Bladder Neck Movement Under Different Conditions - Research Article

This study from the International Urogynecology Journal aimed to investigate the relationship between bladder neck displacement, electromyography (EMG) activity of the pelvic floor and abdominal muscles and intra-abdominal pressure (IAP) during different pelvic floor and abdominal contractions. Although the bladder neck is elevated during a pelvic floor muscle (PFM) contraction, it descends during straining.

The authors of this study aim to examine which contractions and tasks lead to bladder neck elevation as they see this elevation being essential for rehabilitation. The data from this study confirms that bladder neck descent may be due to poor muscle patterns and more exertion of abdominal muscles and therefore higher IAP with insufficient PFM contraction to prevent bladder neck descent. Studies show that incontinent women who depressed the bladder base during attempted PFM contraction had greater activity of abdominal muscles (recorded with surface electrodes) and less activity of PFM compared to continent women who had more PFM activation and less abdominal activation. When other muscles, such as the Obliques and Rectus Abdominis muscle contracted, the PFM activity was not sufficient to overcome the greater increase in IAP and the bladder neck was not elevated.

Once women learn to contract their PFMs with Transversus Abdominis then appropriate training of PFM contraction for strength and co-ordination are important for control of continence. In women without pelvic floor disorders, the authors demonstrated that bladder neck elevation occurred consistently only during PFM and TrA contractions.

They state that attempts to normalise the co-ordination between abdominal and PFMs may be an important step in rehabilitation. This requires multifaceted assessment of the pelvic floor with consideration of bladder neck position, IAP and activity of the PFM and abdominal muscles.

Junginger B, Baessler K, Sapsford R, Hodges P. Effect of abdominal and pelvic floor tasks on muscle activity, abdominal pressure and bladder neck. IUJ (2010) Vol 21;1:69-77