Dilemmas in the management of female stress incontinence: the role of pelvic floor muscle training

Abstract

Treatment options for female stress urinary incontinence include pelvic floor muscle training, lifestyle interventions, bladder retraining, pharmacotherapy, anti-incontinence devices and surgery. Several consensus statements recommend pelvic floor muscle training as first line treatment. The aim of this review is to analyse all the currently available data and propose a treatment algorithm for clinical practice. A literature-based critical presentation of all treatment modalities, methods of assessing efficacy and comparison between them using a patient-centered approach was made. Many of the studies are observational, non-randomized with several methodological problems that lead to confusion. Emphasis was made to high quality randomized trials. The proposed treatment algorithm established only on evidence-based data. Management strategy however, must identify patient expectations and involve them in the decision-making more than traditional measures of treatment success.

TVT vs. TOT: a comparison in terms of continence results, complications and quality of life after a median follow-up of 48 months

“…Treatment options for SUI include pelvic floor muscle training, lifestyle interventions, bladder retraining, pharmacotherapy, anti-incontinence devices and surgery [8][9][10]. The mid-urethral tension-free tape procedures have revolutionized incontinence surgery.…”

Pharmacologic Targets on the Female Urethra

“…Noninvasive treatment options for female SUI include pelvic floor muscle training, lifestyle interventions, bladder retraining and pharmacotherapy, whereas more invasive options include anti-incontinence devices, periurethral bulking agent injectables and surgery [12] . Postpartum pelvic floor exercises seem to be an effective conservative treatment modality in decreasing postpartum urinary incontinence, suggesting the importance of pelvic floor problems in the formation of SUI in women [13] .…”

The Effects of Pelvic Floor Muscle Training on Stress and Mixed Urinary Incontinence and Quality Of Life

“…The muscles that comprise the pelvic floor consist of the anal sphincter, ischiocavernosus, bulbospongiosus, transverse perineal muscle, and levator ani (which is sometimes divided into the pubococcygeus, puborectalis, and iliococcygeus). 3,[9][10][11] The PFM are made up of 2 distinct muscle fiber types based on their contractile characteristics. Approximately one-third are fast twitch (type II) fibers and 67% are slow twitch (type I) fibers.…”

“…Approximately one-third are fast twitch (type II) fibers and 67% are slow twitch (type I) fibers. [11][12][13][14] They both provide support for the pelvic organs and contribute to urinary and fecal continence. 11 PFM contractions promote urinary continence by raising urethral closure pressure in response to rises in abdominal pressure.…”

“…[11][12][13][14] They both provide support for the pelvic organs and contribute to urinary and fecal continence. 11 PFM contractions promote urinary continence by raising urethral closure pressure in response to rises in abdominal pressure. 13,14 Hypertrophy of PFM fibers tends to increase closure pressures of the urethral sphincter mechanism.…”