Pelvic Floor Muscle Contraction During Hypopressive Exercise in Women With Pelvic Floor Dysfunction (HIPOSPFD)

Effects of Voluntary Pelvic Floor Muscle Contraction During Different Modalities of Hypopressive Exercise in Women With Pelvic Floor Dysfunction: A Randomized Controlled Trial

The purpose of this randomized controlled trial is to compare the effectiveness of different modalities of hypopressive exercise in women with pelvic floor dysfunction. The study evaluates the effects of performing the hypopressive manoeuvre with or without the specific postural programme traditionally used in hypopressive exercise and with or without the addition of voluntary pelvic floor muscle contraction. Transabdominal ultrasound biofeedback is incorporated into the groups performing the hypopressive manoeuvre without the specific postural programme.

Study Overview

• Status: Completed
• Conditions: Pelvic Floor Disorders
• Intervention / Treatment: Other: Hypopressive exercises; Other: Hypopressive exercises plus pelvic floor muscle contraction; Other: Hypopressive maneuver; Other: Hypopressive maneuver plus pelvic floor muscle contraction

Detailed Description

This is a four-arm, parallel-group randomized controlled trial conducted in women with pelvic floor dysfunction. Participants are randomly allocated to one of four intervention groups combining different components of hypopressive exercise: the hypopressive manoeuvre performed within the specific postural programme traditionally used in hypopressive exercise, with or without voluntary pelvic floor muscle contraction; or the hypopressive manoeuvre performed without the specific postural programme, with or without voluntary pelvic floor muscle contraction.

All interventions are delivered individually under physiotherapist supervision and include an educational component addressing the anatomy and physiology of the abdominopelvic cavity and pelvic floor, together with hygienic and behavioural recommendations for the prevention and management of pelvic floor dysfunction.

The hypopressive manoeuvre consists of expiration followed by expiratory apnoea and active rib-cage expansion without inhalation, accompanied by inward and cranial displacement of the abdominal wall. In the groups using the specific hypopressive postural programme, the manoeuvre is incorporated into a sequence of postures performed in different body positions according to the principles of Hypopressive Abdominal Gymnastics.

In the groups performing the hypopressive manoeuvre without the specific postural programme, real-time transabdominal ultrasound imaging is used as visual biofeedback to facilitate motor learning and contraction of the transversus abdominis muscle during performance of the manoeuvre.

Interventions are performed twice weekly in individually supervised 45-minute sessions. Participants following the specific hypopressive postural programme receive 16 sessions over 8 weeks, whereas participants performing the hypopressive manoeuvre without the specific postural programme receive 12 sessions over 6 weeks.

• Study Type: Interventional
• Enrollment (Actual): 80
• Phase: Not Applicable

Contacts and Locations

Study Locations

• Spain
  • Madrid
    • Alcalá de Henares, Madrid, Spain, 28005
      • María

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years to 65 years (Adult, Older Adult)
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

• Women diagnosed with pelvic floor dysfunction by their doctor.
• With minimum strength of the pelvic floor muscles of 3 according to Modified Oxford Score

Exclusion Criteria:

• Women who are pregnant or women who have had a vaginal or caesarean birth in the past six months.
• Women whose PFD is severe and the first indication is surgical (POP-Q grade III-IV prolapses).
• Women with only urinary incontinence or fecal urgency.
• Women with pain in the pelvic-perineal region of 3 cm in the visual analog scale, where a score of 0 cm means no pain, and a score of 10cm, the maximum pain that the participant can imagine.
• Women who have received pelvic floor physiotherapy treatment in the last 12 months.
• Women who are unable to voluntarily contract the pelvic floor muscles, quantified by the Modified Oxford Score by a score less than or equal to 2.
• Women with any pathology that may affect the treatment (neurological, gynecological or urological), or with recurrent urinary infection or hematuria.
• Women with cognitive limitations to understand the information, answer the questionnaires, consent and / or participate in the study.

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Single

Number of Arms

4

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Hypopressive exercises&PFM contraction; Hypopressive exercises + active pelvic floor muscle contraction: Anatomical and physiological explanation of the abdomen-pelvic cavity (perineal organs, bone, ligament and muscle structures of the entire abdomen-pelvic cavity).; Hypopressive exercises according to the original method described by Dr.Caufriez, which is based on performing the hypopressive maneuver in 33 postures he described, plus the active contraction of the pelvic floor muscles (PFM) during the hypopressive maneuver.	Other: Hypopressive exercises plus pelvic floor muscle contraction; See information included in arm/group descriptions.
Experimental: Hypopressive maneuver; Hypopressive maneuver: Anatomical and physiological explanation of the abdomen-pelvic cavity (perineal organs, bone, ligament and muscle structures of the entire abdomen-pelvic cavity).; Hypopressive maneuver with transabdominal ultrasound biofeedback.	Other: Hypopressive maneuver; See information included in arm/group descriptions.
Experimental: Hypopressive maneuver&PFM contraction; Hypopressive maneuver + pelvic floor muscles contraction: Anatomical and physiological explanation of the abdomen-pelvic cavity (perineal organs, bone, ligament and muscle structures of the entire abdomen-pelvic cavity).; Hypopressive maneuver plus active contraction of the pelvic floor muscles with transabdominal ultrasound biofeedback.	Other: Hypopressive maneuver plus pelvic floor muscle contraction; See information included in arm/group descriptions.
Experimental: Hypopressive exercises; Hypopressive exercises described according to Dr. Caufriez; Anatomical and physiological explanation of the abdomen-pelvic cavity (perineal organs, bone, ligament and muscle structures of the entire abdomen-pelvic cavity).; Hypopressive exercises according to the original method described by Dr. Caufriez, which is based on performing the hypopressive maneuver in 33 postures that he described (1,2).	Other: Hypopressive exercises; See information included in arm/group descriptions.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Change in life impact of pelvic floor dysfunction	It will be assessed by the PFIQ-7 Spanish version. The PFIQ-7 consists of 3 scales of 7 questions each taken from the Urinary Impact Questionnaire, the Pelvic Organ Prolapse Impact Questionnaire, and the Colorectal-Anal Impact Questionnaire. The 3 scales are scored from 0 (least impact) to 100 (greatest impact) and an overall summary score (0 to 300).	4 assessments to evaluate change from baseline: at baseline, after the intervention period (2 months from baseline), 3 month and 6 months after the intervention.
Change in symptoms and quality of life: PFDI-20	It will be assessed by PFDI-20 that is both a symptom inventory and a measure of the degree of bother and distress caused by pelvic floor symptoms. The PFDI-20 includes 20 questions and 3 scales. Each of the 3 scales is scored from 0 (least distress) to 100 (greatest distress). The sum of the scores of these 3 scales serves as the overall summary score of the PFDI-20 and ranges from 0 - 300 and the higher the score, the worse quality of life. The 3 scales include questions taken from the following widely used outcome measures: Urinary Distress Inventory - 6 questions, Pelvic Organ Prolapse Distress Inventory - 6 questions, and Colorectal-Anal Distress Inventory - 8 questions collecting data about UI, POP and colorectal and anal symptoms.	4 assessments to evaluate change from baseline: at baseline, after the intervention period (2 months from baseline), 3 months and 6 months after the intervention.

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Change in pelvic floor muscle strength by dinamometry	It will be measured by dynamometry (measured in GRAMS).	4 assessments to evaluate change from baseline after the intervention period (2 months from baseline), 3 months and 6 months after the intervention.
Change in pelvic floor muscle pasive tone	It will be measured by dinamometry (measured in GRAMS)	4 assessments to evaluate change from baseline after the intervention period (2 months from baseline), 3 months and 6 months after the intervention.

Collaborators and Investigators

• Sponsor: University of Alcala
• Investigators: Principal Investigator: María Torres-Lacomba, PhD, University of Alcala

Study record dates

Study Major Dates

• Study Start (Actual): February 10, 2019
• Primary Completion (Actual): December 20, 2024
• Study Completion (Actual): December 10, 2025

Study Registration Dates

• First Submitted: March 31, 2020
• First Submitted That Met QC Criteria: April 6, 2020
• First Posted (Actual): April 7, 2020

Study Record Updates

• Last Update Posted (Actual): August 14, 2026
• Last Update Submitted That Met QC Criteria: August 12, 2026
• Last Verified: January 1, 2024

More Information

Terms related to this study

• Keywords: Ultrasound; Hypopressive exercises; Pelvic floor muscle trianing; Active pelvic floor muscle contraction
• Additional Relevant MeSH Terms: Urogenital Diseases; Male Urogenital Diseases; Female Urogenital Diseases; Female Urogenital Diseases and Pregnancy Complications; Pregnancy Complications; Pelvic Floor Disorders
• Other Study ID Numbers: OE13/2017

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No