As a consequence of the physiological and anatomical declines experienced by women associated to the increased life expectancy, and intrinsic longer post-menopausal period, women undergoal structural and functional changes of PFM, which may lead to SUI.  Therefore, it is important to realize systematic review on physical therapies applied specifically to SUI in postmenopausal women emerges. The present study aimed on carrying out a systematic review to assess the most effective physiotherapeutic technique in the treatment of stress urinary incontinence in postmenopausal women.

This systematic review was based on the recommendations of the PRISMA statement. The electronic search was performed until April 30th, 2021 in the databases MEDLINE/PubMed (United States National Library of Medicine - National Institutes of Health), Cochrane Library Registry (Cochrane of Clinical Trials Controlled) and LILACS (Latin American and Caribbean Literature in Health Sciences). For the electronic search, descriptors were crossed. The strategy combined terms related to: (“stress urinary incontinence” OR “urinary incontinence, stress”) AND “menopause” AND (“physical therapy” OR “pelvic floor rehabilitation”). To develop the search strategy, clinical questions were based using the PICOS (population, intervention, control, and outcomes)  method  (Table 1).  Furthermore, it was accepted just randomized and controlled clinical trials (RCCTs) which physical therapy interventions were performed as a primary outcome in postmenopausal women with stress urinary incontinence. It were considered for including methods to strengthen PFM through comparisons with no intervention, conventional pelvic floor muscle training (PFMT) or drug treatment applied to postmenopausal women with stress urinary incontinence. Studies investigating participants with neurological diseases or disorders and which did not specify the type of intervention investigated were excluded from the study. Methodological quality of the selected studies was evaluated applying the PEDro scale score, developed by The Physiotherapy Evidence Database (PEDro) and each trial was revised by two co-authors in order to confirm the PEDro scale score.

One hundred and thirty studies were found in the electronic search, from the Cochrane Registry of Controlled Clinical Trials, PubMed/MEDLINE and LILACS databases, with 14, 72 and 44 studies respectively. Only 6 of 130 corresponded to the inclusion criteria, these articles were published from 1977 until April 30th, 2021. Two studies performed interventions with PFMT and vaginal cone (VC) [1] as a result similar results for treatments with VC and PFMT were found, such as, decreased urinary loss, increased pelvic floor muscle function and quality of life domains as well.  Other article used the combination of electrical muscle stimulation associated with PFMT and hormone therapy could also increased maximum closure urethral pressure and maximum urethral pressure. Another article compared biofeedback with PFMT and as a result, it showed decreased urinary loss and frequency of incontinence and increased muscle function. Other article used a combination of biofeedback plus PFMT with PFMT alone [2] was able to showed that PFMT with or without biofeedback could improve muscle neurofuncional capacity. The last article compared  electroacupuncture [3] with simulated electroacupuncture which showed decrease in the urine loss.

Most of the studies [1,2] started with instructions for the contraction of the pelvic floor. Some of them performed digital palpation, as well as explanations about the anatomy of the pelvic floor and lower urinary-tract muscles, physiology and continence mechanisms. Some dependent variables were similar amongst studies, such as: urinary loss assessed by the 1h Pad Test, PFM strength assessed by the Oxford Scale, muscle function assessed by perineometer and electromyography exam and general quality of life, which was present in the 6 studies, being evaluated by different instruments: King's Health Questionnaire, or Incontinence Impact Questionnaire. All studies which used Pad Test as a tool for evaluating urinary loss obtained improvement or cure in this variable, even though there are methodological differences found in this review.

The physiotherapeutic techniques studied are very effective for improving SUI in postmenopausal women. On the other hand, due to the limited number of studies and the heterogeneity of interventions we were not able to identification of the most effective physiotherapeutic technique for postmenopausal women with stress urinary incontinence and we could not  realize the meta-analysis as well.

Pereira VS, De Melo MV, Correia GN, Driusso P. Vaginal cone for postmenopausal women with stress urinary incontinence: randomized, controlled trial. Climateric. 2012;15(1):45-51.
Bertotto A, Schvartzman R, Uchôa S, Wender MCO. Effect of eletromyographic biofeedback as an add-on to pelvic floor muscle exercises on neuromuscular outcomes and quality of life in postmenopausal women with stress urinary incontinence: A randomized controlled trial. Neurourol Urodyn. 2017;9999:1-6.
Wang W, Liu Y, Sun S, Liu B, Su T, Zhou J, Liu Z. Electroacupuncture for postmenopausal women with stress urinary incontinence: secondary analysis of a randomized controlled trial. World J Urol. 2019;37(7):1421-1427.