{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,2]],"date-time":"2026-07-02T08:24:11Z","timestamp":1782980651186,"version":"3.54.5"},"reference-count":30,"publisher":"MDPI AG","issue":"19","license":[{"start":{"date-parts":[[2022,9,23]],"date-time":"2022-09-23T00:00:00Z","timestamp":1663891200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJERPH"],"abstract":"<jats:p>Teaching Pelvic Floor Muscle (PFM) contraction is a challenging task for clinicians and patients, as these muscles cannot be directly visualized. Thus, this study\u2019s objective is to compare the effectiveness of six verbal instructions for contracting the PFM among young men, as observed with transabdominal ultrasound imaging. Thirty-five male physiotherapy students, mean age 25.9 \u00b1 1.9 years, participated in the study. A 6 MHz 35-mm curved linear array ultrasound transducer (Mindray M5) was placed in the transverse plane, supra-pubically, and angled 15\u201330\u00b0 from the vertical plane. During crook lying, participants received six verbal instructions for contracting the PFM, with bladder base displacement and endurance evaluated. Following the instructions, \u201csqueeze your anus\u201d, \u201cshorten the penis\u201d, and \u201celevate the scrotum\u201d, over 91% of the participants performed a cranial (upward) bladder base displacement. During instruction six, \u201cdraw in\u201d, which involves breathing, the PFM, and the transversus abdominis, only 25% performed cranial bladder base displacement (p &lt; 0.001), and the endurance was the lowest (p &lt; 0.001). Our findings suggest that several simple verbal instructions can be used for teaching PFM contraction to young males. Moreover, two instructions should be avoided: \u201cdraw in\u201d and the general instruction \u201csqueeze your PFM\u201d, as they did not produce effective elevation of the bladder base.<\/jats:p>","DOI":"10.3390\/ijerph191912031","type":"journal-article","created":{"date-parts":[[2022,9,25]],"date-time":"2022-09-25T23:13:27Z","timestamp":1664147607000},"page":"12031","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Verbal Instruction for Pelvic Floor Muscle Contraction among Healthy Young Males"],"prefix":"10.3390","volume":"19","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5067-5178","authenticated-orcid":false,"given":"Noa","family":"Ben Ami","sequence":"first","affiliation":[{"name":"Department of Physiotherapy, Faculty of Health Sciences, Ariel University, Ariel 4077625, Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2072-0198","authenticated-orcid":false,"given":"Ron","family":"Feldman","sequence":"additional","affiliation":[{"name":"Department of Physiotherapy, Faculty of Health Sciences, Ariel University, Ariel 4077625, Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0572-5495","authenticated-orcid":false,"given":"Gali","family":"Dar","sequence":"additional","affiliation":[{"name":"Department of Physical Therapy, Faculty of Social Welfare & Health Sciences, University of Haifa, Mount Carmel, Haifa 3498838, Israel"},{"name":"Ribstein Center for Research and Sports Medicine, Wingate Institute, Netanya 4290200, Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2022,9,23]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.urology.2014.03.016","article-title":"Pelvic Floor Muscle Training in Males: Practical Applications","volume":"84","author":"Siegel","year":"2014","journal-title":"Urology"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"53","DOI":"10.1016\/j.sxmr.2015.10.001","article-title":"The Role of Pelvic Floor Muscles in Male Sexual Dysfunction and Pelvic Pain","volume":"4","author":"Cohen","year":"2016","journal-title":"Sex. Med. Rev."},{"key":"ref_3","first-page":"785263","article-title":"Efficacy of physiotherapy for urinary incontinence following prostate cancer surgery","volume":"2014","author":"Kucharzewski","year":"2014","journal-title":"Biomed Res. Int."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"595","DOI":"10.1111\/j.1464-410X.2005.05690.x","article-title":"Pelvic floor exercises for erectile dysfunction","volume":"96","author":"Dorey","year":"2005","journal-title":"BJU Int."},{"key":"ref_5","unstructured":"(2021, November 01). Dorey|PDF|Urinary Incontinence|Pelvis. Available online: https:\/\/www.scribd.com\/document\/352273177\/Dorey."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1039","DOI":"10.1016\/j.eururo.2010.02.028","article-title":"Preoperative pelvic floor muscle exercise for early continence after radical prostatectomy: A randomised controlled study","volume":"57","author":"Centemero","year":"2010","journal-title":"Eur. Urol."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"397","DOI":"10.1007\/s11701-018-0803-8","article-title":"A systematic review of PFE pre-prostatectomy","volume":"12","author":"Goonewardene","year":"2018","journal-title":"J. Robot. Surg."},{"key":"ref_8","unstructured":"(2021, November 01). Overview|Lower Urinary Tract Symptoms in Men: Management|Guidance|NICE. Available online: https:\/\/www.nice.org.uk\/guidance\/cg97."},{"key":"ref_9","first-page":"201","article-title":"Improved continence outcomes with preoperative pelvic floor muscle strengthening exercises\u2014PubMed","volume":"21","author":"Sueppel","year":"2001","journal-title":"Urol. Nurs."},{"key":"ref_10","first-page":"17","article-title":"Conservative management for postprostatectomy urinary incontinence","volume":"2015","author":"Anderson","year":"2015","journal-title":"Cochrane Database Syst. Rev."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"1329","DOI":"10.1002\/nau.21069","article-title":"Assessing muscle function of the male pelvic floor using real time ultrasound","volume":"30","author":"Nahon","year":"2011","journal-title":"Neurourol. Urodyn."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"1179","DOI":"10.1016\/S0003-9993(96)90144-6","article-title":"Reproducibility of digital testing of the pelvic floor muscles in men","volume":"77","author":"Wyndaele","year":"1996","journal-title":"Arch. Phys. Med. Rehabil."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"1224","DOI":"10.1016\/j.juro.2012.06.028","article-title":"Novel insight into the dynamics of male pelvic floor contractions through transperineal ultrasound imaging","volume":"188","author":"Stafford","year":"2012","journal-title":"J. Urol."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"685","DOI":"10.1016\/j.urology.2012.11.034","article-title":"A new method to quantify male pelvic floor displacement from 2D transperineal ultrasound images","volume":"81","author":"Stafford","year":"2013","journal-title":"Urology"},{"key":"ref_15","doi-asserted-by":"crossref","unstructured":"Stafford, R.E., Coughlin, G., Lutton, N.J., and Hodges, P.W. (2015). Validity of estimation of pelvic floor muscle activity from transperineal ultrasound imaging in men. PLoS ONE, 10.","DOI":"10.14264\/uql.2015.1104"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"673","DOI":"10.1016\/j.urology.2012.05.026","article-title":"Transabdominal Ultrasound Measurement of Pelvic Floor Muscle Mobility in Men With and Without Chronic Prostatitis\/Chronic Pelvic Pain Syndrome","volume":"80","author":"Khorasani","year":"2012","journal-title":"Urology"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"457","DOI":"10.1002\/nau.22745","article-title":"Pattern of activation of pelvic floor muscles in men differs with verbal instructions","volume":"35","author":"Stafford","year":"2016","journal-title":"Neurourol. Urodyn."},{"key":"ref_18","first-page":"105","article-title":"Pelvic floor muscle assessment in men post prostatectomy: Comparing digital rectal examination and real-time ultrasound approaches","volume":"24","author":"Milios","year":"2018","journal-title":"Aust. N. Zeal. Cont. J."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"285","DOI":"10.1007\/s00192-005-1308-3","article-title":"Assessment of pelvic floor movement using transabdominal and transperineal ultrasound","volume":"16","author":"Thompson","year":"2005","journal-title":"Int. Urogynecol. J. Pelvic Floor Dysfunct."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"1620","DOI":"10.1002\/nau.21083","article-title":"Investigation of optimal cues to instruction for pelvic floor muscle contraction: A pilot study using 2D ultrasound imaging in pre-menopausal, nulliparous, continent women","volume":"30","author":"Crotty","year":"2011","journal-title":"Neurourol. Urodyn."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"135","DOI":"10.1097\/SPV.0000000000000145","article-title":"Correct performance of pelvic muscle exercises in women reporting prior knowledge","volume":"21","author":"Kandadai","year":"2015","journal-title":"Female Pelvic Med. Reconstr. Surg."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"2904","DOI":"10.1002\/nau.23810","article-title":"What is the most effective verbal instruction for correctly contracting the pelvic floor muscles?","volume":"37","author":"Ami","year":"2018","journal-title":"Neurourol. Urodyn."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"1076","DOI":"10.1016\/j.urology.2004.01.005","article-title":"International consultation on incontinence questionnaire short form: Comparison of physician versus patient completion and immediate and delayed self-administration","volume":"63","author":"Hajebrahimi","year":"2004","journal-title":"Urology"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"582","DOI":"10.1002\/nau.10139","article-title":"Transabdominal ultrasound measurement of pelvic floor muscle activity when activated directly or via a transversus abdominis muscle contraction","volume":"22","author":"Sherburn","year":"2003","journal-title":"Neurourol. Urodyn."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"148","DOI":"10.1002\/nau.20203","article-title":"Differences in muscle activation patterns during pelvic floor muscle contraction and Valsalva maneuver","volume":"25","author":"Thompson","year":"2006","journal-title":"Neurourol. Urodyn."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"363","DOI":"10.2307\/2529786","article-title":"An application of hierarchical kappa-type statistics in the assessment of majority agreement among multiple observers","volume":"33","author":"Landis","year":"1977","journal-title":"Biometrics"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"1081","DOI":"10.1053\/apmr.2001.24297","article-title":"Contraction of the pelvic floor muscles during abdominal maneuvers","volume":"82","author":"Sapsford","year":"2001","journal-title":"Arch. Phys. Med. Rehabil."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"31","DOI":"10.1002\/1520-6777(2001)20:1<31::AID-NAU5>3.0.CO;2-P","article-title":"Co-activation of the abdominal and pelvic floor muscles during voluntary exercises","volume":"20","author":"Sapsford","year":"2001","journal-title":"Neurourol. Urodyn."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"125","DOI":"10.1007\/s001920200027","article-title":"Pelvic floor and abdominal muscle interaction: EMG activity and intra-abdominal pressure","volume":"13","author":"Neumann","year":"2002","journal-title":"Int. Urogynecol. J. Pelvic Floor Dysfunct."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"187","DOI":"10.1016\/S0004-9514(07)70026-0","article-title":"Healthy adults can more easily elevate the pelvic floor in standing than in crook-lying: An experimental study","volume":"53","author":"Kelly","year":"2007","journal-title":"Aust. J. Physiother."}],"container-title":["International Journal of Environmental Research and Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1660-4601\/19\/19\/12031\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T00:37:59Z","timestamp":1760143079000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1660-4601\/19\/19\/12031"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,9,23]]},"references-count":30,"journal-issue":{"issue":"19","published-online":{"date-parts":[[2022,10]]}},"alternative-id":["ijerph191912031"],"URL":"https:\/\/doi.org\/10.3390\/ijerph191912031","relation":{},"ISSN":["1660-4601"],"issn-type":[{"value":"1660-4601","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,9,23]]}}}