Pelvic floor muscle training (PFMT) should be first line treatment for women with urinary incontinence (UI) (1). We hypothesize that Nepali women may not have a reliable perception about how to contract the pelvic floor muscles (PFM). This original study aims to 1. investigate knowledge of UI, PFM and PFMT in Nepalese women, 2. examine the self-perceived ability of PFM contraction compared with actual ability assessed by vaginal digital palpation, 3. determine associations between socio-demographic background factors and ability to perform a correct PFM contraction.

This cross-sectional study used baseline data from a parallel group randomized controlled trial investigating the effectiveness of a PFMT intervention among Nepalese women with UI. The study included 75 women between 18-45 years, with International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form (ICIQ-UI-SF) total score ≥ 3. Socio-demographic variables such as age, body mass index, parity, work and lifestyle, knowledge regarding UI, PFM, PFMT and self-perception of ability to contract PFM were assessed through a questionnaire administrated by a research assistant. A trained physiotherapist applied vaginal digital palpation to examine ability to perform a correct PFM contraction. The contraction was classified in accordance with International Continence Society (ICS) recommendation (2) as: no contraction, uncertain, straining, contraction only with help from other muscles, and correct contraction.

Knowledge about UI was low, where 29% reported to have heard about it, 19% claimed they knew about the causes of UI and 12% were aware of treatment options for UI. Less than 5% of the women were aware of the location and function of the PFM or claimed that they knew about PFMT. Seventy-one percent perceived that they were able to contract the PFM, while only 24% were able to perform a correct contraction. Seventeen percent were straining instead of performing a squeeze and lift of the PFM. Work responsibilities including fetching water and working in a squatting position were more common in the women unable to perform a correct contraction.

The results of the present study found that there was scant knowledge of UI, PFM and PFMT. Less than one fourth of the participating women were able to contract the PFM correctly, and many were straining instead of squeezing and lifting the pelvic floor inwards. Discrepancy between perception of a correct PFM contraction and measured ability to contract corresponds with findings of a study from Europe and highlights the need for thorough assessment of PFM function before commencing a PFMT program in women with UI (3). To help Nepalese women with UI and to gain an effect of PFMT it is important to increase knowledge about the condition and treatment options, and to secure correct performance of the exercises.

Nepalese women showed low knowledge about UI, PFM and PFMT. Despite most women perceiving they could contract the PFM, only 24% were able to perform a correct contraction. Health service promoting PFMT in prevention and treatment of UI cannot rely solely on self-perception of ability to contract the PFM; instead, proper clinical assessment and supervised training are warranted.

Dumoulin C, Cacciari LP, Hay-Smith EJC. Pelvic floor muscle training versus no treatment, or inactive control treatments, for urinary incontinence in women. Cochrane Database Syst Rev. 2018;10(10):Cd005654.
Frawley H, Shelly B, Morin M, Bernard S, Bø K, Digesu GA, et al. An International Continence Society (ICS) report on the terminology for pelvic floor muscle assessment. Neurourol Urodyn. 2021;40(5):1217-60.
Vermandel A, De Wachter S, Beyltjens T, D'Hondt D, Jacquemyn Y, Wyndaele JJ. Pelvic floor awareness and the positive effect of verbal instructions in 958 women early postdelivery. Int Urogynecol J. 2015;26(2):223-8.