Brain Mechanisms Underlying Urge Incontinence and its Response to Pelvic Floor Muscle Training

Area of Science:

• Neuroscience
• Gerontology
• Urology

Background:

• Urge urinary incontinence (UUI) is a prevalent issue in elderly women, with poorly understood mechanisms and treatment responses.
• Current understanding of brain-bladder control and therapeutic interventions for UUI remains limited.

Purpose of the Study:

• To investigate the cerebral mechanisms underlying UUI using functional magnetic resonance imaging (fMRI) and biofeedback-assisted pelvic floor muscle training (PFMT).
• To enhance the understanding of brain-bladder control and identify predictors of treatment response in UUI patients.

Main Methods:

• A study involving older women with UUI and healthy controls, undergoing clinical evaluation, urodynamic testing, and fMRI.
• fMRI was used to assess brain activity during bladder filling and urgency, both before and after PFMT in UUI patients.

Main Results:

• Twenty-eight out of 65 UUI participants showed significant improvement with PFMT.
• Two distinct brain reaction patterns were observed: responders showed initial activation in dorsal anterior cingulate cortex/supplementary motor area and insula, with decreased activation post-training; non-responders exhibited medial prefrontal cortex deactivation.
• Responders demonstrated diminished dorsal anterior cingulate cortex/supplementary motor area activation and a trend toward medial prefrontal cortex deactivation post-PFMT.

Conclusions:

• Two brain reaction patterns to bladder filling appear to predict response to biofeedback-assisted PFMT in older women with UUI.
• Decreased cingulate activation correlates with UUI improvement, while prefrontal deactivation may facilitate training success.
• The unavailability of the prefrontal deactivation mechanism in non-responders may explain their lack of response to PFMT, indicating a need for alternative therapies.