Effects of Ultrasound Visual Feedback Versus Active Hip Adduction and External Rotation Movements on Bladder Base Elevation and Perceived Awareness of Pelvic Floor Muscle Contraction in Healthy Nulliparous Women

Purpose: The purpose of this study was to compare bladder base elevation and perceived awareness of pelvic floor muscle (PFM) contraction among 3 conditions in healthy nulliparous women. Methods: Twenty-two healthy nulliparous women participated in this exploratory repeated-measures study. Participants performed PFM contraction with real-time transabdominal ultrasound visual feedback, hip adduction, and hip external rotation. The order of the 3 conditions was varied across participants to minimize potential order effects. Bladder base elevation was measured using transabdominal ultrasound imaging, and perceived awareness of PFM contraction was assessed using an 11-point numeric rating scale. Bladder base elevation was analyzed in 21 participants with complete ultrasound data, whereas perceived awareness was analyzed in all 22 participants. Results: No statistically significant differences in bladder base elevation were detected among the 3 conditions (Greenhouse–Geisser corrected: F (1.24, 24.77) = 2.02, P = .166, partial η 2 = 0.09). Perceived awareness differed significantly among conditions (χ 2 (2) = 28.30, P < .001, Kendall’s W = 0.64), with higher ratings during the visual feedback condition than during the hip movement conditions. Bladder base elevation and perceived awareness were moderately correlated during the visual feedback condition ( r s = 0.506, P = .019). Discussion: Ultrasound visual feedback was associated with greater perceived awareness of PFM contraction than hip adduction or external rotation, whereas bladder base elevation did not differ significantly among conditions. Greater perceived awareness should not be interpreted as evidence of improved PFM performance or motor learning.