Verbal Cues to Relax the Pelvic Floor in Females With Urinary Incontinence: A Qualitative Study of Therapist Practices

Background: Non-neurogenic hypertonicity of the pelvic floor muscles is a common cause of pelvic floor dysfunction in females with urinary incontinence (UI). Effective rehabilitation often includes pelvic floor muscle training (PFMT) supported by verbal cues. This study aimed to identify commonly used and perceived effective verbal cues that clinicians employ to promote pelvic floor relaxation during PFMT. Methods: A qualitative survey using grounded theory and interpretivist approaches was distributed to licensed physical and occupational therapists in the US with post-professional training in pelvic health. The survey, administered via Qualtrics, asked participants to list the 3 most commonly used and the 3 most effective verbal cues for promoting pelvic floor muscle relaxation in females with UI. Open-ended responses were thematically analyzed by a team of researchers. Results: Of the 175 responses, 105 met the inclusion criteria and were analyzed. Thematic analysis revealed 4 primary cueing themes: (1) imaginative language (eg, “bloom like a flower”), (2) breathing cues (eg, “inhale to release the pelvic floor”), (3) directional instructions (eg, “drop your pelvic floor down”), and (4) commands to relax (eg, “relax and lengthen”). Themes were consistent across both commonly used and perceived effective cues. Discussion: Clinicians use a variety of verbal cueing strategies to facilitate pelvic floor relaxation in females with UI. An individualized approach that draws from multiple cueing themes has the potential to enhance PFMT outcomes. These findings contribute to best practices in verbal cueing and suggest future research should explore patients’ perspectives on cue effectiveness.