urinary incontinence ( ui ) is well - known to profoundly affect the qol ( quality of life ) of 
 women
. many cases of ui are stress urinary incontinence ( sui ) , and the success of pelvic 
 floor muscle ( pfm ) exercise in the management of sui has been confirmed by multiple 
 randomized controlled studies .
pfm exercise has been reported to be from 50% to 69% 
 effective at reducing urine loss episodes in women1,2,3,4 .
many ui cases are the 
 result of pfm weakness , suggesting that risk of ui can be evaluated by pfm .
recently , 
 several studies reported that the pfm , as the inner unit along with the transverse abdominal 
 muscle ( ta ) , multifidus muscle , and diaphragm , acts to maintain the stability of the trunk , 
 and the pfm has begun to be used in approaches for not only ui but also lumbar pain5,6,7 . in our previous study , we found a 
 significant relationship between the thickness of the ta and the iemg of the levator ani 
 muscle8 .
this result suggests that 
 changes in the thickness of the ta may be used to indicate changes in the electrical 
 activity of the pfm .
the purpose of this study was to devise a new urinary incontinence exercise using 
 co - contraction of both the transverse abdominal muscle and pelvic floor muscle and examine 
 the intervention effect in middle - aged women with stress urinary incontinence .
the subjects were fifteen women who had experienced one or more sui events in the past 1 
 month .
the subjects were divided into two groups randomly : the ta and pfm co - contraction 
 exercise group ( n=9 ) and the control group ( n=6 ) ( table 
 1table 1 .
subject characteristicsage ( y)height ( cm)weight ( kg)exercise group ( n= 9)52.1  9.5156.1  6.251.9  5.3control group ( n= 6)52.0  7.6161.0  7.455.7
all 
 experimental procedures in this study were reviewed and approved by the ethical review 
 committee of jilin dianli hospital .
the thickness of the ta was measured in all subjects under four conditions 
 at random in the supine position .
2 ) the 
 second condition was maximal contraction of the ta . for this , the subjects were instructed 
 to draw in the lower abdominal wall toward the spine , an action that specifically activates 
 the ta .
the 
 subjects were instructed to contract the muscles around the vagina  like a drawstring  and 
 to lift them internally .
4 ) the fourth condition was 
 maximal co - contraction of both the ta and pfm .
subjects were instructed to draw in the lower 
 abdominal wall toward the spine , an action that specifically activates the ta . when the ta 
 sustained isometric contraction , the subjects were instructed to contract the muscles around 
 the vagina  like a drawstring  to lift them internally and to keep this position for 3 
 seconds . under each condition , the subjects were in the supine position with the knees flexed at 90 
 and a pillow under the head .
the three - chamber pressure cells were placed under the lumbar spine , and the subjects were 
 asked to keep the baseline at 40 mmhg . if the pressure of the biofeedback stabilizer 
 decreased under conditions 2 , 3 , or 4 , abdominal muscle re - education was provided by a 
 physical therapist .
ultrasound images of the anterolateral abdominal wall were obtained using a sonosite 
 ultrasound ( sonosite 180plus , b mode,5  mhz linear transducer ) .
the transducer was positioned adjacent to and perpendicular to the 
 abdominal wall , 25  mm anteromedial to the midpoint between the ribs and ilium on the 
 midaxillary line , and parallel to the muscle fibers of the transversus abdominis9 . the same person , a midwife , made the 
 measurements to avoid inter - rater errors .
all 
 thickness measurements were of muscle only , that is , between the fascia boundaries . to judge 
 the effect ,
the measurements were performed before the intervention , 4 weeks after the 
 intervention , and 8 weeks after the intervention .
subjects in the exercise group were provided with an 8-week ta and pfm co - contraction 
 training program .
the exercises prescribed were 40 repetitions ( 2 sets of 20 repetitions ) of 
 a 3-second co - contraction of both the ta and pfm .
the women were told to perform 1 session 
 of exercise 3 times per week .
the women in the control group were asked not to exercise at 
 home during the study but were offered the possibility of receiving a treatment at trial 
 completion . to determine whether there were differences between the exercise group and the control 
 group , the independent t - test was performed on subject characteristics .
the friedman test and 
 wilcoxon test were performed to investigate the differences between before and after the 
 intervention .
there were no significant differences between the exercise group and control group subject 
 characteristics or any measure before the intervention .
comparison of the ta thickness between before and after intervention 
 ( mm)beforeafter 4 weeksafter 8 weeksexercise group ( n= 9)resting state2.5  1.32.5  1.02.7  1.2maximal contraction of ta3.9  1.73.7  1.34.7  1.8maximal contraction of pfm 3.5  1.73.6  1.34.5  1.4maximal co - contraction 3.9  1.04.1  1.35.4  1.4*control group ( n= 6)resting state2.2  0.72.3  0.42.4  0.7maximal contraction of ta3.6  1.13.6  1.04.2  0.7maximal contraction of pfm 3.4  1.53.7  0.83.6  0.8maximal co - contraction 4.1  1.34.1 
0.83.8  0.7values are means  sd . * p<0.05 ( before and after 8 weeks ) .  
ta : 
 transverse abdominal muscle ,   pfm : pelvic floor muscle , 
 maximal co - contraction : maximal co - contraction of both the ta and pfm shows the results for the thickness of the ta .
there were significant 
 differences in the thickness of the ta during maximal co - contraction of both the ta and pfm 
 between before and after the 8 weeks exercise . in the control group
values are means  sd . * p<0.05 ( before and after 8 weeks ) .  
ta : 
 transverse abdominal muscle ,   pfm : pelvic floor muscle , 
 maximal co - contraction : maximal co - contraction of both the ta and pfm in the exercise group , the cure rates of sui were 55.6% ( 5/9 ) after 4 weeks of the 
 intervention and 88.9% ( 8/9 ) after 8 weeks intervention , and the control group showed no 
 change .
this study investigated the effects of ta and pfm co - contraction exercise on stress urinary 
 incontinence .
the exercise group subjects showed not only an increased thickness of the ta 
 during maximal co - contraction of both the ta and pfm but also improved sui . in our previous study ,
the cutoff value for the thickness of the ta during maximal 
 co - contraction of both the ta and pfm was 5.00  mm .
this result indicates that the 
 detectability of the risk of urinary incontinence is high and that quantitative assessment 
 of the risk of ui is possible through measurement of the thickness of the ta during maximal 
 co - contraction of both the ta and pfm10 , 11 . in the present study , when the sui 
 disappeared , the thickness of the ta was greater than the cutoff value .
the ta and pfm 
 co - contraction exercise intervention increases the thickness of the ta and may be 
 recommended to improve sui in middle - aged women .
   [ purpose ] the purpose of this study was to devise a new urinary incontinence exercise 
 using co - contraction of both the transverse abdominal muscle ( ta ) and pelvic floor muscle 
 ( pfm ) and examine the intervention effect in middle - aged women with stress urinary 
 incontinence ( sui ) . 
 [ subjects ] the subjects were fifteen women with sui who were divided 
 into two groups : the ta and pfm co - contraction exercise group ( n=9 ) and the control group 
 ( n=6 ) . [ methods ] participants in the exercise group performed ta and pfm co - contraction 
 exercise . the thickness of the ta was measured before and after 8 weeks of exercise using 
 ultrasound . 
 the thickness of the ta was measured under 4 conditions : ( 1 ) at rest , ( 2 ) 
 maximal contraction of the ta , ( 3 ) maximal contraction of the pfm , and ( 4 ) maximal 
 co - contraction of both the ta and pfm . 
 [ results ] there were no significant differences 
 among the results of the control group . in the exercise group , 
 the cure rate of sui was 
 88.9% after the intervention . 
 there were significant differences in the thickness of the 
 ta during maximal co - contraction of both the ta and pfm after the intervention . 
 
 [ conclusion ] the ta and pfm co - contraction exercise intervention increases the thickness 
 of the ta and may be recommended to improve sui in middle - aged women . 
INTRODUCTION
SUBJECTS AND METHODS
RESULTS
DISCUSSION