***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: AIMS The purpose of the present study was to compare the effectiveness of instruction to contract the pelvic floor muscles ( PFM ) , the transversus abdominis ( TrA ) , and the TrA + PFM visualized as displacement of the pelvic floor by ultrasound . MATERIAL S AND METHODS Twenty female physical therapists , mean age 41.1 years ( range 26 - 56 ) participated in the study . A 3.5 MHz 35 mm curved linear array ultrasound transducer ( Dornier Medtech ) was placed in the mid-sagittal plane immediately suprapubically , angled at 15 - 30 degrees from the vertical depending on subcutaneous fat and anatomical variations , to image the pelvic floor . Six trials of three maneuvers in r and om order were performed : contraction of PFM , TrA , and TrA + PFM . RESULTS In spite of correct contractions assessed by palpation and clinical observation , one subject demonstrated a downward movement of the pelvic floor during PFM contraction on ultrasound . Six subjects ( 30 % ) showed a downward movement during a TrA- contraction , and two during the combined TrA + PFM contraction . Instruction to contract PFM produced significantly greater mean displacement : 11.2 mm ( 95 % CI 7.2 - 15.3 ) than TrA 4.3 mm ( 95 % CI -0.2 - 8.8 ) , P < 0.01 , and combination : 8.5 mm ( 95 % CI 5.2 - 12 ) , P = 0.04 . Hence , instruction of PFM contraction produced a 61.6 % greater displacement of the pelvic floor in the correct direction than a TrA contraction . CONCLUSIONS It is concluded that ultrasound is a more valid method than palpation and clinical observation to assess PFM function , and that instruction to contract the PFM produces a significantly more effective pelvic floor muscle contraction than instruction to perform a TrA contraction OBJECTIVE Urinary incontinence is a chronic health complaint that severely reduces quality of life . Pregnancy and vaginal delivery are main risk factors in the development of urinary incontinence . The aim of this study was to assess whether intensive pelvic floor muscle training during pregnancy could prevent urinary incontinence . METHODS We conducted a single-blind r and omized controlled trial at Trondheim University Hospital and three outpatient physiotherapy clinics in a primary care setting . Three hundred one healthy nulliparous women were r and omly allocated to a training ( n = 148 ) or a control group ( n = 153 ) . The training group attended a 12-week intensive pelvic floor muscle training program during pregnancy , supervised by physiotherapists . The control group received the customary information . The primary outcome measure was self-reported symptoms of urinary incontinence . The secondary outcome measure was pelvic floor muscle strength . RESULTS At follow-up , significantly fewer women in the training group reported urinary incontinence : 48 of 148 ( 32 % ) versus 74 of 153 ( 48 % ) at 36 weeks ' pregnancy ( P = .007 ) and 29 of 148 ( 20 % ) versus 49 of 153 ( 32 % ) 3 months after delivery ( P = .018 ) . According to numbers needed to treat , intensive pelvic floor muscle training during pregnancy prevented urinary incontinence in about one in six women during pregnancy and one in eight women after delivery . Pelvic floor muscle strength was significantly higher in the training group at 36 weeks ' pregnancy ( P = .008 ) and 3 months after delivery ( P = .048 ) . CONCLUSION Intensive pelvic floor muscle training during pregnancy prevents urinary incontinence during pregnancy and after delivery . Pelvic floor muscle strength improved significantly after intensive pelvic floor muscle training To assess the impact of pelvic floor muscle training ( PFMT ) on bladder neck mobility in a prospect i ve observational study , and to correlate any observed changes with objective , st and ardized outcome measures of the severity of stress urinary incontinence ( SUI ) Abstract Objective : To compare the effect of pelvic floor exercises , electrical stimulation , vaginal cones , and no treatment for  genuine stress incontinence . Design : Stratified , single blind , r and omised controlled trial . Setting : Multicentre . Participants : 107 women with clinical ly and urodynamically proved genuine stress incontinence . Mean ( range ) age was 49.5 ( 24 - 70 ) years , and mean ( range ) duration of symptoms 10.8 ( 1 - 45 ) years . Interventions : Pelvic floor exercise ( n=25 ) comprised 8 - 12 contractions 3 times a day and exercise in groups with skilled physical therapists once a week . The electrical stimulation group ( n=25 ) used vaginal intermittent stimulation with the MS 106 Twin at 50 Hz 30 minutes a day . The vaginal cones group ( n=27 ) used cones for 20 minutes a day . The untreated control group ( n=30 ) was offered the use of a continence guard . Muscle strength was measured by vaginal squeeze pressure once a month . Main outcome measures : Pad test with st and ardised bladder volume , and self report of severity . Results : Improvement in muscle strength was significantly greater ( P=0.03 ) after pelvic floor exercises ( 11.0 cm H2O ( 95 % confidence interval 7.7 to 14.3 ) before v 19.2 cm H2O ( 15.3 to 23.1 ) after ) than either electrical stimulation ( 14.8 cm H2O ( 10.9 to 18.7 ) v 18.6 cm H2O ( 13.3 to 23.9 ) ) or vaginal cones ( 11.8 cm H2O ( 8.5 to 15.1 ) v 15.4 cm H2O ( 11.1 to 19.7 ) ) . Reduction in leakage on pad test was greater in the exercise group ( −30.2 g ; −43.3 to 16.9 ) than in the electrical stimulation group ( −7.4 g ; −20.9 to 6.1 ) and the vaginal cones group ( −14.7 g ; −27.6 to −1.8 ) . On completion of the trial one participant in the control group , 14 in the pelvic floor exercise group , three in the electrical stimulation group , and two in the vaginal cones group no longer considered themselves as having a problem . Conclusion : Training of the pelvic floor muscles is superior to electrical stimulation and vaginal cones in the treatment of genuine stress incontinence The aim of this study was to evaluate the effect of postpartum pelvic floor muscle exercise in the prevention and treatment of  urinary incontinence .  A prospect i ve comparison design of 99 matched pairs ( n=198 ) of mothers , a training group and a control group , was used . Eight weeks postpartum the training group attended an 8-week intensive pelvic floor muscle exercise course , training in groups led by a physical therapist for 45 minutes once a week . In addition they were asked to exercise at home at least three times per week . The control group followed the ordinary written postpartum instructions from the hospital . Pelvic floor muscle strength was measured pretreatment at the eighth , and post-treatment at the 16th week after delivery , using a vaginal balloon catheter connected to a pressure transducer .  Vaginal palpation and observation of inward movement of the balloon catheter during contraction were used to test the ability to perform correct the pelvic floor muscle contraction . Urinary leakage was registered by interview , specially design ed instruments to measure how women perceive SUI , and a st and ardized pad test . At baseline ( 8 weeks postpartum ) there was no significant difference in the number of women with urinary incontinence  in the training group compared to the control group . At 16 weeks postpartum , after the 8-week treatment period , there was a significant ( P<0.01 ) difference in favor of the training group . In addition , a significantly greater improvement in pelvic floor muscle strength between test 1 and test 2 was found in the training group compared to the control group . The results show that a specially design ed postpartum pelvic floor muscle exercise course is effective in increasing pelvic floor muscle strength and reducing urinary incontinence in the immediate postpartum period OBJECTIVE : The aim of this study was to compare the effectiveness of multimodal supervised physiotherapy programs with the absence of treatment among women with persistent postnatal stress urinary incontinence . METHODS : This was a single-blind r and omized controlled trial . Sixty-four women with stress urinary incontinence were r and omly assigned to 8 weeks of either multimodal pelvic floor rehabilitation ( n = 21 ) , multimodal pelvic floor rehabilitation with abdominal muscle training ( n = 23 ) , or control non – pelvic floor rehabilitation ( n = 20 ) . The primary outcome measure consisted of a modified 20-minute pad test . The secondary outcome measures included a Visual Analog Scale describing the perceived burden of incontinence , the Urogenital Distress Inventory , the Incontinence Impact Question naire , and pelvic floor muscle function measurements . RESULTS : Two patients dropped out , leaving 62 for analysis . At follow-up , more than 70 % of the women in the treatment groups ( 14/20 in the pelvic floor and 17/23 in the pelvic floor plus abdominal group ) were continent on pad testing compared with 0 % of women in the control group . Scores on the pad test , Visual Analog Scale , Urogenital Distress Inventory , and Incontinence Impact Question naire improved significantly in both treatment groups ( all P < .002 ) , whereas no changes were observed in the control group . Pelvic floor muscle function , however , did not improve significantly in either active group . CONCLUSION : Multimodal supervised pelvic floor physiotherapy is an effective treatment for persistent postnatal stress urinary incontinence . LEVEL OF EVIDENCE : OBJECTIVE To compare the effect of individual pelvic floor muscle training with and without biofeedback in women with urodynamic stress incontinence METHODS The study was a single , blind , r and omized trial . All women completed 6 months of pelvic floor muscle training comprising three sets of ten contractions three times per day , supervised by a physical therapist . One group trained with a biofeedback apparatus at home , the other without biofeedback . The primary outcome measures were pad test with st and ardized bladder volume and self‐report of severity . RESULTS A total of 103 women were r and omized , and data from 94 women were analyzed . Mean age ( range ) was 46.6 ( 30–70 ) years , and mean ( range ) duration of symptoms was 9.7 ( 1–25 ) years . Seventy women had urodynamic stress incontinence alone , and 24 women reported additional urge symptoms . Women training with and without biofeedback showed a statistically significant reduction in leakage on pad test ( P < .01 ) after 6 months of pelvic floor muscle training . Objective cure ( 2 g or less of leakage ) in the total group was 58 % in women training with and 46 % in women training without biofeedback , and in the subgroup of women with urodynamic stress incontinence alone , 69 % in women training with and 50 % in women training without biofeedback . There was no statistically significant difference between the groups posttreatment in any outcome measure . CONCLUSION Cure rate was high , and the reduction in urinary leakage after treatment was statistically significant in both groups . However , there was no statistically significant difference in the effect of individual pelvic floor muscle training with and without biofeedback AIMS Several r and omized controlled trials have demonstrated that pelvic floor muscle training is effective to treat stress urinary incontinence . The aim of the present study was to compare muscle strength increase and maximal strength in responders and non-responders to pelvic floor muscle training . MATERIAL S AND METHODS Fifty-two women with urodynamically proven stress incontinence who had participated in a six months r and omized controlled trial on pelvic floor muscle training , mean age 45.4 years ( range 24 - 64 ) , participated in the study . The women were classified as responders and non-responders based on a combination of five effect variables covering urodynamic measurement , pad test with st and ardized bladder volume , and self-reports . Pelvic floor muscle strength  was measured with a vaginal balloon connected to a fiber optic micro tip transducer ( Camtech AS , S and vika , Norway ) . RESULTS There was a positive correlation between improvement in PFM maximal strength and improvement measured by leakage index ( r = 0.34 , P < 0.01 ) , and reduction in urinary leakage measured by the pad test ( r = 0.23 , P = 0.05 ) . The total sample of 52 women comprised 21 responders , 18 unclassifiable , and 13 non-responders . There was a statistically significant difference in maximal strength after the training period between responders and non-responders ; 24.0 cm H2O ( 95 % CI:18.1 - 29.9 ) versus 12.7 cm H2O ( 95 % CI : 6.8 - 18.6 ) P < 0.001 ) , and strength increase ; 14.8 cm H2O ( 95 % CI : 8.9 - 20.7 ) versus 5.0 cm H2O ( 95 % CI : 2.6 - 12.6 ) , respectively ( P = 0.03 ) . CONCLUSIONS There was a positive relation between both pelvic floor muscle strength increase and maximal strength , and improvement of stress urinary incont 
    Output:
    
RESULTS While a co-contraction of the TrA normally occurs with PFM contraction , there is evidence that a co-contraction of the PFM with TrA contraction can be lost or altered in women with UI .
To date there is insufficient evidence for the use of TrA training instead of or in addition to PFMT for women with UI .
Neurourol .
Urodyn .