 2 children via caesarean section. When exercises were performed without voluntary pelvic floor contraction the bladder neck descended on average between 2.3 and 4.4 mm, and with pelvic floor contraction prior to the exercise only between 0.5 and 2.1 mm (p > 0.05 except for abdominal press p = 0.007). The Pilates clam exercise and toe stand stabilised the bladder neck most effectively.

Discussion Bladder neck descent often occurs during pelvic floor gymnastic exercises as traditionally performed in Germany, and a voluntary pelvic floor contraction during the exercises does not necessarily prevent this.