http://www.sciencedirect.com/science/article/pii/S0022534715035661
Abstract
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.
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