From the Guidelines
The primary muscles weakened in Stress Urinary Incontinence (SUI) are the pelvic floor muscles, particularly the levator ani complex and the external urethral sphincter. These muscles play a crucial role in maintaining continence during activities that increase intra-abdominal pressure. According to the American College of Physicians guideline on nonsurgical management of urinary incontinence in women 1, pelvic floor muscle training is recommended as a first-line treatment for women with stress UI, highlighting the importance of these muscles in SUI. The guideline provides strong evidence for the effectiveness of pelvic floor muscle training in managing SUI, with a strong recommendation and high-quality evidence.
Some key points to consider in the management of SUI include:
- The importance of pelvic floor muscle training, which can be performed through exercises like Kegel exercises
- The role of the levator ani complex and external urethral sphincter in maintaining continence
- The impact of factors like childbirth, aging, obesity, and chronic coughing on the weakening of pelvic floor muscles
- The potential benefits of weight loss and exercise for obese women with UI, as recommended by the American College of Physicians guideline 1
In terms of specific treatment, pelvic floor muscle training is a highly effective and recommended treatment for SUI, with the goal of strengthening the weakened muscles and improving urethral closure pressure and bladder support. This can be achieved through exercises like Kegel exercises, which involve tightening the muscles that stop urination midstream, holding for 5-10 seconds, and repeating 10-15 times, three times daily. As noted in the guideline, this approach has been shown to be effective in reducing or eliminating symptoms in many patients with SUI 1.
From the Research
Muscles Weakened in Stress Urinary Incontinence (SUI)
- The muscles weakened in Stress Urinary Incontinence (SUI) include the pelvic floor muscles (PFM) 2, 3, 4
- The levator ani muscles, which are part of the PFM, play a crucial role in supporting the urethra and maintaining continence 4
- The urethral muscles also contribute to continence, and damage to these muscles can lead to SUI 4
- The transversus abdominis (TrA) muscle, which is a synergistic muscle, works together with the PFM to improve outcomes in women with SUI 2
Pelvic Floor Muscle Training
- Pelvic floor muscle training is a recommended first-line treatment for SUI, and it can improve quality of life and reduce symptoms of incontinence 2, 3, 5
- The strength of the pelvic floor muscles is important for maintaining urinary continence and establishing normal voiding function 3
- Combined training of the PFM and the TrA muscle can be more effective than isolated PFM exercises in improving outcomes in women with SUI 2