Effects of ankle position on pelvic floor muscle electromyographic activity in female stress urinary incontinence: preliminary results from a pilot study.

Objectives: A standing posture including various ankle positions might effectively facilitate pelvic floor muscle activity (PFMa) in incontinent women, and an ankle dorsiflexion (DS) at 15 degrees was identified as the best position able to increase PFMa. Nevertheless, this ankle inclination is very uncomfortable. We carried out this study aiming at identifying smaller ankle inclinations able to significantly affect PFMa in incontinent women reducing patient discomfort.
Methods: Twenty women, not yet entered menopause and with mild-moderate uncomnplicated stress urinary incontinence, were enrolled. An electromyographic (EMG) biofeedback instrument using surface electrodes was employed to measure changes in PFMa while each patient assumed the following different ankle inclinations in upright position: horizontal standing (HS); DS at degrees (5DS), 10 degrees (10DS) and 15 degrees (15DS); and ankle plantar flexion (PS) at 5 degrees (5PS), 10 degrees (10PS) and 15 degrees (15PS).
Results: No EMG differences were found between HS and PS. PFM tension in DS, at whatever angle, was significantly greater than in both HS (P < 0.020) and PS (P < 0.040). No differences were found between IODS and 15DS in terms of resting PFMa. Concerning maximal PFMa, it was higher in 10DS than in 15DS (P = 0.010), and in 5PS than in both 5DS (P = 0.006) and 15DS (P = 0.010); no EMG differences were found between 5PS and 10DS.
Conclusions: These preliminary results showed that 10DS in upright standing had comparable effects on resting PFMa than 15DS with same effectiveness and less patient's discomfort, facilitating a better maximal contraction. Moreover a slight PS might effectively facilitate maximal PFMa.