title: [Pelvic floor rehabilitation for female urinary incontinence: mechanisms of action].
abstract: OBJECTIVE
  To analyze the proven mechanisms of action of pelvic rehabilitation in women presenting with urinary incontinence.
  
  
  METHODS
  Review of literature (PubMed, Embase, Cochrane Database) using following keywords: female; urinary incontinence; overactive bladder syndrome; stress urinary incontinence; bladder training; bladder diary; pelvic floor muscle training; pelvic floor rehabilitation; physiotherapy; cognitive therapies. Among 2906 articles (animal and anatomical studies have been excluded); 66 have been selected because they focused on the evaluation of the pathophysiological mechanisms of pelvic floor rehabilitation concerning female urinary incontinence.
  
  
  RESULTS
  Studies on pelvic floor muscles training exercises showed a significant increase in the force of contraction of these muscles and it was correlated with improved scores of urinary incontinence and pad test (coefficient of correlation r ranged from 0.23 to 0.34) for women presenting with stress urinary incontinence. These studies have not observed an increase in the maximum urethral closure pressure (MUCP) or correction of urethral hypermobility related with the improvement of incontinence after rehabilitation sessions. Studies concerning pelvic floor stimulation observed an increase in the force of contraction of pelvic floor muscles after rehabilitation and a decrease in the intensity of detrusor contractions without changing the MUCP. There is very little data on the precise mechanisms of action of biofeedback and cognitive behavioral therapy.
  
  
  CONCLUSIONS
  In studies that objectively evaluated the mechanisms of action of pelvic rehabilitation, it was observed that pelvic floor muscles voluntary exercises and electrostimulation resulted an increase in force of contraction of these muscles without changing the MUCP.
authors.affiliation: Service de gynécologie-obstétrique et médecine de la reproduction, hôpital Antoine-Béclère, AP-HP, 157, rue de la Porte-de-Trivaux, 92140 Clamart, France. xavier.deffieux@abc.aphp.fr
authors.forename: X
authors.initials: X
authors.lastname: Deffieux
authors.forename: S
authors.initials: S
authors.lastname: Billecocq
authors.forename: G
authors.initials: G
authors.lastname: Demoulin
authors.forename: A-L
authors.initials: AL
authors.lastname: Rivain
authors.forename: C
authors.initials: C
authors.lastname: Trichot
authors.forename: T
authors.initials: T
authors.lastname: Thubert
mesh_terms: D001676:Biofeedback, Psychology; D015928:Cognitive Behavioral Therapy; D004599:Electric Stimulation Therapy; D005081:Exercise Therapy / Q000379:methods; D005260:Female; D006801:Humans; D009119:Muscle Contraction / Q000502:physiology; D017773:Pelvic Floor; D014549:Urinary Incontinence / Q000628:therapy*