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Changes in urethral sphincter size following rehabilitation in older women with stress urinary incontinence

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Abstract

Introduction and hypothesis

The purpose of this study was to evaluate the effects of a pelvic floor muscle (PFM) rehabilitation program on the striated urethral sphincter in women over 60 years with stress urinary incontinence (SUI). We hypothesized that the PFM rehabilitation program would also exercise the striated urethral sphincter and that this would be demonstrated by hypertrophy of the sphincter on magnetic resonance imaging (MRI).

Methods

Women with at least weekly episodes of SUI were recruited. Participants were evaluated before and after a 12-week group PFM rehabilitation intervention with T2-weighted fast-spin-echo MRI sequences recorded in the axial plane at rest to assess urethral sphincter size. Data on SUI symptoms and their bother were also collected. No control group was included.

Results

Seventeen women participated in the study. The striated urethral sphincter increased significantly in thickness (21 %, p < 0.001), cross-sectional area (20 %, p = 0.003), and volume (12 %, p = 0.003) following the intervention. The reported number of incontinence episodes and their bother also decreased significantly.

Conclusions

This study appears to demonstrate that PFM training for SUI also trains the striated urethral sphincter and that improvement in incontinence signs and symptoms is associated with sphincter hypertrophy in older women with SUI. These findings support previous ultrasound (US) data showing an increase in urethral cross-sectional area following PFM training and extend the previous findings by more specifically assessing the area of hypertrophy and by demonstrating that older women present the same changes as younger women when assessed using MRI data.

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Acknowledgments

The authors acknowledge the assistance of the following people and offer each one our sincere thanks: Martine Bernard, Jacques Corcos, Marie-Claude Lemieux, Lisa Merovitz, Cara Tannenbaum, and Jens-Erik Walter assisted with recruitment. Janic Bergeron, Claudia Botelho, Nancy Boudreau, Marjolaine Caya, Sima Chiva-Razavi, André Cyr, Valérie Elliott, Carollyn Hurst, Muriel Jadin, Sophie Lapointe, Alexandre Prud’homme-Delage, and Rébecka Ouellette participated in and assisted with screening, data collection, teaching the rehabilitation classes, and data entry and processing. This study could not have been completed without the financial support of the Canadian Institutes of Health Research, the Canadian Continence Foundation, and les Fonds de recherche en santé du Québec.

Conflict of interest

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Authors and Affiliations

  1. School of Physical Therapy, University of Saskatchewan, 1121 College Drive, Saskatoon, SK, S7N 0W3, Canada

    Stéphanie J. Madill

  2. Centre de recherche de l’Institut unversitaire de gériatrie de Montréal, Université de Montréal, Montréal, Québec, Canada

    Stéphanie Pontbriand-Drolet

  3. Abdominal Radiology, Department of Medical Imaging, Université de Montréal, Montréal, Québec, Canada

    An Tang

  4. Centre de recherche de l’Institut unversitaire de gériatrie de Montréal and École de réadaptation, Université de Montréal, Montréal, Québec, Canada

    Chantale Dumoulin

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  1. Stéphanie J. Madill
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  2. Stéphanie Pontbriand-Drolet
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  3. An Tang
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  4. Chantale Dumoulin
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Correspondence to Stéphanie J. Madill.

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Madill, S.J., Pontbriand-Drolet, S., Tang, A. et al. Changes in urethral sphincter size following rehabilitation in older women with stress urinary incontinence. Int Urogynecol J 26, 277–283 (2015). https://doi.org/10.1007/s00192-014-2507-6

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  • DOI: https://doi.org/10.1007/s00192-014-2507-6

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