Background: Urinary incontinence (UI) is more common than any other chronic disease. Stress urinary incontinence (SUI), among the various forms of urinary incontinence, is the most prevalent (50%) type of this condition. Female urinary continence is maintained through an integrated function of pelvic floor muscles (PFMs), fascial structures, nerves, supporting ligaments, and the vagina. In women with SUI, the postural activity of the PFMs is delayed and the balance ability is decreased. Many women, by learning the correct timing of a pelvic floor contraction during a cough, are able to eliminate consequent SUI. Timing is an important function of motor coordination and could be affected by proprioception. This study was conducted to review and outline the literature on proprioception as a contributory factor in SUI. Methods: PubMed, Scopus, and Google Scholar databases were systematically searched from 1998 to 2017 for articles on the topic of pathophysiology, motor control alterations, and proprioception role in women with SUI. Results: A total of 6 articles addressed the importance of proprioception in motor control and its alterations in women with SUI. There were also publications on postural control, balance, and timing alterations in women with SUI in the literature. However, there was no research on measuring proprioception in the pelvic floor in this group. Conclusion: Both the strength of the PFMs and the contraction timing and proprioception are important factors in maintaining continence. Thus, conducting research on PFMs proprioception in women with SUI, as a cause of incontinence, is encouraged.
Introduction and hypothesis This study synthesized the effects of supervised and unsupervised pelvic floor muscle training (PFMT) programs on outcomes relevant to women’s urinary incontinence (UI). Methods Five databases were searched from inception to December 2021, and the search was updated until June 28, 2022. Randomized and non-randomized control trials (RCTs and NRCTs) comparing supervised and unsupervised PFMT in women with UI and reported urinary symptoms, quality of life (QoL), pelvic floor muscles (PFM) function/ strength, the severity of UI, and patient satisfaction outcomes were included. Risk of bias assessment of eligible studies was performed by two authors through Cochrane risk of bias assessment tools. The meta-analysis was conducted using a random effects model with the mean difference or standardized mean difference. Results Six RCTs and one NRCT study were included. All RCTs were assessed as "high risk of bias", and the NRCT study was rated as "serious risk of bias" for almost all domains. The results showed that supervised PFMT is better than unsupervised for QoL and PFM function of women with UI. There was no difference between supervised and unsupervised PFMT for urinary symptoms and improvement of the severity of UI. Results of patient satisfaction were inconclusive due to the sparse literature. However, supervised and unsupervised PFMT with thorough education and regular reassessment showed better results than those for unsupervised PFMT without educating patients about correct PFM contractions. Conclusions Supervised and unsupervised PFMT programs can both be effective in treating women's UI if training sessions and regular reassessments are provided. Supplementary Information The online version contains supplementary material available at 10.1007/s00192-023-05489-2.
Background: It has been demonstrated that pelvic floor muscles (PFMs) are involved in the pathophysiology of stress urinary incontinence (SUI). Sense of force, an aspect of proprioception, has never been evaluated in PFMs. Objectives: This study aimed to assess the proprioception of PFMs by evaluating the accuracy of force sense in adult women with SUI compared to those with continence. A further aim was to study the accuracy of force sense between various lengths and tensions of PFMs. Methods: Twenty-three women with SUI and 18 women without it were recruited in six trials with four different test conditions: 5 mm/40% (speculum opening/maximum voluntary contraction (MVC) percentage to produce), 5 mm/70%, 10 mm/40%, and 10 mm/70%. All participants were asked to reproduce the target force based on their own perceptions. The dynamometer was used to evaluate the sense of force. Results: The accuracy of force sense differed between women with SUI and those without it. In all test conditions, women with SUI had higher force reproduction accuracy. The highest amount of error was recorded at 10 mm and 40% MVC for either group. Conclusions: Women with SUI were more accurate in reproducing the target force than those with continence. Higher force sense accuracy may result from more attention to the pelvic floor area and a lack of automaticity of movements in women with SUI. Therefore, developing therapeutic management focusing on restoring automaticity seems advisable.
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