In a well-functioning pelvic floor, the pelvic floor muscles and their ligaments and fascia act together to counteract the impact of any increase in intra-abdominal pressure (such as with jogging or coughing) to maintain closure of the openings to the urethra, vagina and rectum. Weakness of the pelvic floor muscles is a common reason for the loss of this control, which can cause incontinence. Training the pelvic floor muscles with repeated voluntary contractions restores their strength and their function, which can cure the incontinence.
In the general population, women with stress urinary incontinence who do pelvic floor muscle training are 8 times more likely (56% versus 6%) to be cured than control groups who don't do the training. The effects of the training are better if it is delivered with regular supervised training (e.g., once a week under the supervision of a physiotherapist, who cues each pelvic floor muscle contraction). Traditionally, this is done on a one-to-one basis, although that limits the number of women who can receive the treatment from a physiotherapist. However, once women have learned the technique, they can do it fully clothed.
Professor Bø reviews the evidence from ten head-to-head trials of individual versus group pelvic floor muscle training, which clearly have equally beneficial effects. This therefore offers a more efficient way to deliver this important intervention to more women.
This topical review by covers from first principles (anatomy, normal function, causes and prevalence of dysfunction) through to the evidence for all forms of pelvic floor muscle training, a practical example of the group class format, and directions for future research.
> From: Bø, J Physiother 66 (2020) 147-154 . All rights reserved to Australian Physiotherapy Association. Click here for the online summary.
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