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The bladder, the urethra and the musculature of the pelvic floor form the responsible functional unit of urinary incontinence. Anatomical structures of the pelvis are divided in passive and active 6. The pelvic bones, viscera fascias and parietal form the passive ones. The condensations of the parietal fascia and visceral (endopelvic fascia) associated to muscular fibers form ligaments and muscles, that will sustain the bladder and the urethra 7. The active anatomical structures comprehend the neuromuscular components, responsible for the maintenance of tonus and muscular contraction in response to a sudden increase of abdominal pressure.
In 1992 De Lancey et al 8, introduced the concept that the connective tissue supports the pelvis in three levels: by the uterus sacral and cardinal, by the vagina ligaments and by the structures that surround the urethra, the anus elevator, perineal muscle and the body o the perineum. The muscle of the elevator of the anus, is the most important component of the pelvic floor, it gives support to the pelvic organs and also helps the urethra’s sphincter, vagina and rectum 9. Two types of muscular fibers compose this muscle, type I, corresponding to 70% of the fibers (slow contraction) and type II, which appears in 30% of the fibers (quick contraction). This composition allows the maintenance of the tonus for a long period of time, and it obtains a sudden increase of the tonus to compensate increases of intra-abdominal pressure, which occur during coughing, sneezing and other types of physical efforts 9. The previous evaluation of the contractibility of the pelvic muscles is an important factor to determine the adequate therapy for each case. Amaro and Moreira 10 using the perineometer for objective evaluation of the muscular strength of the pelvic floor, observed a significant deficit of the muscular strength and in the perception of this muscular group in incontinent women when compared to the continent ones. The thickness of the pelvic floor muscles seems to diminish with age; consequently, a decrease occurs in the muscular strength. In young women we found better conscience of the function and more strength in the pelvic floor muscles 11. Using an ultrasonography in incontinent women who obtained good results after the treatment with perineal exercises, a muscular hypertrophy was shown, and there was still a disappearance in the difference in the thickness of those fibers when compared with a group of continent women 11. The exercise programs seek to strengthen the pelvic musculature, more specifically the elevator muscle of the anus, and this way a strengthening occurs of the component of the peri-urethral of the external urethral sphincter, increasing the tonus and improving the transmission of pressures in the urethra, strengthening the mechanism of continence 12.