Pelvic floor muscle training in spinal cord injury and its impact on neurogenic detrusor over-activity and incontinence

Abstract

Study design: Two case studies. Objectives: To determine whether 6 weeks of regular pelvic floor muscle training (PFMT) can improve the strength and endurance of voluntary contractions in incomplete spinal cord injury and reduce neurogenic detrusor over-activity (NDO) and incontinence. Setting: The London Spinal Cord Injury Centre, Stanmore, London, UK. Methods: A 6-week programme of PFMT was conducted in two male subjects with stable supra-sacral motor incomplete (AIS C and D) spinal cord injuries. Clinical evaluations before and after training comprised measures of strength and endurance of voluntary pelvic floor contractions both objectively by anal canal-pressure measurements and subjectively using the modified Oxford grading system. NDO was determined by standard urodynamic tests of bladder function and incontinence measured by the International Consultation on Incontinence Questionnaire-Urology. Results: Both subjects improved the strength and endurance of their pelvic floor muscle contractions by over 100% at the end of training. After training, Subject 1 (AIS D) was able to reduce bladder pressure during over-activity almost completely by voluntarily contracting the pelvic floor muscles. Subject 2 (AIS C) achieved a lesser reduction overall after training. Continence improved only in subject 1. Conclusion: These case studies provide evidence that a 6-week programme of PFMT may have a beneficial effect on promoting voluntary control of NDO and reduce incontinence in selected cases with a motor incomplete spinal cord lesion. INTRODUCTIONIncontinence remains a priority problem for many people with spinal cord injury 1 despite various current treatments including conservative therapies. 2 Control of the bladder, sphincter and pelvic floor muscles (PFM) relies on the integrity of bulbo-spinal, cortico-spinal and lumbo-sacral reflex pathways. Following a motor incomplete spinal cord injury (iSCI), voluntary control of the PFM including the striated sphincters significantly weakens, neurogenic detrusor over-activity (NDO), detrusor sphincter dyssynergia and incontinence emerge reducing quality of life. Although PFM training (PFMT) has been shown to be effective in non-SCI patients with lower urinary tract symptoms, for example, by reducing stress incontinence and suppressing bladder over-activity, 3 it appears not to have been tested as a potential therapy in iSCI. Therefore the aim of these two case studies was to determine whether 6 weeks of regular PFMT could improve the strength and endurance of voluntary PFM contractions in iSCI so as to suppress NDO and reduce incontinence. A positive outcome may then justify a pilot study with a larger cohort of iSCI subjects presenting with preserved sensorimotor pathways of the sphincters and PFMs. MATERIALS AND METHODS ParticipantsA 6-week programme of regular PFMT with clinical assessments before and after was conducted in two male subjects presenting with chronic-stable iSCI, NDO and incontinence.Local research ethics committee approval was obtained (REC Reference ...

The use of the neurologic exam to predict awareness and control of lower urinary tract function post SCI

“…By allowing clinicians to be able to better predict specific aspects of autonomic function with a simple neurologic exam, targeted methods to retrain neurogenic bladders should be facilitated. 17 For instance, a person with SCI and greater preservation of sensory function between T6 and L2 or S3-S5 should also have more reliable sensation of bladder filling. Thus, we can consider using this information to encourage patients with greater remaining surface sensation to catheterize themselves based on their sensations related to bladder filling in addition to timed catheterizations, provided this is done with attention to bladder filling pressures and safe voiding.…”

Treatment of the pelvic floor in males with incomplete spinal cord injury: a systematic review

“…Un total de 15 estudios cumplieron los criterios de selección ( Fig. 1): un metaanálisis 9 , cuatro estudios aleatorizados controlados (EAC) 6,12,13,24 , ocho estudios de casos 2,8,11,[14][15][16][17]26 y dos estudios piloto de casos 18,25 . Sus características se recogen en la tabla 1.…”

“…8 , aunque el más conocido es la aplicación de la toxina botulínica cuyos efectos temporales obligan a administrarla varias veces 4 . Dentro de las técnicas físicas para mejorar las secuelas mencionadas se encuentran: la neuromodulación para el tratamiento de la disfunción miccional cónica (DMC) refractaria a tratamientos convencionales 8 ; la acupuntura 6,9 ; la electroacupuntura que combina acupuntura con técnicas de electroterapia 2 ; el entrenamiento del suelo pélvico para disminuir la presión del detrusor y reducir la incontinencia [10][11][12] ; las ayudas técnicas para facilitar la deambulación y estimular los movimientos peristálticos 13 ; la estimulación eléctrica o electroterapia, con colocación de electrodos en la zona pélvica 14 o en nervios periféricos o cercanos [15][16][17][18][19][20] , y la estimulación epidural con colocación quirúrgica de electrodos en el espacio epidural (habitualmente lumbar) y de un generador a unos dos centímetros por debajo de la piel 21 .…”

A nonsurgical and nonpharmacological care bundle for preventing upper urinary tract damage in patients with spinal cord injury and neurogenic bladder

“…Studies have shown that conservative treatments such as clean intermittent catheterization (CIC) (Verpoorten & Buyse, 2008), pelvic floor muscle training, regular urination and bladder function training (Vásquez et al, 2015), and transcutaneous low-frequency pulsed electrical nerve stimulation (Radziszewski, Zielinski, Radziszewski, & Swiecicki, 2009) can have some effects on the prevention of UUTD in patients with neurogenic bladder. However, there is still a lack of authoritative guidelines and high-quality randomized controlled trials (RCTs) to test this issue.…”