Pelvic Floor Rehabilitation of the Elderly

Abstract

Pelvic floor rehabilitation (PFR) is nowadays an important strategy for the treatment of many pelvic floor disorders in adults and in older people. Screening for geriatric urinary incontinence (UI) and other pelvic disorders is very important because their prevalence is high, the conditions are underestimated, the consequences are bothersome, and the outcome of PFR is often successful. UI is not an inevitable consequence of aging; it is important, therefore, to identify other non-lower urinary tract conditions that can exacerbate or precipitate incontinence. The basic components of the diagnostic evaluation of UI are history, physical examination, measurement of bladder post-void residual (PVR), and urinalysis. The conservative management, in fit and motivated people, includes mainly bladder retraining and PFR (biofeedback, electrical stimulation, and pelvic floor exercises), considered as a first-line option in the initial management. Pelvic floor muscle training (PFMT) is the core of the PFR also in wealthy elderly, while in frail older people conservative management can often be directed to achieving dependent continence by use of behavioral treatment (prompted or timed voiding). The pharmacologic therapy should be used in addition to PFR, mainly in the treatment of urge urinary incontinence. In the last 30 years, PFR became more and more important in the functional treatment of many other pelvic disorders, including fecal incontinence, constipation, chronic pelvic pain, and sexual disorders.