AIMS: Urge urinary incontinence (UUI) is a major problem, especially in the elderly, and the underlying mechanisms of disease and therapy are unknown.
We used biofeedback-assisted pelvic floor muscle training (PFMT) and functional brain imaging (fMRI) to investigate cerebral mechanisms, aiming to improve understanding of brain-bladder control and therapy.
METHODS: Before receiving PFMT, functionally intact, older, community-dwelling women with UUI-as well as normal controls-underwent comprehensive clinical and bladder-diary evaluation, urodynamic testing, and brain fMRI; the evaluation was repeated post-PFMT in those with UUI. fMRI was used to determine brain reaction to rapid bladder filling with urgency.
RESULTS: 28 of 65 UUI subjects responded to PFMT with >50% improvement of UUI frequency on diary. However, responders and non-responders displayed 2 different patterns of brain reaction. Pattern 1 (Responders): pre-PFMT, the dorsal anterior cingulate cortex (dACC) and adjacent supplementary motor area (SMA) were activated as was the insula. Following PFMT, dACC/SMA activation diminished, and there was a trend to mPFC deactivation. Pattern 2 (non-responders): pre-PFMT, the medial prefrontal cortex (mPFC) was deactivated and this changed little following PFMT.
CONCLUSIONS: In older women with UUI, there appear to be two patterns of brain reaction to bladder filling and they seem to predict response and non-response to PFMT. Moreover, diminished cingulate activation appears to be a consequence of PFMT-induced UUI improvement, whereas prefrontal deactivation may be a mechanism contributing to success of PFMT. In non-responders this latter mechanism is unavailable; this may explain why another form of therapy is required.
Written by:
Griffiths D, Clarkson B, Tadic SD, Resnick NM. Are you the author?
Department of Medicine (Geriatrics), University of Pittsburgh, Pittsburgh, Pennsylvania.
Reference: J Urol. 2015 Mar 28. pii: S0022-5347(15)03566-1.
doi: 10.1016/j.juro.2015.03.102
PubMed Abstract
PMID: 25828973