Pelvic Floor Muscle Training for Urinary Incontinence in Women

Department of Women's and Children's Health, Dunedin School of Medicine, University of Otago, PO Box 913, Dunedin, New Zealand.
Cochrane database of systematic reviews (Online) (Impact Factor: 6.03). 02/2001; 1(1):CD001407. DOI: 10.1002/14651858.CD001407
Source: PubMed


Pelvic floor muscle training is the most commonly recommended physical therapy treatment for women with stress leakage of urine. It is also used in the treatment of women with mixed incontinence, and less commonly for urge incontinence. Adjuncts, such as biofeedback or electrical stimulation, are also commonly used with pelvic floor muscle training. The content of pelvic floor muscle training programmes is highly variable.
To determine the effects of pelvic floor muscle training for women with symptoms or urodynamic diagnoses of stress, urge and mixed incontinence, in comparison to no treatment or other treatment options.
Search strategy: We searched the Cochrane Incontinence Group trials register (May 2000), Medline (1980 to 1998), Embase (1980 to 1998), the database of the Dutch National Institute of Allied Health Professions (to 1998), the database of the Cochrane Rehabilitation and Related Therapies Field (to 1998), Physiotherapy Index (to 1998) and the reference lists of relevant articles. We handsearched the proceedings of the International Continence Society (1980 to 2000). We contacted investigators in the field to locate studies. Date of the most recent searches: May 2000.
Randomised trials in women with symptoms or urodynamic diagnoses of stress, urge or mixed incontinence that included pelvic floor muscle training in at least one arm of the trial.
Two reviewers assessed all trials for inclusion/exclusion and methodological quality. Data were extracted by the lead reviewer onto a standard form and cross checked by another. Disagreements were resolved by discussion. Data were processed as described in the Cochrane Handbook. Sensitivity analysis on the basis of diagnosis was planned and undertaken where appropriate.
Forty-three trials met the inclusion criteria. The primary or only reference for 15 of these was a conference abstract. The pelvic floor muscle training programs, and comparison interventions, varied markedly. Outcome measures differed between trials, and methods of data reporting varied, making the data difficult to combine. Many of the trials were small. Allocation concealment was adequate in five trials, and nine trials used assessors masked to group allocation. Thirteen trials reported that there were no losses to follow up, seven trials had dropout rates of less than 10%, but in the remaining trials the proportion of dropouts ranged from 12% to 41%. Pelvic floor muscle training was better than no treatment or placebo treatments for women with stress or mixed incontinence. 'Intensive' appeared to be better than 'standard' pelvic floor muscle training. PFMT may be more effective than some types of electrical stimulation but there were problems in combining the data from these trials. There is insufficient evidence to determine if pelvic floor muscle training is better or worse than other treatments. The effect of adding pelvic floor muscle training to other treatments (e.g. electrical stimulation, behavioural training) is not clear due to the limited amount of evidence available. Evidence of the effect of adding other adjunctive treatments to PFMT (e.g. vaginal cones, intravaginal resistance) is equally limited. The effectiveness of biofeedback assisted PFMT is not clear, but on the basis of the evidence available there did not appear to be any benefit over PFMT alone at post treatment assessment. Long-term outcomes of pelvic floor muscle training are unclear. Side effects of pelvic floor muscle training were uncommon and reversible. A number of the formal comparisons should be viewed with caution due to statistical heterogeneity, lack of statistical independence, and the possibility of spurious confidence intervals in some instances.
Pelvic floor muscle training appeared to be an effective treatment for adult women with stress or mixed incontinence. Pelvic floor muscle training was better than no treatment or placebo treatments. The limitations of the evidence available mean that is difficult to judge if pelvic floor muscle training was better or worse than other treatments. Most trials to date have studied the effect of treatment in younger, premenopausal women. The role of pelvic floor muscle training for women with urge incontinence alone remains unclear. Many of the trials were small with poor reporting of allocation concealment and masking of outcome assessors. In addition there was a lack of consistency in the choice and reporting of outcome measures that made data difficult to combine. Methodological problems limit the confidence that can be placed in the findings of the review. Further, large, high quality trials are necessary.

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Available from: Rob A de Bie, Sep 30, 2014
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    • "The patients simply need to be trained in how to contract their pelvic floor muscles. Most studies show that Kegel exercises steadily reinforce the pelvic muscles [8]. However, in practice the results of patients vary depending on whether they exercise their pelvic floor muscles "
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    ABSTRACT: Objective. The purpose of this study was to evaluate the effect of Kegel exercises on reducing urinary incontinence symptoms in women with stress urinary incontinence. Methods. Randomized controlled trials (RCTs) were conducted on females with stress urinary incontinence who had done Kegel exercises and met inclusion criteria in articles published between 1966 and 2012. The articles from periodicals indexed in KoreaMed, NDSL, Ovid Medline, Embase, Scopus, and other databases were selected, using key terms such as “Kegel” or “pelvic floor exercise.” Cochrane’s risk of bias was applied to assess the internal validity of the RCTs. Eleven selected studies were analyzed by meta-analysis using RevMan 5.1. Results. Eleven trials involving 510 women met the inclusion criteria. All trials contributed data to one or more of the main or secondary outcomes. They indicated that Kegel exercises significantly reduced the urinary incontinence symptoms of female stress urinary incontinence. There was no heterogeneity in the selected studies except the standardized bladder volumes of the pad test. Conclusion. There is some evidence that, for women with stress urinary incontinence, Kegel exercises may help manage urinary incontinence. However, while these results are helpful for understanding how to treat or cure stress urinary incontinence, further research is still required.
    Full-text · Article · Dec 2014
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    • "Dans notre population, les patientes incontinentes présentaient un IMC plus élevé que les patientes continentes, l'obésité étant un facteur de risque reconnu de l'IU [16]. L'efficacité de la rééducation périnéo-sphinctérienne a été démontrée dans la prise en charge de l'IU féminine [16] [17]. Toutefois, l'adhésion des femmes incontinentes aux programmes de rééducation demeure faible par manque de temps et de motivation [18] [19]. "
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    ABSTRACT: Aims To assess the prevalence of urinary incontinence (UI) in a population of young nulliparous women and the effectiveness of self-perineal exercises in symptomatic women. Material Three hundred and fifteen nulliparous students from French secondary establishments answered through a secure website, created for the study, an anonymous questionnaire about UI. The questionnaire included validated symptom scores (International Consultation on Incontinence Questionnaire-Short Form, ICIQ-UI SF) and quality of life (Contilife). Women who reported UI were asked to perform a self-perineal rehabilitation program for 8 weeks. A second questionnaire was completed after reeducation to assess the evolution of their UI. Results Among the 315 respondents, 92 women (29.2%) reported UI. The mean age was 23.0 (± 4.4) years in the continent group and 22.9 (± 3.6) years in the incontinent group. Only 24 of the 92 women with UI (26.1%) completed the reeducation program with a significant improvement in UI and quality of life (QoL). Conclusion UI is a common disorder in young nulliparous women. Perineal self-exercises without the intervention of a professional could help to improve the disorders. Level of evidence 5.
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    • "Qualitative synthesis performed? Gross [24] Neck disorders Manipulation and mobilization 33 5 no/no yes yes a Assendelft [6] Low back pain Manipulation 39 1 no/no yes no Bonaiuti [7] Osteoporosis in postmenopausal women Exercise 18 3 no/no yes no Bradley [8] Bronchiectasis Physical training 2 1 no/no yes no Busch [12] Fibromyalgia syndrome Exercise 16 4 yes/no yes no Fransen [19] Osteoarthritis hip–knee Exercise 19 1 no/no yes no Gillespie [22] Elderly people Preventing falls 62 12 no/no yes no Glasscoe [23] Cystic fibrosis Psychological interventions 8 4 yes/no yes no Handoll [26] Distal radial fractures Rehabilitation 12 8 no/no yes no Hay Smith [28] Incontinence Pelvic floor muscle training 43 6 yes/no yes no Hayes [30] Schizophrenic-related conditions Cognitive rehabilitation 3 1 no/no yes no Holloway [32] Asthma Breathing exercises 7 1 no/no yes no Lacasse [34] Chronic obstructive pulmonary disease Pulmonary rehabilitation 23 1 no/no yes no Latham [35] Older people Progressive resistance training 66 2 no/no yes no Leng [36] Intermittent claudication Exercise 10 1 no/no yes no McDonald [37] Hip or knee replacement Preoperative education 9 1 no/no yes no Moseley [38] Stroke Treadmill training and bodyweight support 11 3 yes/no yes no Nixon [39] Adults with HIV/AIDS Aerobic exercise 8 5 no/no yes no Outpatient Service Trialists [41] Stroke patients Rehabilitation services at home 14 1 no/no yes no Pollock [42] Postural control and lower limb function "
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