Impact of two reflex pelvic floor muscle contraction patterns on female stress urinary incontinence

To explore the impact of two reflex pelvic floor muscle contraction patterns during coughing on incontinence severity and incontinence-related quality of life in women with stress urinary incontinence (SUI).

A total of 208 women with the symptomatic and urodynamic evidence of SUI and 126 women with no experience of urinary incontinence were recruited in a 5-year period. During hard coughs, reflex pelvic floor muscle contraction was detected using introital ultrasound and two reflex contraction patterns were recognized: an inward clitoral motion and a superior-anterior anorectal lift. The assessment of incontinent severity and impact of quality of life included 1-hour pad tests and short forms of the Urogenital Distress Inventory and the Incontinence Impact Questionnaire.

There is no significant difference in the demographics and the distribution and concordance of two reflex contractions between women with or without urinary incontinence. Neither type of reflex contraction during coughing was identified in 14 incontinent women (7%) and 5 continent women (4%). The concordant rate for synchronous activities of both reflex contractions during coughing was 80% (167) and 81% (102) for incontinent and continent women, respectively. Incontinent women without clitoral reflex motion had significantly greater incontinent severity on 1-hour pad tests (p = 0.018) and higher sum scores of the short form of Incontinence Impact Questionnaire (p = 0.026). By contrast, incontinent women with and without reflex anorectal lifts had similar incontinence severity and impact.

In women with SUI, loss of clitoral reflex motion is associated with worse incontinent severity and impact.