Rationale of pelvic floor muscles training in women with urinary incontinence

Urinary incontinence (UI) is a frequent condition in women and has a significant impact on their quality of life. Its prevalence varies between 10% to 40% and stress urinary incontinence (SUI) is the most frequent condition. In the past surgery was considered the milestone of treatment in women with SUI. Nowadays, conservative approach is commonly considered by the International Continence Society the first line therapy in uncomplicated UI. In particular pelvic floor muscle training (PFMT) has acquired a fundamental role in the prevention and treatment of female UI (FUI), often incited or promoted by occupation, sport activities, vaginal childbirth, menopause or ageing. The rationale of PFMT for SUI is that a strong pelvic floor muscle contraction will clamp the urethra, increasing the urethral pressure to prevent leakage during an abrupt increase in intra-abdominal pressure. In urge urinary incontinence PFMT may inhibit reflexively or voluntarily the involuntary detrusor contraction. The core of PFMT is the pelvic floor muscle (PFM) awareness, followed by sequential program until the concomitant automatic PFM contraction during daily life activities. The last Cochrane review asserted that PFMT is an effective treatment in women with stress and mixed UI. But it is mandatory to emphasise the fundamental role of PFMT in the prevention of FUI, as could be assured by more extensive programs of adaptive physical activity in this field.