Estrogen deficiency is implicated in playing a role in the prevalence of stress and urge incontinence in post-menopausal women. Urogenital atrophy associated with the fall of circulating estrogens is postulated to lead to urinary symptoms of frequency, nocturia, and dysuria. Topical and oral estrogen therapy has been found effective as a treatment of stress incontinence in post-menopausal women. There is documented evidence that estrogen may increase the response of alpha-adrenergic receptors located along the urethra. Its role in the treatment of urge incontinence is less clear, but there is evidence that urge symptoms can be alleviated with estrogen therapy. Pelvic muscle exercise consists of repetitive volitional contractions and relaxations of specific pelvic floor muscles. Pelvic muscle exercise is helpful in the treatment of stress incontinence by increasing the strength of the pubococcygenus portion of the levator ani to effect efficient urethral closure during periods of sudden and sharp intravesical pressure. Pelvic muscle exercise may reduce uninhibited bladder contractions via neuromuscular changes, thus reducing urge incontinence. Biofeedback is a technique used to enhance the educational process of learning the correct muscles to strengthen during pelvic muscle exercises by providing immediate feedback about the efficiency of contractions. The effect of localized estrogen therapy and pelvic muscle exercise with biofeedback on stress and urge incontinence and urinary symptoms is being investigated in this current study. Findings from this study could lead to the development of combined pharmacological and non-surgical interventions in the treatment of prevalent urinary conditions in post-menopausal women.
