[The role of the pelvic physical therapist].
Pelvic physical therapy focuses on the prevention and the treatment of all kinds of functional disorders of the abdominal, pelvic and low back region, like urinary incontinence, that is considered as a high prevalent health problem in women, men, children and the elderly. Physical therapy is often considered as the first-choice treatment, due to its non-invasive character, the results in terms of symptom relief, the possibility of combining physical therapy with other treatments, the low risk of side effects and the moderate to low costs. Important restrictions for success might be motivation and perseverance of patient and therapist and the time needed for physical therapy. The armentum of the pelvic physical therapist contains interventions such as physiotherapeutic diagnostics, education and information of patients, pelvic floor muscle (PFM) training, bladder training (BlT), training with vaginal cones, electrical stimulation, biofeedback, etc. In stress incontinence, to improve the extrinsic closing mechanism of the urethra, physical therapy is aimed on strength improvement and coordination of the peri-urethral and pelvic floor muscles. Especially, PFM training is effective. For detrusor overactivity physical therapy aims to reduce or eliminate involuntary detrusor contractions through reflexinhibition. Here, electrical therapy appears to be an effective intervention. In mixed urinary incontinence the physiotherapeutic diagnostic and therapeutic process focuses on the predominant factors. Radical prostatectomy is the most important cause of incontinence in men. An adequate program of PFM training, after radical prostatectomy, decreases the duration and the extent of incontinence and improves the quality of life.


CONCLUSIONS
physical therapy is in many cases of incontinence an effective treatment option.
Berghmans
B
B
Epidemiólogo, Investigador de la Salud, Academic Pelvic Care Center Maastricht, Hospital Universitario de Maastricht, Maastricht, Países Bajos. bary.berghmans@epid.unimaas.nl
D000465:Algorithms; D001676:Biofeedback, Psychology / Q000295:instrumentation; D004867:Equipment Design; D006801:Humans; D017773:Pelvic Floor; D026741:Physical Therapy Modalities; D014549:Urinary Incontinence / Q000175:diagnosis / Q000628:therapy*