Pelvic Floor Muscle Re-education Treatment of the Overactive Bladder and Painful Bladder Syndrome

Normal function of the pelvic floor muscu-lature is essential in maintaining appropriate function of the pelvic viscera. Low-tone pelvic floor dysfunction, as may be seen in patients with pelvic floor musculature de-nervation, can contribute to pelvic organ prolapse, transurethral urinary incontinence, vaginal laxity, or transrectal fecal inconti-nence. High-tone pelvic floor dysfunction, as may occur in patients with overactive bladder or painful bladder syndrome (inter-stitial cystitis), can manifest as voiding dysfunction, sexual dysfunction with dyspa-reunia, or fecal retention. Pelvic floor reha-bilitation for patients with pelvic floor dys-function is performed in an effort to restore normal tone and function to the muscles of the pelvic floor, and in patients with overac-tive bladder may provide an additional ele-ment of reflex bladder inhibition. Muscle re-education techniques, typically preceded by a trial of behavioral therapy, include pelvic floor musculature exercises, pelvic floor musculature exercises with biofeedback, and electrical stimulation. The purpose of this chapter is to discuss the use of pelvic floor musculature rehabilitation to treat overactive bladder and to correct high-tone pelvic floor dysfunction. Anatomy of the Pelvic Floor The pelvic floor contains layers of connec-tive tissue and muscle that provide support to the pelvic viscera. The urethra, vagina, and rectum are attached to the pelvic side-walls by the endopelvic fascia, penetrating the pelvic floor at the urogenital hiatus. Im-