*1.3.1. Physical therapies for the urinary incontinence*

transobturator insertion (7%) compared to retropubic insertion (3%)(Barber, Kleeman et al.

Vulvovaginal pain can developed after bacterial vaginal infections or bacterial vaginosis. Infections change the vaginal ecosystem. Oestrogen deficiency in peri- and post-menopausal women can also lead to vulvar tissue atrophy and a subsequent irritation. Contact with irritanting agents such as soaps, detergents and topical preparations as well as vulvar trauma associated with accidents or surgery can lead to vulvar irritation and the development of

Urinary incontinence is an extremely common complaint worldwide. It causes a great deal of distress and embarrassment, as well as significant costs, to both individuals and societies (Lucas, Bosch et al. 2012). The standardization committee of the International Continence Society (ICS) has defined the female urinary incontinence as the involuntary urine loss, objectively demonstrable, which represents a social or hygienic problem (Abrahams, Blaivas

At least one out of four women in Europe suffers from a disorder associate with incontinence which often has been present for several years before consultation (Thomas, Plymat et al. 1980). In geriatric hospitals, the incidence of urinary incontinence I in women is 43% and as

Patients with 'complicated incontinence' are those with co-morbidities, a history of previous pelvic surgery, past surgery for incontinence, radiotherapy and associated genitourinary prolapse (Lucas, Bosch et al. 2012). Urinary incontinence is more common in women with UTIs and is also more likely in the first few days following an acute infection (Moore,

In women with incontinence, diagnosis of a UTI by positive leucocytes or nitrites using urine test strips had low sensitivity but high specificity (Semeniuk and Church 1999; Buchsbaum,

Incontinent women with symptoms of lower urinary tract or pelvic floor dysfunction and pelvic organ prolapse have a higher risk of of incomplete bladder emptying (elevated post void residual urine volume) compared to asymptomatic patients. Therefore it is suggested that the presence of post void residual should be ruled out in this patients (Fowler, Panicker et al.

In the elderly incontinence can be caused or worsened by underlying diseases including diabetes (Lee, Cigolle et al. 2009). A higher prevalence of incontinence was associated with higher age and body mass index (Sarma, Kanaya et al. 2009). A recent meta-analysis showed that systemic oestrogen therapy for post-menopausal women was associated with the devel‐ opment and worsening of urinary incontience (Cody, Richardson et al. 2009). Obesity appears

to confer a four-fold increased risk of UI (Chen, Gatmaitan et al. 2009).

2008; Lorenzo-Gómez, B et al. 2013).

294 Electrodiagnosis in New Frontiers of Clinical Research

**1.3. Urinary incontinence**

et al. 1988).

Jackson et al. 2008).

Albushies et al. 2004).

2009).

vulvovaginal pain (White, Jantos et al. 1997 Mar).

high as n 91% in psychogeriatric patients.

The treatment of lower urinary tract's disorders with pelvic floor exercises with or without biofeedback represents a risk-free option which can be applied in a great number of women. The correct function of the female pelvic floor depends on the position and mobility of the urethra and the urethrovesical junction. Pelvic floor muscle training increases urethral closure pressure and stabilises the urethra, preventing downward movement during moments of increased physical activity. There is evidence that increasing pelvic floor strength may help to inhibit bladder contraction in patients with an overactive bladder. This training may be augmented with biofeedback (Bidmead 2002).

The evidence published in the guidelines regarding urinary incontinence suggests that UTI treatment does not correct the UI. It is unclear if improving the incontinence helps decrease recurrence rate of UTI.

Valid methods to evaluate the morphologic and electromyographic abnormalities of the levator ani muscle are necessary in order to better select women or the treatment with pelvic floor training and biofeedback (Bo, Larsen et al. 1988; Espuña-Pons 2002).

The most recently published systematic review in 2010 found that medication was less effective than behavioural therapy in a comparative effectiveness trial (81% vs. 69% reduction in UI episodes) (Goode, Burgio et al. 2010), therefore pelvic floor physiotherapy must always be the first line of treatment for stress incontinence and overactive bladder. Drugs must be prescribed if pelvic floor physiotherapy fails (Bidmead 2002).
