Current management of stress urinary incontinence.

Abstract

Pelvic floor muscle training (PFMT) is the most commonly recommended conservative therapy for women with SUI. PFMT is used to rehabilitate or strengthen the PFMs; it increases the ability to produce an increase in urethral resistance, provided the patient is able to perform a correct voluntary PFM contraction. It counteracts PFM weakness, increasing support for the urethra and bladder, and improves the tone of the PFMs, in particular the levatores ani. A patient-specific regimen should be established, depending on the status of the muscles. PFMT includes long, slow contractions at regular intervals and short, sharp ‘pull-ups’. The major drawback of this type of treatment is compliance, which is usually high upon initiation, but decreases over time. Combined therapy of PFMT and adjuncts like vaginal cones, biofeedback and electrical stimulation seems to have no additional benefit over PFMT alone, but might be useful for some women to learn how to perform a correct PFM contraction [4]. Weighted vaginal cones and electrical stimulation can also be used individually to improve the function of the PFMs.