LITERATURE REVIEW Is pelvic floor muscle training enhanced by supplementary transversus abdominis recruitment in the treatment of female urinary incontinence? A review of the evidence and reflection on current practices
This literature review evaluates whether the treatment of female urinary incontinence (UI) with conventional pelvic floor muscle training (PFMT) is enhanced by the addition of transversus abdominis (TrA) recruitment. The main databases were searched for randomized controlled trials and controlled trials published between 2008 and 2018 (inclusive). Additionally, the National Institute for Health and Care Excellence guidelines, the ResearchGate website and the Journal of Pelvic, Obstetric and Gynaecological Physiotherapy were reviewed, and hand-searches of references and grey literature were also performed. Six articles were identified and selected for full critical review. Heterogeneity in dosage, exercise selection, supervision, setting and outcome measures was highlighted. Articles were critically reviewed with a view to understanding the effect of the addition of TrA recruitment to PFMT, and the possibility of identifying the most effective approach when treating women with UI. Five out of six trials reported positive outcomes after adding TrA recruitment to PFMT; however, the superiority of this method over PFMT alone is weakened by the heterogeneity and limitations of the studies evaluated in this literature review.
Keywords: abdominal canister, coactivation approach, pelvic floor muscle training, transversus abdominis, urinary incontinence.