Pelvic floor muscle training and its impact on neurogenic detrusor overactivity in incomplete spinal cord injury

Author(s): N. Vásquez & M. D. Craggs - Pages: 36–37

Abstract

A cost-effective conservative intervention involving pelvic floor muscle (PFM) training (PFMT) for urinary incontinence (UI) has never before been tested in cases of spinal cord injury (SCI). Improving continence is a priority in SCI. A case-control study determined that residual voluntary pathways remaining after incomplete SCI can be boosted by PFMT so as to improve continence and quality of life. Two participants with a chronic suprasacral incomplete SCI, residual PFM sensorimotor function, neurogenic detrusor overactivity (NDO) and UI consented to participate in a trial. Individualized PFMT was administered for 6 weeks by a physiotherapist. Standard cystometrograms were performed before and after PFMT. A self-controlled urge keypad measured levels of urge UI. The strengths of PFM and sphincter contractions were recorded with a balloon and surface electrodes. The outcome measures included: (1) urinary urgency; (2) the strength and endurance of the PFMs; and (3) suppression of NDO during PFM contractions in the absence of bladder treatment with anti-muscarinic drugs. The participants performed residual PFM contractions in response to their urge to suppress their detrusor pressures. Following 6 weeks of PFMT, both subjects showed a significant increase in PFM endurance, as compared to values recorded before PFMT, that was associated with suppression of NDO by approximately 70% in one individual and 12% in the other. This study shows for the first time that PFMT in incomplete SCI has the potential for promoting continence. These preliminary results support the need for a larger cohort study incorporating 16 weeks of PFMT, as described in recent literature for other conditions. This study explores the potential for neuroplasticity of continence mechanisms that can be targeted for physiotherapy interventions for SCI.

Keywords: incomplete spinal cord injury, neurogenic detrusor overactivity, pelvic floor muscle training, urgency, urinary incontinence.