Cortical magnetic stimulation in patients with genuine stress incontinence: correlation with results of pelvic floor exercises.
Pelvic floor training is an established conservative method of treatment in patients with genuine stress incontinence. It is not known why only a proportion of patients benefit from this form of treatment, while others with a comparable degree of incontinence do not. Since muscle awareness is of vital importance in pelvic floor training, we decided to investigate whether differences in outcome might be explained by differences in cortical control of the pelvic floor muscles. The function in the total motor pathway to the pelvic floor muscles was examined with cortical magnetic stimulation and circumvaginal EMG recording. Since lesions of the peripheral motor pathway have been demonstrated in patients with genuine stress incontinence, possible differences at this level were investigated by means of terminal pudendal motor latencies, using electrical nerve stimulation and anal recording EMG. We found that patients who succeeded with pelvic floor exercises for genuine stress incontinence had a significantly higher probability of response to cortical magnetic stimulation and significantly larger response amplitudes than the patients who did not benefit from training. The findings in the latter group did not differ from those of a healthy control group. No differences between the groups were found in the terminal pudendal motor latencies. We conclude that women with genuine stress urinary incontinence, successfully alleviated by a physiotherapeutic training program, have a higher degree of corticofugal control of their perineal muscles than women who do not succeed with the same treatment program and healthy controls. Neurourol. Urodynam. 18:437-445, 1999.
Gunnarsson
M
M
Department of Urology, University Hospital, Lund, Sweden.
Ahlmann
S
S
Lindström
S
S
Rosén
I
I
Mattiasson
A
A
D000328:Adult; D002540:Cerebral Cortex / Q000503:physiopathology*; D005081:Exercise Therapy; D005260:Female; D006801:Humans; D008280:Magnetics; D008875:Middle Aged; D017773:Pelvic Floor / Q000503:physiopathology*; D016896:Treatment Outcome; D014550:Urinary Incontinence, Stress / Q000503:physiopathology / Q000628:therapy*