[Rehabilitation of female urinary incontinence. Techniques and indications]

Abstract

Female uro-gynaecological retraining was initially confined to prophylactic management during the post-partum period. It has gradually been extended to other diseases, either alone or as a complement to medical or surgical treatment. The results of clinical examination and complementary investigations, especially urodynamic studies, now allow the application of increasingly precise retraining techniques. This progress essentially concerns the three types of technique most frequently used: Manual retraining concerns the bulbospongiosus muscles, as well as the levator ani muscles. Biofeedback is increasingly used to qualitatively improve muscle contraction. Electrostimulation can promote the action of various groups of tonic or phasic muscle fibres. Apart from these endocavitary techniques, retraining is also evolving towards a global management of the abdominopelvic sphere., where it is indicated in the management of the post-partum period and various gynaecological and urinary diseases. However, concomitant diseases such as perineo-abdominodiaphragmatic imbalance, an anorectal problem, a sexual problem or finally painful symptoms, must also be taken into account in some cases. Retraining must be very precisely prescribed, confirming application of all of these techniques and adapting them to the national health refund classification. The number of sessions varies according to the disease, but rarely exceeds 30 sessions in the initial prescription. On the other hand, like any muscle system, the pelvic floor must be maintained by means of several sessions per year. The success of this retraining treatment essentially depends on several factors: the quality of the therapist, his training, his spirit of integration in a multidisciplinary team, but also the patient's motivation.