Physiotherapy methods to facilitate pelvic floor muscle contraction: A systematic review

Physiother Theory Pract. 2018 Jun;34(6):420-432. doi: 10.1080/09593985.2017.1419520. Epub 2017 Dec 26.


Aim: To undertake a systematic review of the literature on physical therapy methods to facilitate voluntary pelvic floor muscles (PFM) contraction.

Methods: The databases consulted were PubMed, the Cochrane Central Register of Controlled Trials, the Cochrane Database of Systematic Reviews, PEDro and CINHAL. The study included randomized controlled trials, quasi-experimental trials and systematic reviews. The GRADE scale was used to assess methodological quality.

Results: Six manuscripts were included. The methods investigated included instruction regarding the anatomy and function of the PFM, vaginal palpation, palpation on the central perineal tendon, interruption of urinary flow, biofeedback using a perineometer, vaginal cones, hypopressive exercise, PFM contraction associated with diaphragmatic breathing; and coactivation of abdominal muscles. The studies showed improvement in PFM contraction, but most were of low methodological quality. Only one study was characterized as being of high methodological quality.

Conclusion: All the studies observed improvement in PFM contraction using various methods, but none were superior over the others. The studies revealed no adverse effects of the interventions used. Patient preferences should be taken into account in clinical decision-making. More studies of high methodological quality on this topic are needed.

Keywords: Awareness; muscle contraction; pelvic floor; physical therapy; systematic review.

Publication types

  • Review
  • Systematic Review

MeSH terms

  • Adolescent
  • Adult
  • Child
  • Exercise Therapy / methods*
  • Female
  • Humans
  • Middle Aged
  • Muscle Contraction*
  • Pelvic Floor / physiopathology*
  • Pelvic Floor Disorders / diagnosis
  • Pelvic Floor Disorders / physiopathology
  • Pelvic Floor Disorders / therapy*
  • Recovery of Function
  • Treatment Outcome
  • Urinary Incontinence / diagnosis
  • Urinary Incontinence / physiopathology
  • Urinary Incontinence / therapy*
  • Young Adult