Pelvic floor muscle training is effective in treatment of female stress urinary incontinence, but how does it work?
Abstract
To date several randomized controlled trials (RCT) have shown that pelvic floor muscle (PFM) training is effective in the treatment of female stress (SUI) and mixed urinary incontinence and, therefore, it is recommended as a first-line therapy. While the effectiveness of treatment is established, there are different theoretical rationales for why PFM training is effective. The aims of this article are to discuss the theories behind why PFM training is effective in treating SUI and to discuss each theory in the framework of new knowledge of functional anatomy and examples of results from RCTs. There are three proposed theories to explain the effectiveness of PFM training for SUI: 1) women learn to consciously pre-contract the PFMs before and during increases in abdominal pressure (such as coughing, physical activity) to prevent leakage; 2) strength training builds up long-lasting muscle volume and thus provides structural support; and 3) abdominal muscle training indirectly strengthens the PFM. The first can be placed in a behavioral construct, while the two latter both have the aim of changing neuromuscular function and morphology, thus making the PFM contraction automatic. To date there are RCTs and basic anatomy studies to support the first two concepts only.
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There is evidence for two mechanisms of how PFMT may be effective in prevention and treatment of stress urinary incontinence.
“Today there is evidence for two mechanisms of how PFMT may be effective in prevention and treatment of SUI [21, 22]”
From International urogynecology consultation chapter 3 committee 2; conservative treatment of patient with pelvic organ prolapse: Pelvic floor muscle training (2022) · cites this paper as [21]
One mechanism is that women learn to consciously contract the pelvic floor muscles before and during increases in intra-abdominal pressure and continue to perform such voluntary contractions as a behavior modification to prevent descent of the pelvic floor during these episodes.
“(1) Women learn to consciously contract the PFM before and during increases in intra-abdominal pressure (IAP) (also termed ‘bracing’ or ‘performing the Knack’) and continue to perform such voluntary contractions as a behavior modification to prevent descent of the pelvic floor during these episodes.”
From International urogynecology consultation chapter 3 committee 2; conservative treatment of patient with pelvic organ prolapse: Pelvic floor muscle training (2022) · cites this paper as [21]
Another mechanism is that women are taught to perform regular strength training to improve firmness and structural support of the pelvic floor over time.
“(2) Women are taught to perform regular strength training to improve ‘firmness’ and structural support of the pelvic floor over time.”
From International urogynecology consultation chapter 3 committee 2; conservative treatment of patient with pelvic organ prolapse: Pelvic floor muscle training (2022) · cites this paper as [21]
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“” Today there is evidence for two mechanisms of how PFMT may be effective in prevention and treatment of SUI [21, 22], and the same mechanisms apply for the effect of PFMT to prevent and treat POP.”
BackgroundInfluentialSelf-citationThe effect of pelvic floor muscle training for women with pelvic organ prolapse: A meta-analysis
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- Authors
- B�, K.
- Corresponding author
- B�, Kari
- Venue
- International Urogynecology Journal and Pelvic Floor Dysfunction
- Published
- 2004-04-01
- Volume
- 15
- Issue
- 2
- Pages
- 76-84
- ISSN
- 0937-3462 (ISSN-L)
- 1433-3023
- OpenAlex
- W2155933342
- Cited by
- 480
- References
- 57
- Citations by year
- 2026: 13 · 2025: 17 · 2024: 21 · 2023: 24 · 2022: 25 · 2021: 22 · 2020: 36 · 2019: 32 · 2018: 21 · 2017: 39 · 2016: 18 · 2015: 18 · 2014: 24 · 2013: 22 · 2012: 28
- FWCI
- 8.06
- Type
- journal article
- Language
- en
- Open access
- closed
- Licence
- www.springer.com/tdm (tdm)
- Locations
- International Urogynecology Journal (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Rheumatology › Pelvic floor disorders treatments
- Health Sciences › Medicine › Urology › Urinary Bladder and Prostate Research
- Health Sciences › Medicine › Psychiatry and Mental health › Sexual function and dysfunction studies
- Keywords
- pelvic floor muscle training, female stress urinary incontinence, mixed urinary incontinence, resistance training, abdominal muscle strengthening, neuromuscular function, pelvic floor morphology, functional anatomy
- MeSH terms
- Female, Humans, Muscle Contraction, Muscle, Smooth, Urinary Incontinence, Stress, Randomized Controlled Trials as Topic, Pelvic Floor, Physical Therapy Modalities
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