Cortical magnetic stimulation in patients with genuine stress incontinence: Correlation with results of pelvic floor exercises

Pelvic floor training is an established conservative method of treatment in patients with genuine stress incontinence. It is not known why only a prop ortion of patients benefit from this form of treatment, while others with a comparable degree of incontinence do not. Since muscle awareness is of vit al importance in pelvic floor training, we decided to investigate whether d ifferences in outcome might be explained by differences in cortical control of the pelvic floor muscles. The function in the total motor pathway to th e pelvic floor muscles was examined with cortical magnetic stimulation and circumvaginal EMG recording. Since lesions of the peripheral motor pathway have been demonstrated in patients with genuine stress incontinence, possib le differences at this level were investigated by means of terminal pudenda l motor latencies, using electrical nerve stimulation and anal recording EM G. We found that patients who succeeded with pelvic floor exercises for genuin e stress incontinence had a significantly higher probability of response to cortical magnetic stimulation and significantly larger response amplitudes than the patients who did not benefit from training. The findings in the l atter group did not differ from those of a healthy control group. No differ ences between the groups were found in the terminal pudendal motor latencie s. We conclude that women with genuine stress urinary incontinence, success fully alleviated by a physiotherapeutic training program, have a higher deg ree of corticofugal control of their perineal muscles than women who do not succeed with the same treatment program and healthy controls. (C) 1999 Wil ey-Liss, Inc.