The problem of urinary incontinence affects half of the adult female population, worsening their comfort of life and significantly hindering ordinary life activities (laughing, sneezing, coughing, physical activity); it also affects the quality of their sexual life [1, 2]. Urinary incontinence is associated with female genital statics disorders, which increase with age. The period of a woman’s life predisposing to genital static disorders is the menopause, especially the senium period, which is associated with hypoestrogenism. The balance of forces acting in the pelvis determines the correct position of the female genital organs. Any weakening of the elements of the apparatus supporting the organs in the correct position, and an increase in the “top down” force lead to genital static disorders.

An analysis of the factors impacting on the risk of developing statist abnormalities of the genital organs indicates that what is important in preventing statist abnormalities of the genital organs is physical activity (pelvic floor exercises) and a proper diet that does not lead to constipation or obesity, but at the same time which takes into account the increased catabolism during the particularly senile period [3, 4, 5].

Collapse and prolapse of the uterus and vagina and secondary incontinence might be caused by the following: insufficiency of the pelvic floor, weakness in the suspensory and supporting apparatus, abnormal intra-abdominal pressure with visceral prolapse due to a weak pelvic floor, a drooping, hanging abdomen, distention of the rectus muscles, and possibly, a petite asthenic physique.

It should be emphasised that significant factors for lowering and prolapse of the genital organs are perinatal tissue damage, flaccidity of the ligaments and parametria, and damage to the pelvic floor muscles.

However, illnesses with persistent cough, heavy physical work and stress, overweight, obesity, and chronic constipation have been identified as additional causative factors. It is worth emphasising that obesity, overweight and constipation, especially habitual constipation, which is one of the factors of static disorders, can be prevented by introducing an appropriate lifestyle and nutrition [6, 7, 8]. Of particular importance in dietary habits is increasing the amount of dietary fibre in the diet (especially its insoluble form), drinking sufficient fluids, including fermented dairy products in the diet, and limiting the intake of fatty foods and sweets.

The basis for urinary system activity is its innervation. Diseases of the central nervous system: demyelination, synaptic disorders, mediator abnormalities, interruption of stimulus-conducting pathways, or the use of psychoactive agents (drugs, narcotics, alcohol, stimulants) lead to impaired or lack of control of urination. Attention should also be paid to orthopaedic conditions that develop with nervous system dysfunction. These can also cause or exacerbate micturition problems [9].

Physiotherapy in gynaecology, obstetrics and urogynaecology has developed significantly over the last decade. Every year women’s awareness of and accessibility to urogynaecological physiotherapy increases [10]. Physiotherapy is becoming an increasingly common method of conservative treatment of genital static disorders and stress urinary incontinence. What is great importance here is the correct qualification of patients for the appropriate physiotherapy technique and the development of a therapy management plan.

Physiotherapy in pelvic floor muscle training involves the use of a wide range of treatments, including behavioural therapy, movement therapy—pelvic floor muscle training, manual visceral therapy, and physical therapy, i.e., treatment with physical stimuli such as electrotherapy, magnetic fields and high-frequency currents. An interdisciplinary approach in treatment is extremely important for improving women’s health and lives.

In this article, the authors consider the following aspect: the use of different physiotherapy treatments as adjunctive treatment for urinary incontinence. The authors reviewed the literature databases in PubMed, Medline and Embase to find an association between the physiotherapeutic treatment applied and its effectiveness. Then, the data obtained from these inquiries were evaluated to remove papers related to other keyword meanings. The following keywords and queries used: physiotherapy, magnetotherapy, electrotherapy, cones, incontinence, physiotherapy in incontinence, physical treatments in incontinence, use of cones in incontinence and pelvic floor muscle exercises in incontinence. These results were assessed for compliance with the inclusion and exclusion criteria based on an analysis of the abstracts (inclusion criterion: research articles describing the use of physiotherapy in urinary incontinence; exclusion criterion: non-research articles and those not within the keywords and queries). Of the 50 articles initially shortlisted for further analysis, 10 were rejected at this stage. The 40 remaining articles were subjected to content analysis and a further eight were rejected on the basis of further analysis. The remaining articles were analysed in depth and are presented in Table 1 (Ref. [11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31, 32, 33, 34, 35, 36, 37, 38, 39, 40, 41, 42, 43]).

Behavioural therapy has a special place in comprehensive therapy intervention. It is important to introduce regular and simple changes to the patient’s daily life to enhance the effect of physiotherapy. Targeted action involves the patients introducing restrictions and avoiding triggers. It is necessary to develop the correct urinary and faecal behaviour based on physiological reflexes, but with the application of the correct habits. It is particularly important to introduce the correct principles in the treatment of patients with overactive bladder-type disorders and mixed incontinence and constipation [44].

The use of comprehensive therapy is crucial, because women who present with micturition disorders due to troublesome complaints often also have emotional disorders and depression. Many patients significantly limit their personal life, work and activities in various areas of life. Loss of urine is also culturally recognised as an embarrassing, often taboo subject. The main technique used in behavioural therapy as preparation for a proper therapy plan is to keep a micturition diary. The patient is instructed by the therapist on how to keep the diary correctly. Usually, urination is measured independently for about two days under normal everyday conditions. The key to reading the test correctly is conscientious and accurate record-keeping. It is suggested that the micturition diary should be kept on a day off, such as at the weekend [45]. Implementing behavioural therapy, including concomitant physical and pharmacological treatment, leads very quickly to subjective improvements and objective improvements in the long term.

Pelvic floor muscle exercises include preventive and problem-specific measures. The use of kinesitherapy mobilises the circulatory and respiratory systems and improves the metabolism of the whole organism. The efficiency of the pelvic floor muscles depends largely on the condition of our muscular, ligamentous and fascial systems, which keep the organs at the right height. When influenced by exercise, the fibres increase in mass and can change their character from fast-twitch to slow-twitch and vice versa.

The main aim of pelvic floor muscle training is to gain muscle mass and increase resting tension. Increased strength, improved deep sensation and neuromuscular control are all direct effects of training. In addition, regular exercise can help to inhibit the stimulation of receptors that are stretch-sensitive and can also reduce complaints of instability, i.e. urgency and frequent urination. A history and basic physical examination by a physiotherapist is necessary before doing pelvic floor muscle exercises. Three basic exercise techniques are commonly used: active exercises, biofeedback, and cone exercises. All these methods may be used together or separately during therapy. Active exercises using muscle synergies, the most accessible and inexpensive method, require no special equipment. The individual exercises consist of adopting the correct position and activating the relevant muscle groups. This works the thighs, buttocks, abdomen and torso. These exercises will enable intermediate tension of the pelvic floor muscles [46, 47, 48]. Properly selected exercises with appropriate body positioning allow activation of the transverse perineal muscles, the urethral sphincter muscle, and the anal lever muscle. It is important to teach the patient the correct activation of the external muscle groups in order to trigger a contraction of the pelvic floor muscles.

Manual visceral techniques can be used effectively in gynaecology and obstetrics for various dysfunctions in the pelvic area [49, 50].

Positive effects in training the pelvic floor muscles are obtained using biofeedback. Many scientific publications prove the effectiveness of this form of therapy [51, 52, 53]. Biofeedback therapy controls the activation of the relevant muscle group, as well as the size and duration of contractions and relaxation. Correct reading of the results makes it possible to monitor the progress in the therapy. However, this treatment requires special conditions, such as a separate room and requires special equipment. During the therapy, the woman must remove her underwear, expose her perineal area and consent to an electrode being applied to her vagina or anus.

Biofeedback therapy involves higher financial costs for both the patient and medical staff. However, studies have shown that conducting therapy with biofeedback quickly teaches patients how to properly tone the correct muscle groups and enhances motivation to undertake exercise [54, 55, 56, 57]. Biofeedback is used in both women and men for treating urinary incontinence and is considered a modern technique that is an effective complement to traditional pelvic muscle exercise programmes [58, 59].

The use of a vaginal cone in the form of a weight that the woman inserts into the vagina is intended to strengthen the anal lever muscle. Gradually increasing the weight of the cones triggers stronger muscle contractions to hold the cone in the vagina. The ability to hold the cone with the correct weight in an upright position while walking is to lead to the correct contractions of the pelvic floor muscles. Cone exercises should be considered as supplementary to training and should only be used when clearly indicated [60, 61]. Weights can be an effective training aid for women with mild to moderate stress urinary incontinence, especially in the absence of severe pelvic organ prolapse. However, incorrect application of vaginal weights may lead to the patient developing pathological muscle contraction in the absence of proper relaxation [62].

Physical treatments using low-frequency medium-frequency or high-frequency currents are the most commonly used of the physical treatments available for patients with urinary incontinence. The main task of electrostimulation is to activate the striated muscles in order to support urethral sphincter function. During electrostimulation, the bladder neck is displaced in the sagittal plane and the posterior urethrovesical angle is reconstructed. The stimulation caused by the electrical impulse also runs to the muscles via the vulvar nerve. If there is no damage to the peripheral motor neuron during electrostimulation through the efferent fibres, smooth muscle excitation of the detrusor muscle is inhibited. This is used in physiotherapy in micturition disorders due to neurogenic causes and in urge incontinence, urinary urgency and overactive bladder. Long-term electrostimulation causes increased muscle mass and also increases resting tension and contraction strength. Moreover, electrostimulation influences the remodelling of striated muscles with an increase in the mass of type I slow-contractile fibres, which makes it possible to perform a longer contraction, and boosts resistance to fatigue. Type II fast-twitch fibres make up 30% of the pelvic muscle mass; they are mainly located in the urogenital diaphragm and become active when intra-abdominal pressure increases, for example, as a result of coughing, laughter or sudden jumping. Normal muscle function is mainly activated by slow-contracting fibres, which account for 60% of all motor units. In the conservative treatment of urinary incontinence, the key is to select the appropriate parameters of electrostimulation which stimulate and engage the right number and types of muscle fibres. Determining the type of incontinence is crucial for selecting the appropriate electrostimulation parameters. The intensity used in electrostimulation should not exceed 100 mA [63]; it needs to be individually adjusted to the sensitivity of the patient, and the sensation of the current may be variable in the same patient on each day of therapy. Some studies have shown that a frequency of 50 Hz is optimal for closing the urethra and about 5–12 Hz for relaxing the detrusor muscle; in a mixed form, a frequency of 25 Hz can be used [64, 65].

Electrostimulation is performed with vaginal or rectal courts or non-invasively in an external manner with flat electrodes taped to the suprapubic area, sacral area and perineal area [66]. Electrostimulation should be long-term therapy over many months; the best results are obtained after approximately 3–5 months of continuous therapy [67].

Magnetostimulation is the therapeutic application of alternating magnetic fields with very low magnetic induction values, which induce contractions in the pelvic floor muscles. For the purposes of urology, flat applicators of no more than a few centimetres have been developed, which are inserted into the patient’s underwear in the perineal area. Stimulation consists in continuously or periodically exposing the organs of the lower pelvis to a magnetic field. This form of stimulation is considered complementary to other forms of conservative measures [68]. Using a pulsating magnetic field makes it possible to select the appropriate strength and frequency for the magnetic field. This field acts directly on the motor fibres of the vulvar and visceral nerves, activating the sodium-potassium pump and regulating the depolarisation of motor neurons, forcing muscle contraction in the innervated area [69, 70]. In the treatment of urinary incontinence through physiotherapy, a magnetic chair in which a field applicator is built into the structure is most commonly used [71]. The S2–S4 sacral nerve roots ensure primary autonomic and somatic innervation of the bladder and urethra, vaginal and rectal walls and pelvic floor muscles. Stimulating these roots is an effective way to modulate the pelvic floor and subsequently to control pelvic organs [72, 73, 74]. This method is used to treat all types of urinary incontinence.

The aim of magnetostimulation is to alleviate the habit of frequent urination, delay urination and lengthen the urinary interval, which improves bladder capacity and reduces displacement instability. The procedure is painless and does not require undressing during therapy or the insertion of a probe into the vagina or rectum [75].

Current recommendations from the European Society of Urology advise against treating urinary incontinence or overactive bladder with magnetic stimulation [76, 77, 78].

The quality of life of women with Stress Urinary Incontinence can also be affected by the distribution of body fat. A study by Ptak and co-authors found that women with a gynoid body type (Waist to Hip Ratio (WHR) 0:8) compared with women with an android body type (WHR $>$0:8) had better quality of life questionnaire (QOL) scores after performing pelvic floor muscle and a transverse abdominal muscle (Pelvic Floor Muscle (PFM) + Transverse abdominal (TrA)) workout [79].

It is important to remember that physical therapy procedures are not used in pregnant women, during menstrual bleeding, or in cases of cancer, active tuberculosis, hyperthyroidism, gastrointestinal bleeding, severe infections of viral, bacterial and fungal origin, or in the presence of electronic implants, e.g., pacemaker. Pelvic procedures should be carefully considered in patients with anal and vaginal varices and endometriosis. In patients undergoing oncological treatment, all electro and magnetotherapy stimulation should be consulted with an oncologist.

Physiotherapy treatments are effective and support the treatment process in women of all age ranges who experience urinary incontinence, thus contributing to an improved quality of life for these women. It is important that treatment is selected based on the patient’s current clinical picture.

This review points to the need for interdisciplinary preparation of an algorithm for managing urinary incontinence in women and conducting randomised trials to identify the physiotherapy interventions with the greatest effectiveness.

It is important that treatment is selected on the basis of the patient’s current clinical picture. A strength of the manuscript is the indication of the use of various physiotherapeutic interventions as adjunctive treatment in urinary incontinence. A weakness of the manuscript is the reference to searching for articles in only three journal databases.

MW and KP analyzed the data; MW, KP, KP-R, GJ-B performed the review and editing. MW, KP, TG, KP-R, PM, MM, DL, MP-K, WK, GJ-B wrote the paper. All authors read and approved the manuscript.

Not applicable.

Thanks to all the peer reviewers for their opinions and suggestions.

This research received no external funding.

The authors declare no conflict of interest. Małgorzata Wójcik, Katarzyna Plagens-Rotman, Piotr Merks and Grażyna Jarząbek-Bielecka are serving as Guest editors of this journal. We declare that Małgorzata Wójcik, Katarzyna Plagens-Rotman, Piotr Merks and Grażyna Jarząbek-Bielecka had no involvement in the peer review of this article and has no access to information regarding its peer review. Full responsibility for the editorial process for this article was delegated to Andrzej Semczuk and Andrea Tinelli.