A contextual model of pelvic floor muscle defects in female stress urinary incontinence: A rationale for physiotherapy treatment

Annals of the New York Academy of Sciences

Volumn 1101, Issue , 2007, Pages 335-360

  Madill, Stéphanie J ^a   McLean, Linda ^a  

^a QUEEN S UNIVERSITY   (Canada)

Author keywords

Anatomy and physiology; Pathophysiology; Physiotherapy; Stress urinary incontinence; Structural defects; Women's health

Indexed keywords

ABDOMINAL PRESSURE; CONFERENCE PAPER; CONNECTIVE TISSUE; EXERCISE; HUMAN; KINESIOTHERAPY; MEDICAL LITERATURE; MOTOR CONTROL; MUSCLE CONTRACTION; MUSCLE DISEASE; MUSCLE STRESS; MUSCLE WEAKNESS; PATHOPHYSIOLOGY; PELVIC FLOOR MUSCLE TRAINING; PELVIS FLOOR; PHYSIOTHERAPY; STRESS INCONTINENCE; URINE INCONTINENCE; AUDIOVISUAL EQUIPMENT; FEMALE; INNERVATION; PHYSIOLOGY; REVIEW; SKELETAL MUSCLE;

FEMALE; HUMANS; MODELS, ANATOMIC; MUSCLE, SKELETAL; PELVIC FLOOR; URINARY INCONTINENCE, STRESS;

EID: 34250647899     PISSN: 00778923     EISSN: 17496632     Source Type: Book Series    
DOI: 10.1196/annals.1389.035     Document Type: Conference Paper

References (158)

1. ABRAMS, P., L. CARDOZO, M. FALL, et al. 2002. The standardisation of terminology of lower urinary tract function: report from the standardisation sub-committee of the International Continence Society. Neurourol. Urodyn. 21: 167-178.
2. HANNESTAD, Y., G. RORTVEIT, H. SANDVIK, et al. 2000. A community-based epidemiological survey of female urinary incontinence: the Norwegian EPICONT Study. J. Clin. Epidemiol. 53: 1150-1157.
3. WOMEN'S DIAGNOSTIC CYBER DISEASE (publisher). 2003. Available from http://www.wdxcyber.com/dxurp001.htm.
4. CARDOZO, L. & S.L. STANTON. 1980. Genuine stress incontinence and detrusor instability - a review of 200 patients. Br. J. Obstet. Gynaecol. 87: 184-190.
5. NYGAARD, I., J.O.L. DELANCEY, L. ARNSDORF, et al. 1990. Exercise and incontinence. Obstet. Gynecol. 75: 848-851.
6. NYGAARD, I.E., F.L. THOMPSON, S.L. SVENGALIS, et al. 1994. Urinary incontinence in elite nulliparous athletes. Obstet. Gynecol. 84: 183-187.
7. SHERMAN, R.A., G.D. DAVIS & M.F. WONG. 1997. Behavioral treatment of exercise-induced urinary incontinence among female soldiers. Mil. Med. 162: 690-694.
8. WILSON, P.D., K. Bø, J. HAY- SMITH, et al. 2002. Conservative treatment inwomen. In Incontinence. 2nd International Consultation on Incontinence. P. Abrams, L. Cardozo, S. Khoury, et al., Eds.: 571-624. Health Publications. Paris.
9. Bø, K. 2004. Urinary incontinence, pelvic floor dysfunction, exercise and sport. Sports Med. 34: 451-464.
10. JEFFCOATE, T.N.A. & H. ROBERTS. 1952. Observations on stress incontinence of urine. Am. J. Obstet. Gynecology 64: 721-738.
11. ALLEN, R.E., G.L. HOSKER, A.R.B. SMITH, et al. 1990. Pelvic floor damage and childbirth: a neurophysiological study. Br. J. Obstet. Gynaecol. 97: 770-779.
12. SNOOKS, S.J., M. SWASH, M.M. HENRY, et al. 1985. Risk factors in childbirth causing damage to the pelvic floor innervation. Br. J. Surg. 72(Suppl): S15-S17.
13. YARNELL, J.W.G., G.J. VOYLE, P.M. SWEETNAM, et al. 1982. Factors associated with urinary incontinence in women. J. Epidemiol. Community Health 36: 58-63.
14. SKONER, M.M., W.D. THOMPSON & V.A. CARON. 1994. Factors associated with risk of stress urinary incontinence in women. Nurs. Res. 43: 301-305.
15. BURGIO, K.L., K.A. MATTHEWS & B.T. ENGEL. 1991. Prevalence, incidence and correlates of urinary incontinence in healthy, middle-aged women. J. Urol. 146: 1255-1259.
16. HANNESTAD, Y., G. RORTVEIT, A. DALTVEIT, et al. 2003. Are smoking and other lifestyle factors associated with female urinary incontinence? The Norwegian EPINCONT study. Br. J. Obstet. Gynaecol. 100: 247-254.
17. HANNESTAD, Y., R. LIE, G. RORTVEIT, et al. 2004. Familial risk of urinary incontinence in women: population based cross sectional study. Br. Med. J. 329: 889-891.
18. NORTON, P.A. 1990. Prevalence and social impact of urinary incontinence in women. Clin. Obstet. Gynecol. 33: 295-297.
19. NORTON, P.A., L. MACDONALD & S.L. STANTON. 1987. Distress associated with female urinary complaints and delay in seeking treatment. Neurourol. Urodyn. 6: 170-172.
20. WYMAN, J.F., S.W. HARKINS & J.A. FANTL. 1990. Psychosocial impact of urinary incontinence in the community-dwelling population. J. Am. Geriat. Soc. 38: 282-288.
21. HOLST, K. & D.P. WILSON. 1988. The prevalence of female urinary incontinence and reasons for not seeking treatment. NZ Med. J. 101: 756-758.
22. REKERS, H., A. DROGENDIJK, H. VALKENBURG, et al. 1992. Urinary incontinence in women from 35 to 79 years of age: prevalence and consequences. Eur. J. Obstet., Gynecol. Reprod. Biol. 42: 229-233.
23. DOLAN, L.M., G.L. HOSKER, V.T. MALLET, et al. 2003. Stress incontinence and pelvic floor neurophysiology 15 years after the first delivery. Br. J. Obstet. Gynaecol. 110: 1107-1114.
24. STATISTICS CANADA. 2004. www.statcan.ca/english/Pgdb/ demo23a.htm.
25. MACAULAY, A.J., R.S. STERN, D.M. HOLMES, et al. 1987. Micturition and the mind: psychological factors in the aetiology and treatment of urinary symptoms in women. Br. Med. J. 294: 540-543.
26. DELANCEY, J.O.L. 1990. Anatomy and physiology of urinary continence. Clin. Obstet. Gynecol. 33: 298-307.
27. DELANCEY, J.O.L. 1988. Structural aspects of the extrinsic continence mechanism. Obstet. Gynecol. 72: 296-301.
28. MCBRIDE, A.W., J. LI & R. GUTMAN. 2003. Anatomy of the pelvis. Pelvic Med. Surg. 9: 103-123.
29. DELANCEY, J.O.L., J.A. GOSLING, K. CREED, et al. 2002. Gross anatomy and cell biology of the lower urinary tract. In Incontinence. 2nd International Consultation on Incontinence. P. Abrams, L. Cardozo, S. Khoury, et al., Eds.: 17-82. Health Publications. Paris.
30. BØ, K., R. STIEN, S. KULSENG- HANSSEN, et al. 1994. Clinical and urodynamic assessment of nulliparous young women with and without stress incontinence symptoms: a case-control study. Obstet. Gynecol. 84: 1028-1032.
31. AMARENCO, G., S.S. ISMAEL, D. LAGAUCHE, et al. 2005. Cough anal reflex: strict relationship between intravesical pressure and pelvic floor muscle electromyographic activity during cough. Urodynamic and electrophysiological study. J. Urol. 173: 149-152.
32. HEIDLER, H., H. WÖLK & U. JONAS. 1979. Urethral closure mechanism under stress conditions. Eur. Urol. 5: 110-112.
33. RUD, T. 1980. Urethral pressure profile in continent women from childhood to old age. Acta Obstetricia et Gynecologica Scandinavica 59: 331-335.
34. CARLILE, A., I. DAVIES, A. RIGBY, et al. 1988. Age changes in the human female urethra: a morphometric study. J. Urol. 139: 532-535.
35. WOODBURNE, R.T. & W.E. BURKEL. 1988. Essentials of Human Anatomy. Oxford University Press. New York.
36. HJARTADOTTIR, S., J. NILSSON, C. PETERSEN, et al. 1997. The female pelvic floor: a dome - not a basin. Acta Obstetricia et Gynecologica Scandinavica 76: 567-571.
37. DELANCEY, J.O.L. & R.A. STARR. 1990. Histology of the connection between the vagina and the levator ani muscles. J. Reprod. Med. 35: 765-771.
38. DEINDL, F.M., D.B. VODUSEK, U. HESSE, et al. 1993. Activity patterns of pubococcygeal muscles in nulliparous continent women. Br. J. Urol. 72: 46-51.
39. VEREECKEN, R.L. & H. VERDUYN. 1970. The electrical activity of the paraurethral and perineal muscles in normal and pathological conditions. Br. J. Urol. 42: 457-463.
40. DELANCEY, J.O.L. 1994. The anatomy of the pelvic floor. Curr. Opin. Obstet. Gynecol. 6: 313-316.
41. BLAIVAS, J.G. 1985. Pathophysiology of lower urinary tract dysfunction. Urol. Clin. North Am. 12: 215-224.
42. Bø, K., F. LILLEÅS, T. TALSETH, et al. 2001. Dynamic MRI of the pelvic floor muscles in an upright sitting position. Neurourol. Urodyn. 20: 167-174.
43. LOSE, G. & H. COLSTRUP. 1991. Urethral pressure and power generation during coughing and voluntary contraction of the pelvic floor in healthy females. Br. J. Urol. 67: 573-579.
44. GUNNARSSON, M. & A. MATTIASSON. 1999. Female stress, urge, and mixed urinary incontinence are associated with a chronic and progressive pelvic floor/vaginal neuromuscular disorder: an investigation of 317 healthy and incontinent women using vaginal surface electromyography. Neurourol. Urodyn. 18: 613-621.
45. WASHINGTON CANNON, T. & M.S. DAMASER. 2004. Pathophysiology of the lower urinary tract: continence and incontinence. Clin. Obstet. Gynecol. 47: 28-35.
46. KOELBL, H., H. STRASSEGGER, P.A. RISS, et al. 1989. Morphologic and functional aspects of pelvic floor muscles in patients with pelvic relaxation and genuine stress incontinence. Obstet. Gynecol. 74: 789-795.
47. DIETZ, H.P. & V. LANZARONE. 2005. Vaginal delivery results in significant trauma to the levator ani muscle. 35th Annu. Meet. Int. Cont. Soc. 24: 509-510.
48. STEENSMA, A.B. & H.P. DIETZ. 2005. What is the clinical relevance of major defects of the levator ani muscle? 35th Annu. Meet. Inte. Cont. Soc. Poster 275.
49. DELANCEY, J.O.L., R. KEARNEY, Q. CHOU, et al. 2003. The appearance of levator ani muscle abnormalities in magnetic resonance images after vaginal delivery. Obstet. Gynecol. 101: 46-53.
50. HOYTE, L., L. SCHIERLITZ, K. ZOU, et al. 2001. Two-and 3-dimensional MRI comparison of levator ani structure, volume, and integrity in women with stress incontinence and prolapse. Am. J. Obstet. Gynecol. 185: 11-19.
51. STOKER, J., E. ROCIU, J.L.H. RUUD BOSCH, et al. 2003. High-resolution endovaginal MR imaging in stress urinary incontinence. Eur. Radiol. 13: 2031-2037.
52. AUKEE, P., J.-P. USENIUS & P. KIRKINEN. 2004. An evaluation of pelvic floor anatomy and function by MRI. Eur. J. Obstet. Gynecol. Reprod. Biol. 112: 84-88.
53. KIRSCHNER-HERMANNS, R., B. WEIN, S. NIEHAUS, et al. 1993. The contribution of magnetic resonance imaging of the pelvic floor to the understanding of urinary incontinence. Br. J. Urol. 72: 715-718.
54. BENSON, J.T. 1989. Neurophysiologic control of lower urinary tract. Obstet. Gynecol. Clin. North Am. 16: 733-752.
55. BARBER, M.D., R.E. BREMER, K.B. THOR, et al. 2002. Innervation of the female levator ani muscles. Am. J. Obstet. Gynecol. 187: 64-71.
56. STANDRING, S., Ed. 2005. True pelvis, pelvic floor and perinuem. In Gray's Anatomy. 1357-1372. Elsevier Churchhill Livingstone. London.
57. HANDA, V.L., T.A. HARRIS & D.R. OSTERGARD. 1996. Protecting the pelvic floor: obstetric management to prevent incontinence and pelvic organ prolapse. Obst. Gynecol. 88: 470-478.
58. WEBSTER, C. & L. BRUBAKER. 1998. Normal pelvic floor physiology. Obstet. Gynecol. Clin. North Am. 25: 707-722.
59. TANAGHO, E.A., F.H. MEYERS & D.R. SMITH. 1969. Urethral resistance: its components and implications I. smooth muscle component. Invest. Urol. 7: 136-149.
60. AGARWAL, P. & M.L. ROSENBURG. 2003. Neurological evaluation of urinary incontinence in the female patient. Neurologist 9: 110-117.
61. KOELBL, H., J.L. MOSTWIN, J.P. BOITEUX, et al. 2002. Pathophysiology. In Incontinence. 2nd International Consultation on Incontinence. P. Abrams, L. Cardozo, S. Khoury, et al., Eds.: 203-265. Health Publications. Paris.
62. TUNN, R., S. PARIS, W. FISCHER, et al. 1998. Static magnetic resonance imaging of the pelvic floor muscle morphology in women with stress urinary incontinence and pelvic prolapse. Neurourol. Urodyn. 17: 579-589.
63. SNOOKS, S.J., M. SWASH, S.E. MATHERS, et al. 1990. Effect of vaginal delivery on the pelvic floor: a 5-year follow-up. Br. J. Surg. 77: 1358-1360.
64. SMITH, A.R.B., G.L. HOSKER & D.W. WARRELL. 1989. The role of pudendal nerve damage in the aetiology of genuine stress incontinence in women. Br. J. Obstet. Gynaecol. 96: 29-32.
65. GILPIN, S.A., J.A. GOSLING, A.R.B. SMITH, et al. 1989. The pathogenesis of genitourinary prolapse and stress incontinence of urine. A histological and histochemical study. Br. J. Obstet. Gynaecol. 96: 15-23.
66. STANDRING, S. Ed. 2005. Gray's Anatomy, 39th edition. Elsevier Churchil Livingtone. Edinburgh.
67. DELANCEY, J.O.L. 2003. Cadavaric lab for incontinence and pelvic organ prolapse surgery. 51st Annual Clinical Meeting of the American College of Obstetricians and Gynecologists.
68. HADERER, J.M., H.K. PANNU, R. GENADRY, et al. 2002. Controversies in female urethral anatomy and their significance for understanding urinary continence: observations and literature review. Int. Urogynecol. J. 13: 236-252.
69. CULAV, E.M., C.H. CLARK & M.J. MERRILEES. 1999. Connective tissues: matrix composition and its relevance to physical therapy. Phys. Ther. 79: 308-319.
70. DELANCEY, J.O.L. & J.A. ASHTON- MILLER. 2004. Pathophysiology of adult urinary incontinence. Gastroenterology 126: S23-S32.
71. PETROS, P.E.P. 1990. An integral theory of female urinary incontinence, experimental and clinical considerations. Acta Obstet. Gynecol. Scand. 69: 7-31.
72. BERGLAS, B. & I.C. RUBIN. 1953. Study of the supportive structures of the uterus by levator myography. Surg. Gynecol. Obstet. 97: 677-692.
73. FIELDING, J.R., E. VERSI, R.V. MULKERN, et al. 1996. MR imaging of the female pelvic floor in the supine and upright positions. J. Magnet. Res. Imag. 6: 961-963.
74. ARTIBANI, W., J.T. ANDERSEN, J.B. GAJEWSKI, et al. 2002. Imaging and other Investigations. In Incontinence. 2nd International Consultation on Incontinence. P. Abrams, L. Cardozo, S. Khoury, et al., Eds.: 425-477. Health Publications. Paris.
75. YANG, A., J.L. MOSTWIN, N.B. ROSENSHEIN, et al. 1991. Pelvic floor descent in women: dynamic evaluation with fast MR imaging and cinematic display. Radiology 179: 25-33.
76. DELANCEY, J.O.L. 1996. Stress urinary incontinence: where are we now, where should we go? Am. J. Obstet. Gynecol. 175: 311-319.
77. ARONSON, M.P., S.M. BATES, A.F. JACOBY, et al. 1995. Periurethral and paravaginal anatomy: an endovaginal magnetic resonance imaging study. Am. J. Obstet. Gynecol. 173: 1702-1710.
78. KLUTKE, C., J. GOLOMB, Z. BARBARIC, et al. 1990. The anatomy of stress incontinence: magnetic resonance imaging of the female bladder neck and urethra. J. Urol. 143: 563-566.
79. VERSI, E., L. CARDOZO, M. BRINCAT, et al. 1988. Correlation of urethral physiology and skin collagen in postmenopausal women. Br. J. Obstet. Gynaecol. 95: 147-152.
80. NORTON, P.A. 1993. Pelvic floor disorders: the role of fascia and ligaments. Clin. Obstet. Gynecol. 36: 926-938.
81. DIETZ, H.P., N.K. HANSELL, M.E. GRACE, et al. 2005. Bladder neck mobility is a heritable trait. Br. J. Obstet. Gynaecol. 112: 334-339.
82. KEANE, D.P., T.J. SIMS, P. ABRAMS, et al. 1997. Analysis of collagen status in premenopausal nulliparous women with genuine stress incontinence. Br. J. Obstet. Gynaecol. 104: 994-998.
83. BURGESON, R.E. & M.E. NIMNI. 1992. Collagen types, molecular structure and tissue distribution. Clin. Orthopaed. Rel. Res. 282: 250-272.
84. ULMSTEN, U., G. EKMAN, G. GIERTZ, et al. 1987. Different biochemical composition of connective tissue in continent and stress incontinent women. Acta Obstet. Gynecol. Scand. 66: 455-457.
85. JAMES, M., N. AVERY, S. JACKSON, et al. 1999. The pathophysiological changes of vaginal tissue in women with stress urinary incontinence: a controlled trial. Neurourol. Urodyn. 18: 283-284.
86. SAYER, T.R., J.S. DIXON, G.L. HOSKER, et al. 1990. A study of paraurethral connective tissue in women with stress incontinence of urine. Neurourol. Urodyn. 9: 319-320.
87. KUSHNER, L., Y. CHEN, M. DESAUTEL, et al. 1999. Collagenase activity is elevated in conditioned media from fibroblasts of women with pelvic floor weakening. Neurourol. Urodyn. 18: 282-283.
88. MATHRUBUTHAM, M., Z. AYBEK, J. FOGARTY, et al. 1999. Plasma elastase regulation in stress urinary incontinence. Neurourol. Urodyn. 18: 281-282.
89. GONÇALVES, F., C. BROWN & L. MCLEAN. 2006. Abdominal and pelvic floor muscle activation during coughing inwomen with and without urinary incontinence. XVI Cong. Int. Soc. Electrophysiol. Kinesiol. 30.
90. GONÇALVES, F. & L. MCLEAN. 2005. Pelvic floor muscle activation during coughing in continent and incontinent women. The Eighth Annual Scientific Meeting for Health Sciences Research Trainees Faculty of Health Sciences. Abstract 110.
91. SMITH, M.D., M.W. COPPIETERS & P.W. HODGES. 2006. Postural response of the pelvic floor and abdominal muscles in women with and without incontinence. XVI Cong. Int. Soc. Electrophysiol. Kinesiol. 31.
92. SAPSFORD, R.R., P.W. HODGES, C.A. RICHARDSON, et al. 2001. Co-activation of the abdominal and pelvic floor muscles during voluntary exercises. Neurourol. Urodyn. 20: 31-42.
93. NEUMANN, P. & V. GILL. 2002. Pelvic floor and abdominal muscle interaction: EMG activity and intra-abdominal pressure. Int. Urogynecol. J. 13: 125-132.
94. Bø, K., B. KVARSTEIN, R. HAGEN, et al. 1990. Pelvic floor muscle exercise for the treatment of female stress urinary incontinence: II. Validity of vaginal pressure measurements of pelvic floor muscle strength and the necessity of supplementary methods for control of correct contraction. Neurourol. Urodyn. 9: 479-487.
95. MADILL, S.J. & L. MCLEAN. 2006. A biomechanical model of pelvic floor and abdominal muscle activity in continent women. Neurourol. Urodyn.
96. DELANCEY, J.O.L. 1994. Structural support of the urethra as it relates to stress urinary incontinence: the hammock hypothesis. Am. J. Obstet. Gynecol. 170: 1713-1723.
97. CONSTANTINOU, C.E. & D.E. GOVAN. 1982. Spatial distribution and timing of transmitted and reflexly generated urethral pressures in healthy women. J. Urol. 127: 964-969.
98. BARBIC, M., B. KRALJ & A. COR. 2003. Compliance of the bladder neck supporting structures: importance of activity pattern of levator ani muscle and content of elastic fibers of endopelvic fascia. Neurourol. Urodyn. 22: 269-276.
99. LOSE, G. 1991. Urethral pressure and power generation during coughing and voluntary contraction of the pelvic floor in females with genuine stress incontinence. Br. J. Urol. 67: 580-585.
100. THOMPSON, J.A., P.B. O'SULLIVAN, K. BRIFFA, et al. 2006. Altered muscle activation patterns in symptomatic women during pelvic floor muscle contraction and Valsalva manouevre. Neurourol. Urodyn. 25: 268-276.
101. HUNGERFORD, B., W. GILLEARD & P.W. HODGES. 2003. Evidence of altered lumbopelvic muscle recruitment in the presence of sacroiliac joint pain. Spine 28: 1593-1600.
102. SHEPHERD, A.M. 1983. Management of urinary incontinence - prevention or cure. Physiotherapy 69: 109-110.
103. DEINDL, F.M., D.B. VODUSEK, U. HESSE, et al. 1994. Pelvic floor activity patterns: comparison of nulliparous continent and parous urinary stress incontinent women. A kinesiological EMG study. Br. J. Urol. 73: 413-417.
104. MORIN, M., D. BOURBONNAIS, D. GRAVEL, et al. 2004. Pelvic floor muscle function in continent and stress urinary incontinent women using dynamometric measurements. Neurourol. Urodyn. 23: 668-674.
105. MILLER, J.M., J.A. ASHTON-MILLER & J.O.L. DELANCEY. 1998. A pelvic muscle precontraction can reduce cough-related urine loss in selected women with mild SUI. J. Am. Geriat. Soc. 46: 870-874.
106. ABRAMS, P. et al. 2002. Incontinence. 2nd International Consultation on Incontinence July 1-3, 2001 Health Publications Ltd. Paris. 2nd edition.
107. Bø, K. 2004. Pelvic floor muscle training is effective in treatment of female stress urinary incontinence, but how does it work? Int. Urogynecol. J. 15: 76-84.
108. HU, T.-W., K.H. MOORE, L. SUBAK, et al. 2002. Economics of Incontinence. In Incontinence. 2nd International Consultation on Incontinence. P. Abrams, L. Cardozo, S. Khoury, et al., Eds.: 965-983. Health Publications. Paris.
109. KEGEL, A.H. 1948. Progressive resistance exercise in the functional restoration of the perineal muscles. Am. J. Obstet. Gynecol. 56: 238-248.
110. KEGEL, A.H. 1951. Stress incontinence of urine in women: physiologic treatment. J. Int. Coll. Surg. 25: 487-499.
111. Bø, K., R. HAGEN, B. KVARSTEIN, et al. 1990. Pelvic floor muscle exercise for the treatment of female stress urinary incontinence: III. Effects of two different degrees of pelvic floor muscle exercises. Neurourol. Urodyn. 9: 489-502.
112. CHIARELLI, P., B. MURPHY & J. COCKBURN. 2004. Promoting urinary continence in postpartum women: 12-month follow-up data from a randomised controlled trial. Int. Urogynecol. J. 15: 99-105.
113. CHRISTENSEN, L.L., J.C. DJURHUUS & C.E. CONSTANTINOU. 1995. Imaging of pelvic floor contractions using MRI. Neurourol. Urodyn. 14: 209-216.
114. KIESSWETTER, H. 1976. EMG- patterns of pelvic floor muscles with surface electrodes. Urol. Int. 31: 60-69.
115. DI GANGI HERMS, A.M.R., R. VEIT, C. REISENAUER, et al. 2006. Functional imaging of stress urinary incontinence. NeuroImage 29: 267-275.
116. CANADIAN SOCIETY FOR EXERCISE PHYSIOLOGY. 1998. Canadian Physical Activity, Fitness and Lifestyle Appraisal, Second edition. CSEP. Ottawa.
117. Bø, K., S. LARSEN, O. OSEID, et al. 1998. Knowledge about and ability to correct pelvic floor muscle exercises in women with urinary stress incontinence. Neurourol. Urodyn. 7: 261-262.
118. BURGIO, K.L., J.C. ROBINSON & B.T. ENGEL. 1986. The role of biofeedback in Kegel exercise training for stress urinary incontinence. Am. J. Obstet. Gynecol. 154: 58-64.
119. HAY-SMITH, E.J.C., K. Bø, L.C.M. BERGHMANS, et al. 2002. Pelvic floor muscle training for urinary incontinence in women (review). Cochrane Database Syst. Rev. 1: CD 001407.
120. Bø, K. 2003. Pelvic floor muscle strength and response to pelvic floor muscle training for stress urinary incontinence. Neurourol. Urodyn. 22: 654-658.
121. KUJANSUU, E. 1983. The effect of pelvic floor exercises on urethral function in female stress urinary incontinence: an urodynamic study. Annales Chirurgiae et Gynaecologiae 72: 28-32.
122. WILSON, P.D., T. AL SAMARRAI, M. DEAKIN, et al. 1987. An objective assessment of physiotherapy for female genuine stress incontinence. Br. J. Obstet. Gynaecol. 94: 575-582.
123. HIRSCH, A., G. WEIRAUCH, B. STEIMER, et al. 1999.Treatment of female urinary incontinence with EMG-controlled biofeedback home training. Int. Urogynecol. J. 10: 7-10.
124. PAGES, I.H., S. JAHR, M. SCHAUFELE, et al. 2001. Comparative analysis of biofeedback and physical therapy for treatment of urinary stress incontinence in women. Am. J. Phys. Med. Rehab. 80: 494-502.
125. BERNSTEIN, I.T. 1997. The pelvic floor muscles: muscle thickness in healthy and urinary-incontinent women measured by perineal ultrasonography with reference to the effect of pelvic floor training. Estrogen receptor studies. Neurourol. Urodyn. 16: 237-275.
126. KEGEL, A.H. 1956. Stress incontinence of urine in women: physiologic treatment. J. Int. Coll. Surg. 25: 487-499.
127. LAGRO-JANSSEN, T.L., F.M.J. DEBRUYNE, A.J.A. SMITS, et al. 1991. Controlled trial of pelvic floor exercises in the treatment of urinary stress incontinence in general practice. Br. J. Gen. Pract. 41: 445-449.
128. SUSSET, J., G. GALEA, K. MANBECK, et al. 1995. A predictive score index for the outcome of associated biofeedback and vaginal electrical stimulation in the treatment of female incontinence. J. Urol. 153: 1461-1466.
129. CAMMU, H., M. VAN NYLEN, C. BLOCKEEL, et al. 2004. Who will benefit from pelvic floor muscle training for stress urinary incontinence? Am. J. Obstet. Gynecol. 191: 1152-1157.
130. O'SULLIVAN, R., A. SIMONS, S. PRASHAR, et al. 2003. Is objective cure of mild undifferentiated incontinence more readily achieved than that of moderate incontinence? Costs and 2-year outcome. Int. Urogynecol. J. 14: 193-198.
131. TRUIJEN, G., J.J. WYNDAELE & J. WEYLER. 2001. Conservative treatment of stress urinary incontinence in women: who will benefit? Int. Urogynecol. J. 12: 386-390.
132. BERGHMANS, L.C.M., H.J.M. HENDRICKS, K. Bø, et al. 1998. Conservative treatment of stress urinary incontinence in women: a systematic review of randomized clinical trials. Br. J. Urol. 82: 181-191.
133. MATTIASSON, A., J.C. DJURHUUS, D. FONDA, et al. 1998. Standardization of outcome studies in patients with lower urinary tract dysfunction: a report on general principles from the Standardisation Committee of the International Continence Society. Neurourol. Urodyn. 17: 249-253.
134. HUNSKAAR, S., K.L. BURGIO, A. DIOKNO, et al. 2002. Epidemiology and natural history of urinary incontinence. In Incontinence. 2nd International Consultation on Incontinence. P. Abrams, L. Cardozo, S. Khoury, et al., Eds.: 165-201. Health Publications. Paris.
135. KEGEL, A.H. 1952. Stress incontinence and genital relaxation; a nonsurgical method of increasing the tone of sphincters and their supporting structures. Clin. Symp. 4: 35-51.
136. THOMPSON, J.A. & P.B. O'SULLIVAN. 2003. Levator plate movement during voluntary pelvic floor muscle contraction in subjects with incontinence or prolapse: a cross-sectional study and review. Int. Urogynecol. J. 14: 84-88.
137. Bø, K. & R. STIEN. 1994. Needle EMG registration of striated urethral wall and pelvic floor muscle activity patterns during cough, valsalva, abdominal, hip adductor, and gluteal muscle contractions in nulliparous healthy females. Neurourol. Urodyn. 13: 35-41.
138. BUMP, R.C., W.G. HURT, J.A. FANTL, et al. 1991. Assessment of Kegel pelvic muscle exercise performance after brief verbal instruction. Am. J. Obstet. Gynecol. 165: 322-329.
139. MøRKVED, S., K. Bø & T. FJøRTOFT. 2002. Effect of adding biofeedback to pelvic floor muscle training to treat urodynamic stress incontinence. Obstet. Gynecol. Clin. North Am. 100: 730-739.
140. WEATHERALL, M. 1999. Biofeedback or pelvic floor muscle exercises for female genuine stress incontinence: a meta-analysis of trials identified in a systematic review. Br. J. Urol. Int. 83: 1015-1016.
141. Bø, K. & T. TALSETH. 1997. Change in urethral pressure during voluntary pelvic floor muscle contraction and vaginal electrical stimulation. Int. Urogynecol. J. 8: 3-7.
142. Bø, K. 1995. Vaginal weight cones. Theoretical framework, effect on pelvic floor muscle strength and female stress urinary incontinence. Acta Obstetricia et Gynecologica Scandinavica 74: 87-92.
143. MOURITSEN, L., C. FRIDODT-MøLLER & M. MøLLER. 1991. Long-term effect of pelvic floor exercises on female urinary incontinence. Br. J. Urol. 68: 32-37.
144. DATTILO, J. 2001. A long-term study of patient outcomes with pelvic muscle re-education for urinary incontinence. J. Wound Ostomy Cont. Nurs. 28: 199-205.
145. Bø, K. 1995. Adherence to pelvic floor muscle exercise and long-term effect on stress urinary incontinence; a five-year follow-up study. Scand. J. Med. Sci. Sports 5: 36-29.
146. CAMMU, H. & M. VAN NYLEN. 1995. Pelvic floor muscle exercises: 5 years later. Urology 45: 113-118.
147. Bø, K., B. KVARSTEIN & I. NYGAARD. 2005. Lower urinary tract symptoms and pelvic floor muscle exercise adherence after 15 years. Obstet. Gynecol. 105: 999-1005.
148. ANDERSSON, K.-E., R.A. APPELL, S. AWAD, et al. 2002. Pharmacological treatment of urinary incontinence. In Incontinence. 2nd International Consultation on Incontinence. P. Abrams, L. Cardozo, S. Khoury, et al., Eds.: 479-511. Health Publications. Paris.
149. SCHUESSLER, B. & K. BAESSLER. 2003. Pharmacologic treatment of stress urinary incontinence: expectations for outcome. Urology 62: 31-38.
150. SMITH, A.R.B., F. DANESHGARI, R. DMOCHOWSKI, et al. 2002. Surgical treatment of incontinence in women. In Incontinence. 2nd International Consultation on Incontinence. P. Abrams, L. Cardozo, S. Khoury, et al., Eds.: 823-863. Health Publications. Paris.
151. ROCK, J.A. & J.D. THOMPSON, Eds. 1997. Linde's Operative Gynecology. Eighth edition. Lippincott-Raven. Philadelphia.
152. STANTON, S.L. 1990. Surgical management of urethral sphincter incompetence. Clin. Obstet. Gynecol. 33: 346-357.
153. BROWN, J.S. & W.R. CROMBLEHOLME. 1993. Handbook of Gynecology and Obstetrics. Appleton and Lange. Norwalk, CT.
154. NILSSON, C.G., N. KUUVA, C. FALCONER, et al. 2001. Long-term results of the tension-free vaginal tape (TVT) procedure for surgical treatment of female stress urinary incontinence. Int. Urogynecol. J. 12: S5-S8.
155. STASKIN, D., T. BAVENDAM, J. MILLER, et al. 1996. Effectiveness of a urinary control insert in the management of stress urinary incontinence: early results of a multicenter study. Urology 47: 629-636.
156. MOORE, K.H., A. FOOTE, S. SIVA, et al. 1997. The use of the bladder neck support prosthesis in combined stress incontinence and detrusor instability. Aust. NZ J. Obstet. Gynaecol. 37: 440-445.
157. Bø, K. & H.B. FINCKENHAGEN. 2001. Vaginal palpation of pelvic floor muscle strength: inter-test reproducibility and comparison between palpation and vaginal squeeze pressure. Acta Obstet. Gynecol. Scand. 80: 883-887.
158. Bø, K. & M. SHERBURN. 2005. Evaluation of female pelvic-floor muscle function and strength. Phys. Ther. 85: 269-282.