(646) 355-8777

Herman & Wallace Blog

Using Transabdominal Ultrasound to Assess Pelvic Floor Muscle Activation

Have you ever tried to teach a patient how to isolate their transversus abdominis (TA) contraction or a pelvic floor muscle (PFM) contraction and the patient had difficulty or you weren’t sure how well they were isolating it? Did you ever wish you had the ability to use real-time ultrasound (US) to confirm which abdominal layers they were isolating or use it for visual feedback to assist in your patient’s learning?  Could it be helpful to be able to use real-time US to identify if they were isolating the pelvic floor muscles and give your patient visual feedback? Of course!

Real- time US has been used as an assessment and teaching tool to directly visualize abdominal and PFMs.  PFM function can be assessed by observing movement at the bladder base and bladder neck.  Various studies have used US on women with and without urinary incontinence (UI).  These studies usually use transabdominal (TAUS) and transperineal (TPUS) ultrasound to measure if PFM isometrics or exercises are performed correctly or incorrectly, or how the muscles are functioning.

A 2015 study in the International Urogynecology Journal utilized TAUS to identify the ability to perform a correct elevating PFM contraction and assess bladder base movement during an abdominal curl up exercise. Abdominal curl ups are cited to increase intra-abdominal pressure.  Activities that increase intra-abdominal pressure have been cited to provoke stress urinary incontinence (SUI). Abdominal curl ups are often completed in group exercise classes and have been found to provoke SUI in up to 16% of women.

Use of PFM exercises and of “the knack” (performing an isometric pelvic contraction before an exertional activity where intra-abdominal pressure increases, such as before lifting or coughing) has been shown to help manage stress urinary incontinence.

The theory is that elevation of the PFMs during activities that increase intraabdominal pressure (like a curl up) assist in urethral closure and counter act the downward movement, therefore stabilizing the urethra and bladder neck. When using TAUS, while performing a correct PFM contraction, one might expect to see an elevating PFM contraction.  In the study, TAUS was used on 90 women participating in a variety of group exercise classes.  The participants completed a survey and then three attempts of an abdominal curl up exercise in hooklying.  During the curl ups, bladder base displacement was measured to determine correct or incorrect activation patterns.  It was found that 25% of the women were unable to demonstrate an elevating PFM contraction, and all women displayed bladder base depression on the abdominal curl exercise.  It was also found that parous women displayed more bladder base depression than nulliparous women, and overall 60% of the participants reported SUI.  Lastly, this study found there was no association between SUI and the inability to perform an elevating PFM contraction or the amount of bladder base depression.

What interesting information.  Using real time US in the clinic could help us identify if our patients were completing “the knack” correctly with specific activities. This study is a great example of how we can use real time US to help collect evidence to provide us with more information that can help us answer our own questions, patient questions, and improve our instructional methods to patients when teaching core or PFM exercises.


1) Barton, A., Serrao, C., Thompson, J., & Briffa, K. (2015). Transabdominal ultrasound to assess pelvic floor muscle performance during abdominal curl in exercising women. International urogynecology journal, 26(12), 1789-1795.

Preventing Pre-term Delivery: What Do Women Want?
Bed Rest- It Can Make You Crazy…

Upcoming Continuing Education Courses

Feb 25, 2018 - Feb 27, 2018
Location: Touro College: Bayshore

Mar 2, 2018 - Mar 4, 2018
Location: Texas Children’s Hospital

Mar 2, 2018 - Mar 3, 2018
Location: Texas Children’s Hospital

Mar 2, 2018 - Mar 4, 2018
Location: Marathon Physical Therapy

Mar 3, 2018 - Mar 4, 2018
Location: Florida Hospital - Wesley Chapel

Mar 3, 2018 - Mar 4, 2018
Location: Loyola University Stritch School of Medicine

Mar 9, 2018 - Mar 11, 2018
Location: Mount Saint Mary’s University

Mar 9, 2018 - Mar 11, 2018
Location: Northern Arizona Healthcare

Mar 9, 2018 - Mar 11, 2018
Location: Core 3 Physical Therapy

Mar 9, 2018 - Mar 11, 2018
Location: Bella Physical Therapy

Mar 16, 2018 - Mar 18, 2018
Location: Middlesex Hospital

Mar 17, 2018 - Mar 18, 2018
Location: DeKalb Medical Atlanta Hospital and Medical Center

Mar 17, 2018 - Mar 19, 2018
Location: The Sage Colleges

Mar 23, 2018 - Mar 25, 2018
Location: University of Central Arkansas

Mar 23, 2018 - Mar 25, 2018
Location: Henry Ford Macomb Hospital

Mar 23, 2018 - Mar 25, 2018
Location: Robert Wood Johnson Medical Associates

Mar 24, 2018 - Mar 25, 2018
Location: St. Francis Physical Therapy

Apr 6, 2018 - Apr 8, 2018
Location: WakeMed Health & Hospitals

Apr 6, 2018 - Apr 8, 2018
Location: Aurora Medical Center

Apr 7, 2018 - Apr 8, 2018
Location: Florida Hospital - Wesley Chapel

Apr 7, 2018 - Apr 8, 2018
Location: Saint Luke\'s Health System

Apr 13, 2018 - Apr 15, 2018
Location: St. Joseph Hospital Rehabilitative Services

Apr 13, 2018 - Apr 15, 2018
Location: 360 Sports Medicine & Aquatic Rehabilitation Centers

Apr 13, 2018 - Apr 15, 2018
Location: Highline Medical Center

Apr 14, 2018 - Apr 15, 2018
Location: University Hospitals

Apr 15, 2018 - Apr 17, 2018
Location: Touro College: Bayshore

Apr 20, 2018 - Apr 22, 2018
Location: The George Washington University

Apr 20, 2018 - Apr 22, 2018
Location: Marathon Physical Therapy

Apr 21, 2018 - Apr 22, 2018
Location: Core 3 Physical Therapy

Apr 21, 2018 - Apr 22, 2018
Location: The Everett Clinic