[Pelvic floor rehabilitation for female urinary incontinence: mechanisms of action]. / Mécanismes d'action de la rééducation périnéale pour l'incontinence urinaire de la femme.

ABSTRACT

OBJECTIVE: To analyze the proven mechanisms of action of pelvic rehabilitation in women presenting with urinary incontinence. METHODS: Review of literature (PubMed, Embase, Cochrane Database) using following keywords female; urinary incontinence; overactive bladder syndrome; stress urinary incontinence; bladder training; bladder diary; pelvic floor muscle training; pelvic floor rehabilitation; physiotherapy; cognitive therapies. Among 2906 articles (animal and anatomical studies have been excluded); 66 have been selected because they focused on the evaluation of the pathophysiological mechanisms of pelvic floor rehabilitation concerning female urinary incontinence. RESULTS: Studies on pelvic floor muscles training exercises showed a significant increase in the force of contraction of these muscles and it was correlated with improved scores of urinary incontinence and pad test (coefficient of correlation r ranged from 0.23 to 0.34) for women presenting with stress urinary incontinence. These studies have not observed an increase in the maximum urethral closure pressure (MUCP) or correction of urethral hypermobility related with the improvement of incontinence after rehabilitation sessions. Studies concerning pelvic floor stimulation observed an increase in the force of contraction of pelvic floor muscles after rehabilitation and a decrease in the intensity of detrusor contractions without changing the MUCP. There is very little data on the precise mechanisms of action of biofeedback and cognitive behavioral therapy. CONCLUSION: In studies that objectively evaluated the mechanisms of action of pelvic rehabilitation, it was observed that pelvic floor muscles voluntary exercises and electrostimulation resulted an increase in force of contraction of these muscles without changing the MUCP.