Can the functional assessment of abdominal, diaphragmatic, and pelvic floor muscles reflect post-prostatectomy urinary incontinence severity?

BACKGROUND: Post-prostatectomy incontinence can substantially impair patients' quality of life. While rehabilitation typically targets the pelvic floor muscles, the role of the diaphragm and deep abdominal muscles is under-explored. This study aimed to determine the utility of evaluating and managing the transversus abdominis (TrA), diaphragm, and levator ani muscle (LAM) to facilitate post-prostatectomy urinary incontinence recovery.

METHODS: This single-center observational cohort study included 90 patients. During post-prostatectomy rehabilitation, we regularly assessed muscle capacity using a standardized clinical examinations comprising nine tests. Capacity score ranges were 0-2, 0-3, and 0-4 for the TrA, diaphragm, and levator ani. Data were collected until continence was restored or improvement plateaued, generally by 8 months. Incontinence was classified as severe, moderate, mild, or corrected. Spearman's rho assessed associations between incontinence grade and muscle scores.

RESULTS: Higher muscle scores were associated with lower incontinence severity. The most consistently significant correlation was with the TrA, followed by the diaphragm (p < 0.05). LAM scores were no longer significantly correlated with incontinence from month 4 onward. Only patients in the corrected-continence group passed both TrA tests.

CONCLUSION: Improved functional capacity of the TrA, diaphragm, and LAM was associated with the recovery of urinary continence. This association was strongest for the TrA. Our findings support the functional assessment of these three muscles in the evaluation and management of post-prostatectomy urinary incontinence.