Article

Pelvic floor muscle exercise for the treatment of female stress urinary incontinence: III. Effects of two different degrees of pelvic floor muscle exercises

January 1990
Neurourology and Urodynamics 9(5):489 - 502

DOI:10.1002/nau.1930090505

Authors:

Norwegian School of Sport Sciences (NIH)

Fifty-two women, mean age 45.9 years (24–64) with clinically and urodynamically proven stress urinary incontinence (SUI) were randomly assigned to one of two different pelvic floor muscle (PFM) exercise groups. Both groups performed 8–12 maximal PFM contractions 3 times a day for 6 months. In addition one group exercised with an instructor intensively 45 min once a week performing long-lasting contractions with the supplement of 3–4 fast contractions at the end of each long-lasting contraction. Initially and after 6 months an examination was performed comprising history, urinary leakage index, pad test, maximum urethral closure pressure, functional urethral profile length, and recording of vaginal pressure during PFM contractions. The latter was performed monthly. After the treatment 60% of the intensive exercise (IE) group and 17.3% of the home exercise (HE) group reported to be continent or almost continent (P < .01). Only the IE group demonstrated significant reduction in urine loss; from mean 27 g to 7.1 g (P < .01) and improvement in maximum resting urethral closure pressure (mean improvement 4.6 cm H2O. P = .02). PFM strength improved with mean 15.5 cm H2O (P < .01) in the IE group while the HE group improved with 7.4 cm H2O (P < .01). It is concluded that the results of PFM exercise for female SUI is highly dependent upon the degree and duration of treatment and frequent supervision by the therapist.

Pelvic Floor Muscle Training in the Management of Female Pelvic Floor Disorders

Article

Full-text available

Jun 2022

Purpose of Review We review contemporary data to understand the role of pelvic floor muscle training (PFMT) in the physiology, prevention, and treatment of stress and urge urinary incontinence, pelvic organ prolapse, and chronic pelvic pain. In addition, a review of treatment regimens and adjuvant therapies is provided. Recent Findings A large body of literature supports the role of PFMT in the treatment of various PFD. A wide variety of treatment regimens are reported and complicate systematic analysis of related outcomes. Less investigation is available to understand the role of PFMT as an adjuvant therapy. Summary Pelvic floor muscle training is recognized as an effective treatment for a variety of pelvic floor disorders and is supported by large body of research and expert guideline statements. Related investigation is limited by significant variety in treatment protocols, outcome measures, and study methodology and further well-designed trials are helpful.

Physiotherapy management of urinary incontinence in females

Article

Full-text available

Jul 2020

Kari Bø

App‐based pelvic floor muscle training in pregnant and postnatal women: A prospective cohort study exploring factors associated with prevention and improvement of urinary incontinence

Article

Full-text available

Aug 2022

Background and aims: Pelvic floor muscle training (PFMT) is recommended for continent pregnant women and postnatal women experiencing urinary incontinence (UI). The app Tät® has been developed for the treatment of stress UI with a focus on PFMT. The aim of this study was to investigate factors associated with the improvement of incontinence symptoms and retained continence in pregnant and postnatal women who used the app. Methods: A prospective cohort study was carried out based on user questionnaires from the app Tät®. We included pregnant and postnatal women who answered the inclusion questionnaire between June 19, 2019 and September 19, 2020. The questionnaire included questions about the frequency and amount of leakage, the impact that UI has on everyday life, and experienced improvements at follow-up. We analyzed factors associated with improvement and retained continence using logistic regression. Results: We included 10,307 pregnant and 13,670 postnatal women, and 44% of the pregnant women and 52% of the postnatal women were incontinent. A total of 3680 women were included in the follow-up analysis, and 52% of the pregnant incontinent women and 73% of the postnatal incontinent women experienced improvement. Pregnant women who performed PFMT and used the app at least once per week had increased odds of improvement (odds ratio [OR]: 1.83, 95% confidence interval [CI]: 1.01-3.29 and OR: 3.38, 95% CI: 1.94-5.90, respectively) compared to those who performed no training and had no app usage. Postnatal women who used the app at least once per week and had more severe incontinence had increased odds of improvement (OR: 4.26, 95% CI: 2.37-7.64 and OR: 1.11, 95% CI: 1.05-1.16, respectively). Conclusions: The app Tät® is widely used by pregnant and postnatal women in Sweden for the prevention and treatment of UI. Majority of the women with incontinence experienced improvement after using the app. Regular PFMT and app use seemed to be important factors for experiencing improvement.

The role of vaginal palpation in motor learning of the pelvic floor muscles for women with stress urinary incontinence: study protocol for a randomized controlled trial

Article

Full-text available

Jul 2020
TRIALS

Background: Approximately 30 to 50% of women are unable to correctly perform pelvic floor muscle (PFM) contractions. For women to benefit from a pelvic floor muscle training (PFMT) programme for stress urinary incontinence (SUI), the awareness phase of PFMT cannot be omitted. The purpose of this study is to evaluate whether vaginal palpation together with verbal instructions about PFMs and body awareness techniques helps women with SUI learn how to correctly contract the PFMs and improve their functions. Methods: This single-centre, double-blind randomized controlled trial with two intervention groups was designed following the standard protocol items for randomized interventional trials (SPIRIT). The results will be reported in a manner consistent with the Consolidated Standards of Reporting Trials (CONSORT) guidelines. Patients with SUI (n = 172) will be recruited. The experimental group will receive verbal instructions about PFM function and body awareness techniques together with vaginal palpation; the control group will receive similar protocol without vaginal palpation. The primary outcome includes the number of fast-twitch muscle fibres assessed by vaginal palpation and visual observation. Secondary outcomes include power and muscular endurance that will be assessed by visual observation and vaginal palpation (Oxford scale), the use of accessory muscles during the voluntary contraction of PFMs, and the self-efficacy and the expectations for the results using the self-efficacy scale of pelvic floor exercises. Discussion: This study will determine whether vaginal palpation can help women with SUI to correctly perform PFM contractions and improve their functions. Trial registration: ClinicalTrials.gov NCT03325543 . Registered on 30 November 2017. Study protocol version 1; 30 November 2020. Prospectively registered.

Impacto de um Protocolo de Exercícios na Sexualidade e Qualidade de Vida de Mulheres Climatéricas

Article

Full-text available

May 2020

Introdução: O climatério é um período de transição entre as fases reprodutiva e não reprodutiva da mulher consequente ao hipoestrogenismo. Sintomas vasomotores, alterações do trato urogenital e disfunções sexuais são algumas condições características deste período que podem interferir negativamente na qualidade de vida. Entretanto, exercícios específicos podem influenciar positivamente na melhora dessas condições. Objetivo: Verificar o impacto de um protocolo de exercícios supervisionado por fisioterapeuta nos sintomas menopausais, na sexualidade e na qualidade de vida de mulheres no climatério. Métodos: Estudo quase-experimental com intervenção fisioterapêutica por meio de protocolo de exercícios específicos. Participaram do estudo 18 mulheres usuárias do Instituto da Mulher e da Gestante, do município de Santos (SP). Resultados: As mulheres foram submetidas à avaliação fisioterapêutica inicial, responderam aos questionários de sexualidade Female Sexual Function Index, Índice Menopausal de Kupperman e de qualidade de vida SF-36. Foram então submetidas a grupo de exercício supervisionado por fisioterapeuta, uma vez por semana, com duração de 50 minutos, por 12 semanas. Os mesmos questionários foram reaplicados ao final deste período. Conclusão: O protocolo de exercícios específicos em grupo e supervisionado por fisioterapeuta não influenciou a função sexual, mas foi eficaz para melhor qualidade de vida e enfrentamento da sintomatologia do climatério.

Pelvic floor muscle training for female stress urinary incontinence: a randomised control trial comparing home and outpatient training

Article

Aug 2019

Introduction and hypothesis In the literature, it is suggested that supervised pelvic floor muscle training (PFMT) might be the first option treatment for female stress urinary incontinence (SUI). However, inadequate accessibility to health care and scarce individual resources may prevent adherence to the treatment. Our study is aimed at comparing the efficacy of performing PFMT in an outpatient clinic and at home in Brazilian incontinent women, and to verify if home PFMT may be an alternative to those not able to attend the outpatient sessions. Methods A total of 69 women with predominant SUI were randomised into two groups: outpatient PFMT and home PFMT. The primary outcome was the cure of SUI defined as <2 g of leakage in a 20-min pad test. Secondary outcomes were: pelvic floor muscle function; urinary symptoms; quality of life; patient satisfaction; and adherence to home exercise sets. The assessments were conducted at baseline and after 3 months of treatment. Statistical analyses consisted of Student’s t, Mann–Whitney U, Chi-squared, and Wilcoxon tests, with a 5% cut-off for significance. Results A superior objective cure of SUI was observed in the outpatient clinic (62%) compared with the home (28%) PFMT groups (OR: 4.0 [95% CI: 1.4–11.0]; p = 0.011). Secondarily, there was no difference between groups regarding the following: satisfaction with the treatment; quality of life; function of the PFMs; and number of episodes of urine leakage per week. The home adherence to the exercises was superior in the outpatient PFMT group only during the first-month training. Conclusions Outpatient PFMT was associated with a higher objective cure of SUI than home PFMT. However, subjective findings show equal benefit of home PFMT providing evidence that this may be an alternative treatment to our population.

Pelvic floor muscle training for prevention and treatment of urinary incontinence during pregnancy and after childbirth and its effect on urinary system and supportive structures assessed by objective measurement techniques

Article

Full-text available

Mar 2019
ARCH GYNECOL OBSTET

Purpose During the second and the third trimesters of pregnancy and in the first 3 months following childbirth, about one-third of women experience urinary incontinence (UI). During pregnancy and after delivery, the strength of the pelvic floor muscles may decrease following hormonal and anatomical changes, facilitating musculoskeletal alterations that could lead to UI. Pelvic floor muscle training (PFMT) consists in the repetition of one or more sets of voluntary contractions of the pelvic muscles. By building muscles volume, PFMT elevates the pelvic floor and the pelvic organs, closes the levator hiatus, reduces pubovisceral length and elevates the resting position of the bladder. Objective of this review is to evaluate the efficacy of PFMT for prevention and treatment of UI during pregnancy and after childbirth and its effect on urinary system and supportive structures assessed by objective measurement techniques. Methods The largest medical information databases (Medline–Pubmed, EMBASE, Lilacs, Cochrane Library and Physiotherapy Evidence Database) were searched using the medical subject heading terms “pelvic floor muscle training”, “prevention”, “urinary incontinence”, “urinary stress incontinence”, “objective measurement techniques”, “pregnancy, “exercise”, “postpartum” and “childbirth” in different combinations. Results and conclusions Overall, the quality of the studies was low. At the present time, there is insufficient evidence to state that PFMT is effective in preventing and treating UI during pregnancy and in the postpartum. However, based on the evidence provided by studies with large sample size, well-defined training protocols, high adherence rates and close follow-up, a PFMT program following general strength-training principles can be recommended both during pregnancy and in the postnatal period.

Pelvic Rehabilitation for Urinary Incontinence after Radical Prostatectomy

Article

Oct 2022

Radical prostatectomy (RP) performed by open, laparoscopic, or robotic approach is considered the gold standard for localized prostate cancer (PCa). However, it carries the risk of postprostatectomy urinary incontinence (UI) and erectile dysfunction (ED) which significantly reduce patients' satisfaction with surgery and quality of life (QoL), therefore it is important to decrease the possibility or severity of these complications to a minimum. There are several preoperative prognostic factors such as urethral length and closing pressure obtained by magnetic resonance imaging and profilometry, as well as several variations in the surgical approach such as preservation of the neurovascular bundle (NVB) and puboprostatic ligaments, sparing or reconstruction of bladder neck, Retzius-sparing approach, and meticulous surgical dissection, used to predict or prevent unwanted side effects of RP. In addition, there are postoperative methods that can help reduce complications. In this review, we will present the role of pelvic rehabilitation with an emphasis on pelvic floor muscle training (PFMT) in reducing consequences of radical surgery.

Pelvic Floor Muscle Exercises for Stress Urinary Incontinence (SUI): A Review Article

Article

Feb 2023

Introduction: The International Continence Society (ICS) describes Urinary incontinence (UI) as the complaint of involuntary leakage of urine and proposes a classification according to the existence of signs and symptoms and mechanisms of occurrence [1, 2]. Purpose: The purpose of this review is to find existing evidence based intervention for Stress Urinary Incontinence (SUI) among women. A preliminary search on Cochrane database, PUBMED, EMBASE, SCOPUS & CINHAL done by the researcher and found relevant studies which provided strong evidence to support role of Pelvic Floor Muscle Exercises (PFME) or Pelvic Floor Muscle Training (PFMT) in reducing symptoms among women diagnosed with SUI. Conclusion: The review concluded that PFMT is a feasible and patient friendly exercise program used for treating SUI with high quality evidence and to be followed under supervision of a health professional. It is also found that less number of recent studies hence suggest having long term studies in future.

The development of urotherapy in pediatric care and the training of urotherapists

Article

Jan 2023

The terms urotherapy and urotherapist are often mentioned in the literature, but their origins and meanings are less well-known. Objective: To describe the background and development of the concept of urotherapy in pediatric care and the profession of urotherapist. Methods: Data has been searched for in Medline PubMed and selection has been limited to papers important for the purpose. Results: Understanding of urinary bladder function was developed in the 1970’s, mainly due to new urodynamic methods opened up for possible treatment options. Standard urotherapy is a concept developed in the 1980’s and aims to treat dysfunction by helping the patient to learn to understand bladder function and then practice certain techniques in order to normalize it. To succeed, guidance and support are needed from a skilled urotherapist. In Scandinavian and German-speaking countries, quality-assured training for urotherapists at the university level is available. Conclusion: Urotherapy standard therapy is a non-invasive treatment recommended as the first-choice treatment for lower urinary tract disorders. However, we must have requirements as to what knowledge a urotherapist needs to have, and training has to be certified and be at the university level.

Incontinencia urinaria y otras lesiones del suelo pelviano: etiología y estrategias de prevención

Article

Oct 2017

La incontinencia urinaria así como otras lesiones del suelo pelviano como desgarros musculares de tercer y cuarto grado, así como la incontinencia anal, el prolapso genital o la dispareunia tienen su origen en el traumatismo obstétrico, y generalmente vinculadas a la primiparidad. El objetivo de este trabajo es analizar, desde un punto de vista fisioterápico, y por tanto desde la perspectiva de la fisiología muscular y de la biomecánica, el porqué se producen dichas lesiones, estudiando el proceso del parto tal y como se lleva a cabo en nuestro país actualmente en la mayoría de los centros sanitarios. Dicho análisis del proceso del parto, y en concreto de los tipos de pujo y de las posturas empleadas para la dilatación y el expulsivo, así como de los cuidados aplicados a la mujer en el puerperio, nos lleva a proponer una estrategia global de prevención, que tendría sus líneas de actuación en tres fases: - Prevención pre-natal: preparación específica de la musculatura del suelo pelviano y de los abdominales durante el embarazo, empleando técnicas de masaje y de estiramiento manual del perineo. Aprendizaje de aquellas posturas y pujos facilitadores tanto de ecajamiento como de la expulsión del feto. Tratamiento osteopático de las articulaciones de la pelvis para facilitar al máximo su movilidad o liberar bloqueos si existieran. - Prevencion en el parto: desarrollo del mismo respetando la fisiología y utilizando técnicas manuales, posturales y respiratorias para protección del bebé y del suelo pelviano. - Prevención post-parto: actuación en el puerperio inmediato mediante ejercicios, posturas y en su caso manipulaciones articulares para facilitar la correcta involución de todos los tejidos blandos y duros implicados en el parto. Tratamiento fisioterápico específico de forma precoz para aquellas puérperas con patología funcional al acabar el período de cuarentena.

Effect of Maximum Repetition of Pelvic Floor Stabilization Exercise in Stress Urinary Incontinence

Article

Jan 2022

Introduction: Stress urinary incontinence (SUI) in females is a common gynaecological issue that impedes lifestyle. Exercise had a significant effect; however, studies did not determine the exercise frequency and intensity for pelvic floor stabilization in stress urinary incontinence. Aim: The aim of the study is to determine if maximum repetition of pelvic stabilization exercise impacts the management of stress urinary incontinence in females. Methodology: One arm quasi-experimental study design was used. 40 patients having SUI and associated musculoskeletal complaints were recruited from the outpatient unit of Physiotherapy department of the Centre for the Rehabilitation of the Paralysed (CRP), Bangladesh. The study was conducted over 4weeks. Outcome measurement was included pelvic floor and abdominal muscle strength, endurance, and incontinence measurement. Result: Pelvic floor muscle and abdominal strength, and endurance had a positive and significant result in maximum repetition (P.001). Pelvic floor strength has been significantly improvement in week 2 (P.001), and week 3 (P.01). Interference in activities (P.003), and ICIQ total (P.001) had improvement but majority of the improvement was noted in weeks 2-3. There was a significant improvement in the frequency of urine leakage in the first week (P.001), and week 3 (P.005) and week 4 (P.001). Conclusion: Pelvic floor exercise with increasing repetition is an effective approach to improve stress urinary incontinence in women. The study also found its significant impact on incontinence frequency, amount, and associated quality of life for women with stress urinary incontinence with pelvic floor exercise with maximum repetition.

Pelvic floor muscle function differs between supine and standing positions in women with stress urinary incontinence: an experimental crossover study

Article

Dec 2021

Question In women with stress urinary incontinence, how does pelvic floor muscle (PFM) function differ between supine and standing when assessed using manometry, vaginal palpation, dynamometry and electromyography? Design An experimental crossover study. Participants A total of 101 women with stress urinary incontinence were included. Intervention The PFM evaluations were performed and compared in supine and standing positions. The participants were assigned to either Group 1 (assessments in supine followed by standing) or Group 2 (assessments in standing followed by supine). Outcome measures The primary outcome was the PFM pressure during the maximum voluntary contraction (MVC). Secondary outcomes were the measures of PFM pressure at rest; PFM function (PERFECT scheme); active and passive forces (dynamometry); and PFM electromyography (EMG) activity. Results The mean MVC pressure was significantly lower in standing (MD −7 cmH2O, 95% CI −10 to −4). The mean PFM resting pressure was higher in standing (7 cmH2O, 95% CI 5 to 10). Three measures of PFM function derived from vaginal palpation were better in supine than in standing. The PFM active and the passive forces measured using dynamometry were higher in standing (0.18 kgf, 95% CI 0.16 to 0.20). The resting EMG activity was higher in standing than in supine (MD 3.6 μV, 95% CI 2.6 to 4.5), whereas EMG activity during MVC was higher in supine than standing (MD −8.7 μV, 95% CI −12.5 to −4.8). Conclusion The pressure and EMG activity during MVC, and PFM function were lower in standing. The resting pressure, the passive and active forces of the PFM and the resting EMG activity of the PFM were higher in standing.

Effects of visceral manipulation associated with pelvic floor muscles training in women with urinary incontinence: A randomized controlled trial

Article

Nov 2021

Aims To compare the effects of manual visceral therapy (MVT) associated with pelvic floor muscle training (PFMT) on urinary incontinence (UI) symptoms, vaginal resting pressure, and maximum voluntary contraction of the pelvic floor muscles (PFM). Methods A double-blinded randomized controlled trial of 5 weeks duration with two active intervention arms: PFMT + MVT and PFMT + manual sham therapy (MST). Participants were women over 18 years of age with complaint or diagnosis of UI symptoms. The primary outcome was the severity of UI symptoms, assessed by the International Consultation on Incontinence Questionnaire – Short Form. The secondary outcomes measures included the vaginal resting pressure and the maximum voluntary contraction of PFM assessed by digital manometry. Results Fifty-two incontinent women participated in the study. There was no significant difference between groups in UI symptoms (F (1.74, 86.9) = 0.406; p = 0.638), vaginal resting pressure (mean difference −1.5 cmH₂0 [95% confidence interval [CI] −4.5 to 1.5; p = 0.33]), and maximum voluntary contraction of PFM (median 0.0 cmH₂0 [25%–75% interquartile range 0.0–5.6; p = 0.12]) after the intervention period. Conclusions Combining MVT with PFMT was not more effective than PFMT alone in reducing UI symptoms, in change vaginal resting pressure and maximum voluntary contraction of PFM. Due to the limitations of the study, further investigations are still needed to confirm these findings.

Telehealth in the rehabilitation of female pelvic floor dysfunction: a systematic literature review

Article

Nov 2020

Introduction and hypothesisThe pandemic caused by coronavirus disease 2019 (COVID-19) increased the awareness and efforts to provide care from distance using information technologies. We reviewed the literature about the practice and effectiveness of the rehabilitation of the female pelvic floor dysfunction via telehealth regarding symptomatology and quality of life and function of pelvic floor muscles (PFM).MethodsA bibliographic review was carried out in May 2020 in the databases: Embase, Medline/PubMed, LILACS and PEDro. A total of 705 articles were reviewed after the removal of duplicates. The methodological quality of the articles was evaluated by the PEDro scale. Two authors performed data extraction into a standardized spreadsheet.ResultsFour studies were included, two being randomized controlled trials. Among the RCTs, only one compared telehealth with face-to-face treatment; the second one compared telehealth with postal treatment. The other two studies are follow-up and cost analysis reports on telehealth versus postal evaluation. Data showed that women who received the intervention remotely presented significant improvement in their symptoms, such as reducing the number of incontinence episodes and voiding frequency, improving PFM strength and improving quality of life compared to women who had the face-to-face treatment.Conclusions Telehealth promoted a significant improvement in urinary symptoms, PFM function and quality of life. Telehealth is still emerging, and more studies are needed to draw more conclusions. The recommendations of the governmental authorities, physical therapy councils and corresponding associations of each country also need to be considered.

Effectiveness of a Conditioning Program on Amateur Female Marathon Runners

Article

Full-text available

Jul 2020

BACKGROUND There is a sudden rise in the participation of middle-aged women in marathons across India without proper knowledge about how to prepare for these marathons. This leads to rise in injuries in them like low back pain, knee pain, stress fractures, urinary incontinence etc., some of which can easily be avoided. There is a need to find out a suitable conditioning program for these participants that will target problems affecting this age group and gender specifically. The objective of this study was to determine the effect of conditioning program on post run physical functioning in female amateur marathon runners. Pain Assessment, DOMS, Modified Borg Scale were used for assessing the individuals. METHODS In this comparative study, 52 amateur female marathon runners, were randomly allocated into two groups with 26 runners in each group. We evaluated pain and exertion using pain assessment and Borg Scale. Occurrence of incontinence was assessed by asking a simple ‘yes’ or ‘no’ question. Delayed onset muscle soreness (DOMS) was assessed using pain pressure threshold (PPT) 24 hrs. post run. RESULTS There was a significant effect of the conditioning program on these female runners compared to administration of no conditioning at all. There was a reduction of pain in all the components of the pain scale (p= <0.001). Exertion of the trained runners was also less (p= <0.001) as well as in the occurrence of incontinence (p= <0.0430). PPT was also substantially increased in them (p= <0.001). CONCLUSIONS The conditioning program administered to amateur female marathon runners was effective in reducing their risk of injuries and problems related to women’s health that occur while running a marathon. KEY WORDS Amateur Female Marathon Runners, Pain, Borg Scale, Delayed Onset Muscle Soreness, Pressure Pain Threshold (PDF) Effectiveness of a Conditioning Program on Amateur Female Marathon Runners. Available from: https://www.researchgate.net/publication/343132778_Effectiveness_of_a_Conditioning_Program_on_Amateur_Female_Marathon_Runners [accessed Aug 19 2021].

Perioperative pelvic floor muscle training did not improve outcomes in women undergoing pelvic organ prolapse surgery: a randomised trial

Article

Full-text available

Dec 2019

Question: In women undergoing surgery for pelvic organ prolapse (POP), what is the average effect of the addition of perioperative pelvic floor muscle training on pelvic organ prolapse symptoms, pelvic floor muscle strength, quality of life, sexual function and perceived improvement after surgery? Design: Randomised controlled trial with concealed allocation, blinded assessors, and intention-to-treat analysis. Participants: Ninety-six women with an indication for POP surgery. Intervention: The experimental group received a 9-week pelvic floor muscle training protocol with four sessions before the surgery and seven sessions after the surgery. The control group received surgery only. Outcome measures: Symptoms were assessed using the Pelvic Floor Distress Inventory (PFDI-20), which is scored from 0 'unaffected' to 300 'worst affected'. Secondary outcomes were assessed using vaginal manometry, validated questionnaires and Patient Global Impression of Improvement, which is scored from 1 'very much better' to 7 'very much worse'. All participants were evaluated 15 days before surgery, and at Days 40 and 90 after surgery. Results: There was no substantial difference in POP symptoms between the experimental and control groups at Day 40 (31 (SD 24) versus 38 (SD 42), adjusted mean difference -6, 95% CI -25 to 13) or Day 90 (27 (SD 27) versus 33 (SD 33), adjusted mean difference -4, 95% CI -23 to 14). The experimental group perceived marginally greater global improvement than the control group; mean difference -0.4 (95% CI -0.8 to -0.1) at Day 90. However, the estimated effect of additional perioperative pelvic floor muscle training was estimated to be not beneficial enough to be considered worthwhile for any other secondary outcomes. Conclusion: In women undergoing POP surgery, additional perioperative pelvic floor muscle training had negligibly small effects on POP symptoms, pelvic floor muscle strength, quality of life or sexual function. Trial registration: ReBEC, RBR-29kgz5.

Bo K, Dumoulin C, Ferreira C, Frawley H, Hay-Smith J, Mokved S, Nygarrd I, Sherburn M. (2019) Comment and questions to Mottola et al: 2019 Canadian guideline for physical activity throughout pregnancy: letter to the editor. British Journal of Sport Medicine, First published online: January 4, 2019

Article

Full-text available

Jan 2019

Chantale Dumoulin

2019 Canadian guideline for physical activity throughout pregnancy: letter to the editor. British Journal of Sport Medicine, First published online: January 4, 2019. --> https://blogs.bmj.com/bjsm/2019/01/04/comment-and-questions-to-mottola-et-al-2019-canadian-guideline-for-physical-activity-throughout-pregnancy/

Pelvic floor exercises according to the Integral Theory - strengthening the 3 directional muscle forces improves chronic pelvic pain, bladder & bowel dysfunctions

Article

Full-text available

Jan 2017

As regards urinary stress incontinence and bladder evacuation The extra muscle strength would pull on PUL and USL to strengthen them. Stronger muscles improve the strength of urethral closure (incontinence) and also stretch open the posterior wall of the urerthra more strongly, improving bladder emptying. As regards urinary urge incontinence The extra muscle strength would stretch the vaginal membrane to better support the bladder base stretch receptors , thereby preventing the micturition reflex from being inappropriately activated, and so improve urge incontinence , figure 3. In the normal patient, figure 3, central inhibition (white arrow) and reflex stretching of the vagina by opposite muscle forces (arrows) to support the stretch receptors 'N'. Connective tissue laxity in the suspensory ligaments or vaginal membrane (figure 3) may not transmit the forces applied and so the vagina cannot be adequately stretched; the stretch receptors (N) may 'fire off' at a lower hydrostat-ic pressure (smaller bladder volume) and the cortex interprets this as urgency At night, there is nocturia. The sensitivity of the stretch receptors is clearly an important variable. The original aim was to address a wide range of pelvic floor dysfunctions by strengthening all possible components of the system, in particular ligaments and muscles, as much as possible. We aimed for minimal time loss, weaving every element of treatment seamlessly into a daily routine. On this basis, we included the Kegel regime, even though the muscle responsible for squeezing upwards, pub-orectalis muscle, does not contract against the suspensory ligaments, but directly against the pubic bone, figure 1. Abstract. Background: By 1995 it was evident from the surgical data that a substantial percentage of chronic pelvic pain, bladder & bowel dysfunctions in the female could be cured by surgical repair of the pelvic suspensory ligaments. Aims: Using a squatting-based regime, we aimed to strengthen the 3 directional muscle forces and the ligaments against which they contract, to improve urethral closure (incontinence) opening (bladder emptying), support of the bladder base stretch receptors (urge incontinence) and, Frankenhauser and Sacral nerve plexuses (chronic pelvic pain). Results: The standard regime comprised four visits in 3 months. HRT was administered to all patients, electrotherapy 20 min per day for 4 weeks with a 50Hz probe placed into the posterior fornix of the vagina, squeezing 3x12 per day, reverse pushdowns 3x12 per day and squatting or equivalent up to 20 min per day as part of daily routine (such as household tasks). Of 147 patients (mean age 52.5 years), 53% completed the programme. Median QOL improvement reported was 66%, mean cough stress test urine loss reduced from 2.2 g (range 0-20.3 g) to 0.2 g (range 0-1.4 g), p =<0.005, and 24-h pad loss from a mean of 3.7 g (range 0-21.8 g) to a mean of 0.76 g (range 0-9.3 m), p=<0.005. Frequency, nocturia and pelvic pain were significantly improved (p=<0.005). Residual urine reduced from mean 202 ml to mean 71 ml (p=<0.005). This method extends indications for nonsurgical therapy beyond stress incontinence, and the results appear to encourage this approach. Approximately 3% of patients reported worsening of their stress incontinence and these were referred for surgery. Conclusions: The 50% dropout rate was a concern. Subsequently we performed a small pilot study (unpublished) using a simpler regime: electrotherapy, situps before getting out of bed, developing a "squatting culture" as part of a daily routine, sitting on a round fitball instead of a chair. The initial results suggested better compliance and equivalent improvement. This method, though promising, awaits rigorous scientific assessment.

Traduction française de la terminologie commune de l’International Urogynecological Association (IUGA) et de l’International Continence Society (ICS) relative à la prise en charge conservatrice et non pharmacologique des troubles pelvi-périnéaux de la femme

Article

Feb 2019
PROG UROL

Résumé Introduction Colliger la terminologie concernant les troubles pelvi-périnéaux de la femme à partir d’un consensus basé sur la pratique clinique est devenu un besoin avéré. Méthodologie Cet article fait la synthèse des travaux des membres et représentants élus des Comités de standardisation et de terminologie de deux sociétés savantes internationales, à savoir l’International Urogynecological Association (IUGA) et l’International Continence Society (ICS). Ces comités étaient assistés par de nombreux relecteurs experts externes. Un vaste processus de relectures internes et externes, au nombre de neuf, a été mis en place pour étudier en détail chaque définition, les décisions étant prises collectivement (consensus). Préalablement à sa diffusion pour commentaires sur les sites internet de l’ICS et de l’IUGA, le manuscrit a été soumis à l’examen de cinq experts en kinésithérapie/physiothérapie, neurologie, urologie, urogynécologie et soins infirmiers. Résultats Une terminologie de la prise en charge conservatrice des troubles pelvi-périnéaux de la femme a été constituée, rassemblant plus de 200 définitions. Elle se fonde sur la pratique clinique, avec les symptômes, signes, évaluations, diagnostics et traitements définis les plus courants. Clarté et facilité d’utilisation ont été les objectifs clefs pour la rendre intelligible aux praticiens et aux stagiaires en formation dans toutes les spécialités impliquées dans les troubles pelvi-périnéaux de la femme. Des révisions régulières sont non seulement prévues mais seront nécessaires pour garder ce document à jour et acceptable par le plus grand nombre. Conclusion À l’issue du consensus, un rapport a été élaboré sur la terminologie de la prise en charge conservatrice des troubles pelvi-périnéaux de la femme afin d’apporter une aide significative pour la pratique clinique et encourager la recherche.

Effect of Group-Administered Behavioral Treatment on Urinary Incontinence in Older Women: A Randomized Clinical Trial

Article

Full-text available

Sep 2018

Importance Urinary incontinence (UI) guidelines recommend behavioral interventions as first-line treatment using individualized approaches. A one-time, group-administered behavioral treatment (GBT) could enhance access to behavioral treatment. Objective To compare the effectiveness, cost, and cost-effectiveness of GBT with no treatment for UI in older women. Design, Setting, and Participants Multisite randomized clinical trial (the Group Learning Achieves Decreased Incidents of Lower Urinary Symptoms [GLADIOLUS] study), conducted from July 7, 2014, to December 31, 2016. The setting was outpatient practices at 3 academic medical centers. Community-dwelling women 55 years or older with UI were recruited by mail and screened for eligibility, including a score of 3 or higher on the International Consultation on Incontinence Questionnaire–Short Form (ICIQ-SF), symptoms of at least 3 months’ duration, and absence of medical conditions or treatments that could affect continence status. Of 2171 mail respondents, 1125 were invited for clinical screening; 463 were eligible and randomized; 398 completed the 12-month study. Interventions The GBT group received a one-time 2-hour bladder health class, supported by written materials and an audio CD. Main Outcomes and Measures Outcomes were measured at in-person visits (at 3 and 12 months) and by mail or telephone (at 6 and 9 months). The primary outcome was the change in the ICIQ-SF score. Secondary outcome measures assessed UI severity, quality of life, perceptions of improvement, pelvic floor muscle strength, and costs. Evaluators were masked to group assignment. Results Participants (232 in the GBT group and 231 in the control group) were aged 55 to 91 years (mean [SD] age, 64 [7] years), and 46.2% (214 of 463) were African American. In intent-to-treat analyses, the ICIQ-SF scores for GBT were consistently lower than control across all time points but did not achieve the projected 3-point difference. At 3 months, the difference in differences was 0.96 points (95% CI, −1.51 to −0.41 points), which was statistically significant but clinically modest. The mean (SE) treatment effects at 6, 9, and 12 months were 1.36 (0.32), 2.13 (0.33), and 1.77 (0.31), respectively. Significant group differences were found at all time points in favor of GBT on all secondary outcomes except pelvic floor muscle strength. The incremental cost to achieve a treatment success was $723 at 3 months; GBT dominated at 12 months. Conclusions and Relevance The GLADIOLUS study shows that a novel one-time GBT program is modestly effective and cost-effective for reducing UI frequency, severity, and bother and improving quality of life. Group-administered behavioral treatment is a promising first-line approach to enhancing access to noninvasive behavioral treatment for older women with UI. Trial Registration ClinicalTrials.gov identifier: NCT02001714

Pelvic floor muscle training: Novel versus traditional remote rehabilitation methods. A systematic review and meta‐analysis on their effectiveness for women with urinary incontinence

Article

Feb 2023

Objective: To investigate the effectiveness of supervised remote rehabilitation programs comprising novel methods of pelvic floor muscle (PFM) training for women with urinary incontinence (UI). Design: A systematic review and meta-analysis including randomized controlled trials (RCTs), involving novel supervised PFM rehabilitation programs as intervention groups (e.g., mobile applications programs, web-based programs, vaginal devices) versus more traditional PFM exercise groups (acting as control); both sets of groups being offered remotely. Methods: Data have been searched and retrieved from the electronic databases of Medline, PUBMED, and PEDro using relevant key words and MeSH terms. All included study data were handled as reported in the Cochrane Handbook for Systematic Reviews of Interventions and the evaluation of their quality was undertaken utilizing the Cochrane risk-of-bias tool 2 (RoB2) for RCTs. The included RCTs, involved adult women with stress UI (SUI) or mixed urinary incontinence, where SUI were the most predominant symptoms. Exclusion criteria involved pregnant women or up to 6-month postpartum, systemic diseases and malignancies, major gynecological surgeries or gynecological problems, neurological dysfunction or mental impairments. The searched outcomes included subjective and objective improvements of SUI and exercise adherence in PFM exercises. Meta-analysis was conducted and included studies pulled by the same outcome measure. Results: The systematic review included 8 RCTs with 977 participants. Novel rehabilitation programs included mobile applications (1 study), web-based programs (1 study) and vaginal devices (6 studies) versus more traditional remote PFM training, involving home-based PFM exercise programs (8 studies). Estimated quality with Cochrane's RoB2, presented the 80% of the included studies as "some concerns" and the 20% as "high risk." Meta-analysis included 3 studies with no heterogeneity (I2 = 0) across them. Weak-evidenced results presented home PFM training equally effective with novel PFM training methods (mean difference: 0.13, 95% confidence interval: -0.47, 0.73), with small total effect size (0.43). Conclusions: Novel PFM rehabilitation programs presented as effective (but not superior) to traditional ones in women with SUI, both offered remotely. However, individual parameters of novel remote rehabilitation including supervision by the health professional, remains in question and larger RCTs are required. Connection between devices and applications in combination with real-time synchronous communication between patient and clinician during treatment is challenged for further research across novel rehabilitation programs.

Special Pelviperineology Issn new on chronic pelvic pain

Article

Full-text available

Jan 2023

Are hypopressive and other exercise programs effective for the treatment of pelvic organ prolapse?

Article

Full-text available

Nov 2022
INT UROGYNECOL J

Introduction and hypothesis: Pelvic floor muscle training (PFMT) is effective for the treatment of pelvic organ prolapse (POP), but other exercise programs have also been promoted and used. The aim of this review was to evaluate the effect of hypopressive and other exercise programs besides PFMT for POP. Methods: A literature search was conducted on Ovid Medline, EMBASE, CINAHL, Cochrane, PEDro, and Scopus databases from January 1996 to 30 December 2021. Only randomized controlled trials (RCTs) were included. The keywords were combinations of "pelvic organ prolapse" or "urogenital prolapse," and "exercise therapy," "hypopressive exercise," "Kegel," "pelvic floor muscle training," "pelvic floor muscle exercises," "Pilates," "treatment," "yoga," "Tai Chi." Methodological quality was assessed using the PEDro rating scale (0-10). Results: Seven RCTs containing hypopressive exercise, yoga or breathing and hip muscle exercises in an inverted position were retrieved and analyzed. PEDro score ranged from 4 to 7. There was no additional effect of adding hypopressive exercise to PFMT, and PFMT was more effective than hypopressive exercise alone. The studies that included the term "yoga" included regular PFMT and thus can be classified as PFMT. Hip exercises in an inverted position added to PFMT vs PFMT alone showed better improvement in some secondary outcomes but not in the primary outcome, POP stage. Conclusions: There are few RCTs assessing the effects of other exercise programs besides PFMT in the treatment of POP. To date, there is no evidence that other exercise programs are more effective than PFMT for POP.

Pelvic floor muscle training: a practical guide

Article

Sep 2022
Br Med J

Conservative interventions for treating urinary incontinence in women: an Overview of Cochrane systematic reviews

Article

Sep 2022
COCHRANE DB SYST REV

Background: Urinary incontinence (UI) is the involuntary loss of urine and can be caused by several different conditions. The common types of UI are stress (SUI), urgency (UUI) and mixed (MUI). A wide range of interventions can be delivered to reduce the symptoms of UI in women. Conservative interventions are generally recommended as the first line of treatment. Objectives: To summarise Cochrane Reviews that assessed the effects of conservative interventions for treating UI in women. Methods: We searched the Cochrane Library to January 2021 (CDSR; 2021, Issue 1) and included any Cochrane Review that included studies with women aged 18 years or older with a clinical diagnosis of SUI, UUI or MUI, and investigating a conservative intervention aimed at improving or curing UI. We included reviews that compared a conservative intervention with 'control' (which included placebo, no treatment or usual care), another conservative intervention or another active, but non-conservative, intervention. A stakeholder group informed the selection and synthesis of evidence. Two overview authors independently applied the inclusion criteria, extracted data and judged review quality, resolving disagreements through discussion. Primary outcomes of interest were patient-reported cure or improvement and condition-specific quality of life. We judged the risk of bias in included reviews using the ROBIS tool. We judged the certainty of evidence within the reviews based on the GRADE approach. Evidence relating to SUI, UUI or all types of UI combined (AUI) were synthesised separately. The AUI group included evidence relating to participants with MUI, as well as from studies that combined women with different diagnoses (i.e. SUI, UUI and MUI) and studies in which the type of UI was unclear. Main results: We included 29 relevant Cochrane Reviews. Seven focused on physical therapies; five on education, behavioural and lifestyle advice; one on mechanical devices; one on acupuncture and one on yoga. Fourteen focused on non-conservative interventions but had a comparison with a conservative intervention. No reviews synthesised evidence relating to psychological therapies. There were 112 unique trials (including 8975 women) that had primary outcome data included in at least one analysis. Stress urinary incontinence (14 reviews) Conservative intervention versus control: there was moderate or high certainty evidence that pelvic floor muscle training (PFMT), PFMT plus biofeedback and cones were more beneficial than control for curing or improving UI. PFMT and intravaginal devices improved quality of life compared to control. One conservative intervention versus another conservative intervention: for cure and improvement of UI, there was moderate or high certainty evidence that: continence pessary plus PFMT was more beneficial than continence pessary alone; PFMT plus educational intervention was more beneficial than cones; more-intensive PFMT was more beneficial than less-intensive PFMT; and PFMT plus an adherence strategy was more beneficial than PFMT alone. There was no moderate or high certainty evidence for quality of life. Urgency urinary incontinence (five reviews) Conservative intervention versus control: there was moderate to high-certainty evidence demonstrating that PFMT plus feedback, PFMT plus biofeedback, electrical stimulation and bladder training were more beneficial than control for curing or improving UI. Women using electrical stimulation plus PFMT had higher quality of life than women in the control group. One conservative intervention versus another conservative intervention: for cure or improvement, there was moderate certainty evidence that electrical stimulation was more effective than laseropuncture. There was high or moderate certainty evidence that PFMT resulted in higher quality of life than electrical stimulation and electrical stimulation plus PFMT resulted in better cure or improvement and higher quality of life than PFMT alone. All types of urinary incontinence (13 reviews) Conservative intervention versus control: there was moderate to high certainty evidence of better cure or improvement with PFMT, electrical stimulation, weight loss and cones compared to control. There was moderate certainty evidence of improved quality of life with PFMT compared to control. One conservative intervention versus another conservative intervention: there was moderate or high certainty evidence of better cure or improvement for PFMT with bladder training than bladder training alone. Likewise, PFMT with more individual health professional supervision was more effective than less contact/supervision and more-intensive PFMT was more beneficial than less-intensive PFMT. There was moderate certainty evidence that PFMT plus bladder training resulted in higher quality of life than bladder training alone. Authors' conclusions: There is high certainty that PFMT is more beneficial than control for all types of UI for outcomes of cure or improvement and quality of life. We are moderately certain that, if PFMT is more intense, more frequent, with individual supervision, with/without combined with behavioural interventions with/without an adherence strategy, effectiveness is improved. We are highly certain that, for cure or improvement, cones are more beneficial than control (but not PFMT) for women with SUI, electrical stimulation is beneficial for women with UUI, and weight loss results in more cure and improvement than control for women with AUI. Most evidence within the included Cochrane Reviews is of low certainty. It is important that future new and updated Cochrane Reviews develop questions that are more clinically useful, avoid multiple overlapping reviews and consult women with UI to further identify outcomes of importance.

Identification of preferred reminder systems and patient factors to promote adherence in the management of urinary incontinence

Article

Jul 2022

Objective To investigate comfort level and preferences of automated reminder systems (mail, email, text message, phone call, patient-portal message, and/or smartphone application) to promote adherence to recommended therapies for patients seeking care for urinary incontinence (UI) at our urology clinic in Phoenix, Arizona. Methods Anonymous surveys were distributed in English to adult patients with UI from 4/2019–5/2019. Patient demographics, UI type, and access to and use of the Internet, smartphone and patient-portal were assessed. Using a Likert scale, patients indicated level of comfort with each reminder system and numerically ranked each system. Statistical analyses were performed to identify patient characteristics associated with reminder modality and determine significance in ranking of systems. Results Fifty-seven patients (67.3 ± 16.3 years) completed the survey with an 87% response rate. Text-message and phone call reminder modalities were ranked the highest compared to other modalities (p < 0.05). A Chi-squared test showed no correlation between preferred reminder system modality and type of incontinence, age, gender, race/ethnicity, or language spoken (p > 0.05). Internet usage and access significantly correlated with preference for smartphone application and patient-portal message reminder systems (p < 0.05). Conclusion Patients reported they were extremely comfortable with all communication modalities, except for smartphone applications in which patients were the least comfortable. The modalities most preferred by patients were phone call and text message and least preferred were patient portal and smart phone application. In conclusion, phone calls and text messages were the most preferred communication modality, with smart phone applications as the least comfortable. Innovation This study demonstrates the potential utility of specific reminder modalities for patients seeking help with treatment adherence.

Pelvic floor muscle exercise for prevention of pelvic floor disorders at each life stage in women骨盤臓器脱の予防・改善にむけた骨盤底筋エクササイズ～女性のライフステージと生活行動の視点から

Article

Full-text available

Jun 2022
JPN J PHYS FIT SPORT

Pelvic floor muscles play an important role in inner unit functioning related to excretion, reproduction, support of pelvic organs, posture, and respiration, while their weakening is a characteristic health problem for many women. The pelvic floor is closely related to women’s life events, and protection and strengthening of the pelvic floor in accordance with life stages will lead to the prevention of pelvic floor disorders (pelvic frailty). Pelvic floor muscle exercises may be the first choice for prevention, improvement, and/or conservative treatment of pelvic organ prolapse caused by weakening of pelvic floor muscle groups. Also, pelvic floor muscle exercises can be done on a daily and continuous basis as a fitness activity; but proper assessment and practice with appropriate methods are important. In addition, an integrated program that includes lifestyle modification can enhance its effectiveness. In order to realize the lifelong well-being of women, there is a need to further develop effective pelvic floor exercises in creating a more comprehensive prevention-care health system for society.

Pelvic floor muscle training for pelvic organ prolapse ~Pelvic floor rehabilitation in our hospital~骨盤臓器脱に向けた骨盤底筋トレーニングの実際～当院における骨盤臓器脱に対する骨盤底リハビリテーション

Article

Full-text available

Jun 2022
JPN J PHYS FIT SPORT

Nao Muta

Pelvic organ prolapse (POP) is the descent of one or more of the anterior vaginal wall, posterior vaginal wall, the uterus (cervix), or the apex of the vagina (vaginal vault or cuff scar after hysterectomy). This is a female specific illness and is one of the women’s health problems that negatively impacts quality of life (QOL). The causes of prolapse are multifactorial. However, it is primarily associated with vaginal delivery, which leads to pelvic floor muscle and connective tissue injury. POP presents with various symptoms that may include urinary, bowel, and/or sexual dysfunction. Available POP treatments vary according to the degree of the prolapse symptoms. Pelvic floor muscle training (PFMT) is the treatment of first choice for mild POP (evidence level Ⅰ, recommended grade A). In Japan, it is not yet covered by health insurance, so patients have limited opportunities to learn about correct PFMT under the diagnosis from a specialist physician in pelvic floor disorder. In this article, the PFMT for POP provided in our hospital is reported.

Fundamentals and practices for pelvic floor muscle training骨盤底筋トレーニングのための基礎と実践

Article

Full-text available

Jun 2022
JPN J PHYS FIT SPORT

Recently, pelvic floor muscle training has become popular not only in health magazines but also in women’s magazines, on television and on social networking services. The pelvic floor muscles are difficult to visually confirm movement of in a clothed situation, making it difficult to get a sense of muscle contraction; and, thus, there are many cases of incorrect training leading to pelvic floor dysfunction, including urinary incontinence and pelvic organ prolapse, and significant reduction of quality of life and healthy life expectancy. Therefore, the ability of instructors to teach appropriate pelvic floor muscle training is an important key to the prevention and improvement of pelvic floor dysfunction. The purpose of this review is to understand the functional anatomy and motor function of the pelvic floor muscles and to disseminate evaluation and training practices for preventing and improving pelvic floor dysfunction such as urinary incontinence and pelvic organ prolapse.

Conservative Therapy of Stress Incontinence

Chapter

Apr 2022

Kate H. Moore

This chapter describes practical evidence-based aspects of the conservative management of stress incontinence, starting with chronic cough, obesity, constipation, and vaginal atrophy. The evidence for the benefit of pelvic floor muscle training is summarized, along with electrostimulation of the pelvic floor muscles. If these methods are insufficient, then the objective benefits of specialized vaginal ring pessaries for incontinence, and practical advice about their use, are explained.

Management of Urinary Incontinence in Aesthetic & Regenerative Gynecology

Chapter

Jan 2022

Ronen Gold

Worldwide, urinary incontinence (UI) is a major health burden that affects 17–45% of adult women with high costs in terms of well-being and financial expenditure for both patients and society. The most prevalent type is stress incontinence, contributing 48% of all cases (1–3).

Women’s Awareness linked by Pelvic Floor Muscle Activity

Preprint

Full-text available

Jul 2021

Levator ani is a healthy and fatigue resistant striated muscle. It is stung like a sway around the midline pelvic effluents like the uterus, bladder, and bowel. The pubococcygeus muscle has four fibers; Posterior fibers, Puborectalis, Puboanalis, Pubovaginalis. Here, the Pubovaginalis forms a U-shaped sling, supporting the Pelvic organ-like bladder, uterus. Therefore, during Parturition, weakness or tear of the sling occurs, responsible for the pelvic organ prolapse. Pelvic organ prolapse includes the drop of the vaginal wall or the uterus. The weakness of the pelvic floor also causes urinary incontinence, defined as the involuntary loss of urine when the intravesical pressure exceeds the urethral pressure in the absence of detrusor muscle. So, it is very important to be aware of the pelvic floor exercises, which help in strengthening the pelvic floor and prevent complications. Some women may think the leakage of urine and organ prolapse as a regular phenomenon that may contribute to incontinence and prolapse, study objective was to see the awareness in the women about the complications. This survey highlights the need for awareness. It promotes early education among females about pelvic floor structure, exercise, the importance of early diagnosis, and the correct treatment to avoid complications. Author contribution: Authors have analyzed the data and wrote the paper. The author contributed to manuscript revisions and approved the final version of the manuscript and agreed to the responsibility for the content. Methods. This survey has developed on the basis of analysis of women suffering from urinary leakage and prolapse issues. The date in which the responses have been collected are 2-11-2020 to 3-03-2021.This study comprises a cross-sectional survey, a 3-part questionnaire to 246 females who know the English language, which has three sections where section one, prolapse and incontinence knowledge questionnaire which is made up of 13 questions, to evaluate knowledge of females about urinary incontinence. Section two has 14 questions that contain information about the treatment of the problem and prognosis and the remaining 12 questions in section three including demographic information. It has been distributed among 700 women on which 246 filled this form and answered all the questions which were asked in the questionnaire . Inclusion and exclusion criteria: The following inclusion criteria: age - born between 2003 − 1960, understanding of basic english language it is because this is the common language which is understood by the whole community. As there is no specification in terms of region or nation. The English language is commonly understood by most people. should have a smartphone or computer, should have access to the internet and awareness of the google form. Exclusion criteria are as follows: Women who have gone under surgical intervention, who do not know the english language, who cannot see. Data collection procedure: The conduction of this research involves the questionnaire used by researchers; the difference is of inclusion criteria among females. This form has reliability and validity as per prior check by an expert. The technique to distribute the questionnaire is snowball sampling. Results: The overall awareness level for the sub sample population was calculated to be at 42.67%. Awareness for urinary leakage was 45.12% and pelvic organ prolapse 40.25% Conclusions: More than half of the population is estimated to be unaware of basic knowledge of the subject

Real-World Effectiveness of Pelvic Floor Muscle Training for Women With Urinary Tract Symptoms and/or Prolapse

Article

May 2021

Objectives To determine the real-world effectiveness of pelvic floor muscle therapy (PFMT) recommendations for patients. Methods We conducted a cross-sectional study of 70 women who were advised to undergo PFMT after their initial urogynaecology consultation for lower urinary tract symptoms and/or pelvic organ prolapse. About half (51%) of potential participants consented to answer our telephone survey. We calculated the proportion of patients who complied with the recommendation of PFMT, and we subjectively assessed whether these patients found PFMT to be helpful. We also collected demographic data and looked for reasons why patients did not attend PFMT. Chi-square, 2-tailed t, or Fisher's exact tests were used to compare differences between patients who attended and those who did not. Results During the 6-month period after their initial consultation, only 28 of 70 women (40%) followed the recommendation to attend PFMT. Sixteen of the 28 women who attended PFMT (57%) reported that they found it helpful. Therefore, the “real-world effectiveness” of the entire study sample was 23%, with only 16 of 70 women benefiting from PFMT. Time constraints (27%) and cost (18%) were the top 2 reasons given for not attending. Conclusions Despite evidence-based recommendations in favour of PFMT for various pelvic floor disorders, its real-world effectiveness is quite low. A public health commitment to providing access to PFMT would be of significant benefit.

Narrative review of pelvic floor muscle training for childbearing women—why, when, what, and how

Article

May 2021

Introduction and hypothesis: Urinary incontinence (UI) is prevalent during pregnancy and postpartum. UI in pregnancy strongly predicts UI postpartum and later in life. UI reduces women's wellbeing and quality of life and presents a significant burden to healthcare resource. Methods: A narrative review summarizing quantitative and qualitative evidence about pelvic floor muscle training (PFMT) for prevention and treatment of UI for childbearing women. Results: There are clinically important reductions in the risk of developing UI in pregnancy and after delivery for pregnant women who start PFMT during pregnancy, and PFMT offers additional benefits preventing prolapse and improving sexual function. If women develop UI during pregnancy or postpartum then PFMT is an appropriate first-line treatment. For novice exercisers, a programme comprising eight contractions, with 8-s holds, three times a day, 3 days a week, for at least 3 months is a reasonable minimum and 'generic' prescription. All women need clear accurate verbal instruction in how to do PFMT. Incontinent women, and women who cannot do a correct contraction, require referral for pelvic floor rehabilitation. Behavioural support from maternity care providers (MCPs)-increasing women's opportunity, capability, and motivation for PFMT-is as important as the exercise prescription. Conclusion: PFMT is effective to prevent and treat UI in childbearing women. All pregnant and postpartum women, at every contact with a MCP, should be asked if they are continent. Continent women need exercise prescription and behavioural support to do PFMT to prevent UI. Incontinent women require appropriate referral for diagnosis or treatment.

Multicenter Randomized Controlled Trial of Pelvic Floor Muscle Training with a Motion-based Digital Therapeutic Device versus Pelvic Floor Muscle Training Alone for Treatment of Stress-predominant Urinary Incontinence

Article

Mar 2021
J Pelvic Med Surg

Objective: To determine whether use of an intravaginal motion-based digital therapeutic device for pelvic floor muscle training (PFMT) was superior to PFMT alone in women with stress-predominant urinary incontinence (SUI). Methods: A multicenter, randomized-controlled trial was conducted where women with SUI or SUI-predominant mixed urinary incontinence were treated with either PFMT using the device (intervention group) or PFMT alone (control group). Primary outcomes, measured at 8 weeks, included change in Urinary Distress Inventory, short-version and improvement in the Patient Global Impression of Improvement, defined as "much better" or "very much better." Participants also completed Pelvic Organ Prolapse and Colorectal-anal Distress Inventories, Pelvic-Floor-Impact Questionnaire and a 3-day bladder diary. Primary analysis used a modified intention-to-treat approach. Statistical analysis used Student t test and χ2 test. The trial was prematurely halted due to device technical considerations. Results: Seventy-seven women were randomized, and final analysis included 61 participants: 29 in intervention and 32 in control group. There was no statistical difference in Urinary Distress Inventory, short-version scores between the intervention (-13.7 ± 18.7) and the control group (-8.7 ± 21.8; P = 0.85), or in Patient Global Impression of Improvement (intervention 51.7% and control group 40.6%; P = 0.47). Pelvic Organ Prolapse and Colorectal-anal Distress Inventories and Pelvic-Floor-Impact Questionnaire scores improved significantly more in the intervention group than the control group (all P < 0.05). Median number of SUI episodes decreased from baseline to 8 weeks by -1.7 per-day [(-3)-0] in the intervention group and -0.7[(-1)-0] in the control group, (P = 0.047). Conclusions: In this prematurely terminated trial, there were no statistically significant differences in primary outcomes; however, PFMT with this digital therapeutic device resulted in significantly fewer SUI episodes and greater improvement in symptom-specific quality of life outcomes. A larger powered trial is underway.

Comparison between the Effect of Three Instructions on Motor Control and Contraction Pattern of Pelvic Floor Muscles Assessed by Ultrasound Imaging: Protocol and Ethics Application for a Crossover Trial

Thesis

Aug 2020

Monika Ritthaler

Background A functional pelvic floor is crucial for health and well-being by regulating the continence mechanism amongst other functions. Though practiced in clinical settings, there is a lack of scientific evidence on how to teach pelvic floor muscle contractions most effectively. This is a study protocol to examine which cue works best to instruct a pelvic floor muscle contraction in terms of effectiveness, specificity and subjective compliance Study Design, Methods and Analysis The study protocol for a randomized, controlled crossover trial is explicated, including its intended design, participants with in- and exclusion criteria, instrumentation with its quality criteria, data collection techniques, hypotheses, statistical analyses and detailed study procedure. A crossover study is planned incorporating three treatments (three instructional cues) ordered in six sequences, examining 24 healthy subjects. Each participant will receive three different cues to volitionally contract pelvic floor muscles. Contraction induced displacement of anourogenital landmarks will be recorded by 3D ultrasound with subjects in supine position. Activity of adjacent muscles will be controlled by surface electromyography. Linear mixed effect modeling is planned to compare the landmark displacements between the three different instructions. Correlations of landmark displacement with body awareness and movement imagery will be tested. Participants subjective preferences for pelvic floor contractions and its transfer to everyday integration will be collected. Ethics Application Process and requested documentation for the ethics committee proposal are outlined. Study synopsis is presented. For study participants a bulletin and declaration of consent was prepared. A written, standardized questionnaire was tailored to the study, including validated assessment tools. Discussion The approach is discussed regarding its design, the choice of instructional cues in the treatment, the measurement technique and its limitations.

Pregnancy in the female athlete Part 1: antenatal

Article

Full-text available

Dec 2020

Interventions used by allied health professionals in sexual rehabilitation after stroke: A systematic review

Article

Full-text available

Dec 2020

Background: Although sexuality can be affected post-stroke, few individuals receive sexual rehabilitation because of clinicians’ lack of knowledge regarding evidence-based interventions. Objective: To document and describe the best available evidence supporting interventions that target post-stroke rehabilitation of sexuality. Methods: This systematic review searched the databases Medline, Embase, Psycinfo, CINAHL, Web of science, PEDRO and OTSeeker up to 29 May 2020. Inclusion criteria were: published studies with a sample composed of ≥ 50% stroke clients and describing an intervention that could be applied by an allied health professional. Data was extracted according to the PRISMA guidelines by two independent reviewers. Interventions were described according to the Template for intervention description and replication checklist. Results: Among the 2446 articles reviewed, 8 met the inclusion criteria. Two randomized controlled trials (RCT) and one non-RCT showed improvement in sexual functioning and satisfaction following a 30–45-minute structured rehabilitation program. Two other RCT showed significant improvement in sexual functioning with physical therapy oriented toward 1) structured physical and verbal sexual counseling and 2) pelvic floor muscle training. Three studies showed that interdisciplinary sexual rehabilitation improved satisfaction and sexual functioning; implementation of an interview script for clinicians improved the proportion of clients who addressed sexuality from 0 to 80% in 10 months; and two-day couple retreats improved perceived intimacy between couples. Conclusions: This review highlights promising interventions that could orient future research and improve the access to sexual rehabilitation services for post-stroke, with structured sexual rehabilitation and pelvic floor muscle training being the most strongly supported.

The Effect of Pelvic Floor Muscle Training on Pelvic Floor Dysfunction in Pregnant and Postpartum Women

Article

Full-text available

Oct 2020

Background: Pelvic floor dysfunction (PFD) seriously affects the patients’ quality of life, and its incidence is closely related to pregnancy and delivery. Pelvic floor muscle training (PFMT) is a conservative treatment of PFD. For decades, different researchers have conducted PFMT research on different female groups. However, the efficacy of PFMT for pregnant and postpartum women is controversial. Therefore, this article aimed to systematic review the efficacy of PFMT for them. This article reviewed the relationship between the occurrence and development of PFD during pregnancy and delivery, and the effect of PFMT on PFD in pregnant and postpartum women.Method: We used the keywords of “pelvic floor dysfunction” and “pelvic floor muscles training”, and focused on the study of PFMT during pregnancy and postpartum. Finally, 54 related studies were selected, including randomized controlled trials, quasi experimental trials, observational studies, longitudinal cohort studies, cross-sectional studies, and systematic reviews.Result: During pregnancy, PFMT can prevent the occurrence of PFD in late pregnancy and early postpartum, and in the early postpartum period, PFMT can improve the symptoms of PFD. PFMT has a protective effect on the pelvic floor without obvious negative effects. However, PFMT has not been popularized in pregnant and postpartum women. And its beneficial effects cannot be maintained for a long time if women cannot insist on it for a long time. Conclusion: The popularization and standard guidance of PFMT during the pregnancy and postpartum period should be strengthened vigorously in hospital. The development of a personalized PFMT program according to the individual situation of pregnant and postpartum women can improve the pelvic floor symptoms and their quality of life of women.

Can abdominal hypropressive technique improve stress urinary incontinence? an assessor‐blinded randomized controlled trial

Article

Aug 2020

Aim To verify which one improves better stress urinary incontinence (SUI) symptoms: abdominal hypopressive technique (AHT) or pelvic floor muscle training (PFMT). Methods Randomized controlled trial. Women with SUI who had not participated of physiotherapy program before were invited. The outcome measures were 7‐day bladder diary, International Consultation on Incontinence Questionnaire‐Short Form (ICIQ‐SF) and pelvic floor muscles (PFM) function measured by Modified Oxford grading System with vaginal palpation and manometry with Peritron. Intervention consisted by 12 weeks of exercises program including PFMT or AHT program, in groups of maximum three women, twice a week, with physiotherapist supervision. Results AHT and PFMT groups reduced urinary leakage episodes in 7 days, −0.64 and −1.91, respectively, but PFMT was superior, whit mean difference −1.27 (95% confidence interval [CI]: −1.92 to −0,62) and effect size was 0.94 in favor to PFMT. Regarding to total score of ICIQ‐SF, both groups improved, with mean difference between groups −4.7 (95% CI: −6.90 to −2.50) and effect size was 1.04 in favor to PFMT. Manometry also presented improvement after treatment for both groups with mean difference between them of 11 (95% CI: 6.33‐15.67) and effect size was 1.15 also in favor to PFMT. Conclusion Regarding to SUI symptoms, quality of life impact and PFM function both groups presented improvement, however, PFMT was superior to AHT among all of them.

Effect of pelvic floor muscle training program in reducing postpartum levator hiatus area in Japanese women: A prospective cohort study using three‐dimensional ultrasonography

Article

May 2020

Aim To assess the effect of a pelvic floor muscle training (PFMT) program on postpartum levator hiatus area. Methods A prospective cohort study was conducted at a clinic in Japan. Training and control groups were recruited from outpatient pregnant women at two separate time periods. Only the training group underwent the PFMT program, including education for home PFMT, home PFMT, and follow‐up instructions. Education for home PFMT was held by 1 month postpartum to acquire the correct contraction of the pelvic floor muscle. Home PFMT was prescribed between 1 and 5 months postpartum; during this period, follow‐up instructions were provided to keep the women motivated. Before and after home PFMT, the levator hiatus area was measured using ultrasonography. Results In total, 44 women in the training group and 45 in the control group were analyzed. There were 36 women who reached a high adherence to three daily sets of home PFMT. The reduction in the levator hiatus area at rest was not statistically higher in the training group than that in the control group. For the subgroup with high adherence, the reduction in the area at rest was significantly higher by 4.43% in the training group than that in the control group (19.90% vs. 15.49%). Conclusions Although the PFMT program did not significantly reduce the postpartum levator hiatus area at rest, performing at least three sets of home PFMT each day significantly reduced the levator hiatus area by 4.43%. Clinical trial registration UMIN Clinical Trials Registry (ID; UMIN 000026188, Date; 17 February 2017).

Pelvic floor muscle training for preventing and treating urinary and faecal incontinence in antenatal and postnatal women

Article

May 2020

Background: About one-third of women have urinary incontinence (UI) and up to one-tenth have faecal incontinence (FI) after childbirth. Pelvic floor muscle training (PFMT) is commonly recommended during pregnancy and after birth for both preventing and treating incontinence. This is an update of a Cochrane Review previously published in 2017. Objectives: To assess the effects of PFMT for preventing or treating urinary and faecal incontinence in pregnant or postnatal women, and summarise the principal findings of relevant economic evaluations. Search methods: We searched the Cochrane Incontinence Specialised Register, which contains trials identified from the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, MEDLINE In-Process, MEDLINE Epub Ahead of Print, CINAHL, ClinicalTrials.gov, WHO ICTRP, and handsearched journals and conference proceedings (searched 7 August 2019), and the reference lists of retrieved studies. Selection criteria: We included randomised or quasi-randomised trials in which one arm included PFMT. Another arm was no PFMT, usual antenatal or postnatal care, another control condition, or an alternative PFMT intervention. Populations included women who, at randomisation, were continent (PFMT for prevention) or incontinent (PFMT for treatment), and a mixed population of women who were one or the other (PFMT for prevention or treatment). Data collection and analysis: We independently assessed trials for inclusion and risk of bias. We extracted data and assessed the quality of evidence using GRADE. Main results: We included 46 trials involving 10,832 women from 21 countries. Overall, trials were small to moderately-sized. The PFMT programmes and control conditions varied considerably and were often poorly described. Many trials were at moderate to high risk of bias. Two participants in a study of 43 pregnant women performing PFMT for prevention of incontinence withdrew due to pelvic floor pain. No other trials reported any adverse effects of PFMT. Prevention of UI: compared with usual care, continent pregnant women performing antenatal PFMT probably have a lower risk of reporting UI in late pregnancy (62% less; risk ratio (RR) 0.38, 95% confidence interval (CI) 0.20 to 0.72; 6 trials, 624 women; moderate-quality evidence). Antenatal PFMT slightly decreased the risk of UI in the mid-postnatal period (more than three to six months' postpartum) (29% less; RR 0.71, 95% CI 0.54 to 0.95; 5 trials, 673 women; high-quality evidence). There was insufficient information available for the late postnatal period (more than six to 12 months) to determine effects at this time point (RR 1.20, 95% CI 0.65 to 2.21; 1 trial, 44 women; low-quality evidence). Treatment of UI: compared with usual care, there is no evidence that antenatal PFMT in incontinent women decreases incontinence in late pregnancy (very low-quality evidence), or in the mid-(RR 0.94, 95% CI 0.70 to 1.24; 1 trial, 187 women; low-quality evidence), or late postnatal periods (very low-quality evidence). Similarly, in postnatal women with persistent UI, there is no evidence that PFMT results in a difference in UI at more than six to 12 months postpartum (RR 0.55, 95% CI 0.29 to 1.07; 3 trials; 696 women; low-quality evidence). Mixed prevention and treatment approach to UI: antenatal PFMT in women with or without UI probably decreases UI risk in late pregnancy (22% less; RR 0.78, 95% CI 0.64 to 0.94; 11 trials, 3307 women; moderate-quality evidence), and may reduce the risk slightly in the mid-postnatal period (RR 0.73, 95% CI 0.55 to 0.97; 5 trials, 1921 women; low-quality evidence). There was no evidence that antenatal PFMT reduces the risk of UI at late postpartum (RR 0.85, 95% CI 0.63 to 1.14; 2 trials, 244 women; moderate-quality evidence). For PFMT started after delivery, there was uncertainty about the effect on UI risk in the late postnatal period (RR 0.88, 95% CI 0.71 to 1.09; 3 trials, 826 women; moderate-quality evidence). Faecal incontinence: eight trials reported FI outcomes. In postnatal women with persistent FI, it was uncertain whether PFMT reduced incontinence in the late postnatal period compared to usual care (very low-quality evidence). In women with or without FI, there was no evidence that antenatal PFMT led to a difference in the prevalence of FI in late pregnancy (RR 0.64, 95% CI 0.36 to 1.14; 3 trials, 910 women; moderate-quality evidence). Similarly, for postnatal PFMT in a mixed population, there was no evidence that PFMT reduces the risk of FI in the late postnatal period (RR 0.73, 95% CI 0.13 to 4.21; 1 trial, 107 women, low-quality evidence). There was little evidence about effects on UI or FI beyond 12 months' postpartum. There were few incontinence-specific quality of life data and little consensus on how to measure it. Authors' conclusions: This review provides evidence that early, structured PFMT in early pregnancy for continent women may prevent the onset of UI in late pregnancy and postpartum. Population approaches (recruiting antenatal women regardless of continence status) may have a smaller effect on UI, although the reasons for this are unclear. A population-based approach for delivering postnatal PFMT is not likely to reduce UI. Uncertainty surrounds the effects of PFMT as a treatment for UI in antenatal and postnatal women, which contrasts with the more established effectiveness in mid-life women. It is possible that the effects of PFMT might be greater with targeted rather than mixed prevention and treatment approaches, and in certain groups of women. Hypothetically, for instance, women with a high body mass index (BMI) are at risk of UI. Such uncertainties require further testing and data on duration of effect are also needed. The physiological and behavioural aspects of exercise programmes must be described for both PFMT and control groups, and how much PFMT women in both groups do, to increase understanding of what works and for whom. Few data exist on FI and it is important that this is included in any future trials. It is essential that future trials use valid measures of incontinence-specific quality of life for both urinary and faecal incontinence. In addition to further clinical studies, economic evaluations assessing the cost-effectiveness of different management strategies for FI and UI are needed.

Immediate Effect of Abdominal and Pelvic Floor Muscle Exercises on Interrecti Distance in Women With Diastasis Recti Abdominis Who Were Parous

Article

Apr 2020
PHYS THER

Objective: There is a lack of consensus on which abdominal or pelvic floor muscle (PFM) exercises to recommend for the treatment of diastasis recti abdominis (DRA). The objective of this study is to investigate the immediate effect of abdominal and PFM exercises on interrecti distance (IRD) in women with DRA who are parous. Methods: In this cross-sectional study, 38 women who were parous, with a mean age of 36.2 years (SD = 5.2), diagnosed with DRA participated. IRD was assessed with 2D real-time ultrasonography during rest and during 8 randomly ordered different exercises. A paired t test was used to compare the IRD at rest with the IRD recorded during each exercise as well as the differences between exercises. Means with 95% CI are reported. Results: Head lift and twisted curl-up exercises significantly decreased the IRD both above and below the umbilicus. Above the umbilicus, the mean IRD difference from rest during head lift was 10 mm (95% CI = 7 to 13.2), whereas during twisted curl-up, it was 9.4 mm (95% CI = 6.3 to 12.5). Below the umbilicus, the corresponding values were 6.1 mm (95% CI = 3.2 to 8.9) and 3.5 mm (95% CI = 0.5 to 6.4), respectively, but PFM contraction, maximal in-drawing, and PFM contraction+maximal in-drawing increased the IRD (mean difference = -2.8 mm [95% CI = -5.2 to 0.5), -4.7 mm (95% CI = -7.2 to -2.1) and - 5.0 mm (95% CI = -7.9 to -2.1), respectively. Conclusions: Head lift and twisted curl-up exercises decreased the IRD both above and below the umbilicus, whereas maximal in-drawing and PFM contraction exercises only increased the IRD below the umbilicus. A randomized controlled trial is needed to investigate whether head lift and twisted curl-up exercises are effective in permanently narrowing the IRD. Impact: To date there is scant scientific knowledge of which exercises to recommend in the treatment of DRA. In-drawing and PFM contraction leads to an acute increase in IRD while head lift and twisted curl-up leads to an acute decrease in IRD in postpartum women. There is a need for high quality RCTs to investigate if there is a long-term reduction in IRD by doing these exercises over time. The acute IRD increase and decrease during the different exercises is also present in a sample of women with larger separations.

Effectiveness of therapeutic interventions for the women with urinary incontinence: A systematic review

Article

Full-text available

Jan 2020
Crit Rev Phys Rehabil Med

ABSTRACT Background: Urinary incontinence is a common condition that reduces the quality of life of women specifically. To reduce this problem, it is necessary to identify the best possible therapeutic options. Purpose: To synthesize the evidence on effective therapeutic options for women with urinary incontinence. Data Sources: We extracted relevant papers from the Hinari, PubMed, Cochrane, Science Direct, Embase, PEDro, and Cinahl databases. Several studies were searched comprehensively. Study Selection: We integrated data from 17 randomized controlled trials related to therapeutic interventions for the management of urinary incontinence in women. Data Extraction: The PEDro scale was used to grade the level of evidence. The contents and outcomes of different therapeutic interventions for various types of urinary incontinence were explored. Data Synthesis: The comparative effectiveness of the interventions was analyzed based on intervention and control groups, long-term follow-up, adequate sample size, and intention to treat analyses. The primary outcomes of the studies considered reduced severity of urinary incontinence and secondary outcomes such as satisfaction, improved self-esteem, sexual function, and quality of life. Conclusions: Our findings suggest that pelvic-floor muscle exercise, behavioral training, electrical stimulation, vaginal cones, whole-body vibration treatment, and modified Pilates are significantly effective at reducing urinary incontinence. Nevertheless, persisting with one of these intervention procedures is difficult. Therefore, we recommend further study for long-term follow-up. KEY WORDS: severity, therapeutic intervention, urinary incontinence

Can postpartum pelvic floor muscle training reduce urinary and anal incontinence? An assessor-blinded randomized controlled trial

Article

Sep 2019
AM J OBSTET GYNECOL

Background: Pelvic floor dysfunction, including urinary and anal incontinence, is a common postpartum complaint and likely to reduce quality of life. Objectives: To study the effects of individualized physical therapist-guided pelvic floor muscle training in the early postpartum period on urinary and anal incontinence and related bother, as well as pelvic floor muscle strength and endurance. Study design: Assessor-blinded parallel randomized controlled trial evaluating effects of pelvic floor muscle training by a physical therapist on the rate of urinary and/or anal leakage (primary outcomes), while related bother and muscle strength and endurance in the pelvic floor were secondary outcomes. Between 2016-2017 primiparous women giving birth at Landspitali University Hospital in Reykjavik, Iceland were screened for eligibilty 6-10 weeks after childbirth. Of those identified as urinary incontinent 95 were invited to participate of whom 84 agreed. The intervention, starting at ∼9 weeks postpartum consisted of 12 weekly sessions with a physical therapist after which the main outcomes were assessed (endpoint, ∼6 months postpartum). Additional follow-up was conducted at ∼12 months postpartum. The control group received no instructions after the initial assessment. Fisher´s exact test was used to test differences in the proportion of women with urinary and anal incontinence between intervention and control groups, while independent sample t-tests were used for mean differences in muscle strength and endurance. Significance levels were set as α=0.05. Results: Forty-one and 43 women were randomized to the intervention and control groups, respectively. Three and one participants withdrew from these respective groups. Measurement variables and main delivery outcomes were not different at recruitment. At the endpoint, urinary incontinence was less frequent in the intervention group with 21 (57%) still symptomatic compared to 31 (82%) of the controls (P=0.03), as was bladder-related bother with 10 (27%) in the intervention vs. 23 (60%) in the control group, P=0.005. Anal incontinence was not influenced by pelvic floor muscle training (P=0.33), nor was bowel-related bother (P=0.82). The mean differences between groups in measured pelvic floor muscle strength changes at endpoint was 5 hPa (95%CI 2-8; P=0.003), and for pelvic floor muscle endurance changes, 50 hPa/sec (95%CI 23-77; P=0.001), both in favor of the intervention group. The mean between-group differences for anal sphincter strength changes was 10 hPa (95%CI 2-18; P=0.01), and for anal sphincter endurance changes 95 hPa/sec (95%CI 16-173; P=0.02), both in favor of the intervention. At the follow-up visit, 12 months postpartum, no differences were observed between the groups regarding rates of urinary and anal incontinence, nor related bother. Pelvic floor- and anal muscle strength and endurance favoring the intervention group were maintained. Conclusions: Postpartum pelvic floor mucle training decreased the rate of urinary incontinence and related bother 6 months postpartum and increased muscle strength and endurance.

Effectiveness of a pelvic floor muscle exercise program on urinary incontinence following childbirth

Article

Jan 2005

Supplementary Material 1

Data

Full-text available

Feb 2019

The effect of an exercise program in pregnancy on vitamin D status among healthy, pregnant Norwegian women: a randomized controlled trial

Article

Full-text available

Feb 2019

Background Vitamin D insufficiency is common in pregnant women worldwide. Regular prenatal exercise is considered beneficial for maternal and fetal health. There is a knowledge gap regarding the impact of prenatal exercise on maternal vitamin D levels. The objective of this study was to investigate whether a prenatal exercise program influenced serum levels of total, free and bioavailable 25-hydroxyvitamin D (25(OH)D) and related parameters. This is a post hoc analysis of a randomized controlled trial with gestational diabetes as the primary outcome. Methods Healthy, pregnant women from two Norwegian cities (Trondheim and Stavanger) were randomly assigned to a 12-week moderate-intensity exercise program (Borg perceived rating scale 13–14) or standard prenatal care. The intervention group (n = 429) underwent exercise at least three times weekly; one supervised group training and two home based sessions. The controls (n = 426) received standard prenatal care, and exercising was not denied. Training diaries and group training was used to promote compliance and evaluate adherence. Serum levels of 25(OH)D, parathyroid hormone, calcium, phosphate, magnesium and vitamin D-binding protein were measured before (18–22 weeks′ gestation) and after the intervention (32–36 weeks′ gestation). Free and bioavailable 25(OH)D concentrations were calculated. Regression analysis of covariance (ANCOVA) was applied to assess the effect of the training regime on each substance with pre-intervention levels as covariates. In a second model, we also adjusted for study site and sampling month. Intention-to-treat principle was used. Results A total of 724 women completed the study. No between-group difference in serum 25(OH)D and related parameters was identified by ANCOVA using baseline serum levels as covariates. The second model revealed a between-group difference in levels of 25(OH)D (1.9, 95% CI 0.0 to 3.8 nmol/L; p = 0.048), free 25(OH)D (0.55, 95% CI 0.10 to 0.99 pmol/L; p = 0.017) and bioavailable 25(OH)D (0.15 95% CI 0.01 to 0.29 nmol/L; p = 0.036). No serious adverse events related to regular exercise were seen. Conclusion This study, a post hoc analysis, indicates that exercise may affect vitamin D status positively, and emphasizes that women with uncomplicated pregnancies should be encouraged to perform regular exercise. Trial registration ClinicalTrials.gov: NCT00476567, registered May 22, 2007. Electronic supplementary material The online version of this article (10.1186/s12884-019-2220-z) contains supplementary material, which is available to authorized users.

Effectiveness of pelvic floor muscle training and bladder training for women with urinary incontinence in primary care: a pragmatic controlled trial

Article

Full-text available

Mar 2019

Background: Although the efficacy of pelvic floor muscle training (PFMT) and bladder training are well established, there is a paucity of patient centered models using these interventions to treat women with UI at primary level of health assistance in Brazil. Objective: To investigate the effectiveness of a physical therapy intervention to treat women with UI in primary health centers. Methods: Pragmatic non-randomized controlled trial in which women with UI from the community participated in a supervised physical therapy program consisting of bladder training plus 12 weeks of PFMT, performed either at home or in the health center. Outcome measures were amount and frequency of urine loss measured by the 24-h pad-test and the 24-h voiding diary; secondary outcome was the impact of UI on quality of life measured by the ICIQ-SF. Outcomes were measured at baseline, at the 6th and 12th weeks of the intervention and 1 month after discharge. Results: Interventions reduced the amount (pad-test, p = 0.004; d = 0.13, 95% CI = −0.23 to 0.49) and frequency of urine loss (voiding diary, p = 0.003; d = 0.51, 95%CI = 0.14 to 0.87), and the impact of UI on quality of life (ICIQ-SF, p < 0.001; d = 1.26, 95%CI = 0.87 to 1.66) over time, with positive effects from the 6th week up to 1 month for both intervention setting (home and health center), and no differences between them. Conclusion: Interventions were effective, can be implemented in primary health centers favoring the treatment of a greater number of women who do not have access to specialized physical therapy. Trial registration: RBR-8tww4y. © 2019 Associação Brasileira de Pesquisa e Pós-Graduação em Fisioterapia

A new approach to the troubles of urinary continence in women: urodynamic ultrasound examination by the vaginal route

Article

Full-text available

Feb 1987
J Gynecol Obstet Biol Reprod

The vesicourethral junction, the urethra cannot be seen when using the abdominal approach because of the interposition of the pubic symphysis. The ultrasonic vaginal approach makes it possible. 53 patients were ultrasonically observed during an urodynamic exploration. The simultaneous utilization of both methods has permit to observe the mechanisms of normal or pathological voiding. When initiating a voluntary micturition, an area (called "prepubic muscle") located in front of the pubic symphysis between the clitoris and the urethral meatus, exert a traction on the periurethral sphincteric area. This sphincteric area, which is well shown by ultrasound, contracts longitudinally (causing shortening of the urethra and opening of the bladder neck) and causes a drop in urethral closure pressure. The increase in the distance between the inferior part of the pubic symphysis and the anterior vaginal wall comes about because of slackening of the elevator ani muscles. This slackening occurs at different times before the bladder contracts. The urethra opens; the complete course of this organ is well defined. Things return to their previous state when voiding finishes. In the case of stress incontinence, the lack of transmission of pressure urodynamically found when the woman is coughing can be seen as a sliding mechanism within the space of Retzius and at the urethro-vesical junction behind the symphysis pubis. The degree of sliding depends on the strength of the cough. In all cases of pure stress incontinence without there being low urethral closure pressure, a maximum stress caused by coughing will produce more than 5 MM sliding before the urethra opens. If the urinary incontinence is due to low urethral closure pressure, the urethra opens without sliding of the urethro-vesical junction whenever the abdominal pressure increases. Urethral instability resembles voluntary voiding but without any voluntary command. "Prepubic" contractions, longitudinal contractions in the sphincteric area and slackening of the levator ani muscles, alone or in association, explain why urethral closure pressure drops. Sometimes this drop is followed by an increase in bladder pressure.

Urinary Incontinence in the Elderly

Article

Oct 1985

Kathryn Larsen Burgio

Pelvic floor muscle exercise for the treatment of female stress urinary incontinence: I. Reliability of vaginal pressure measurements of pelvic floor muscle strength

Article

Jan 1990
NEUROUROL URODYNAM

The reliability of measurements of pelvic floor muscle strength using a vaginal balloon catheter connected to a pressure transducer was tested in 28 healthy women, mean age 32.3 years (21–50). Fourteen women (group 1) performed three pelvic floor muscle contractions in three series with reinstallation of the balloon catheter to the same vaginal position between each series. Additionally, retest was done after a period of 2 weeks. Reproducibility of the results was tested in another similar group of 14 women (group 2) who did a 1 day test. In the first group the maximum contraction value (resting pressure not included) varied from 5 to 40 cm H2O. However, the median difference value of the three series tested on two different days was only 3, 1, and 1 cm H2O, respectively. The two groups of women demonstrated similar values of vaginal pressure measurements. Thus, a balloon with a given vaginal position for measurements of pelvic floor muscle strength gives reliable pressure recordings.

Pelvic floor muscle exercise for the treatment of female stress urinary incontinence: II. Validity of vaginal pressure measurements of pelvic floor muscle strength and the necessity of supplementary methods for control of correct contraction

Article

Jan 1990
NEUROUROL URODYNAM

The present investigation comprises three methodological studies concerning vaginal pressure measurements of pelvic floor muscle (PFM) strength. Vaginal pressure was measured by a balloon (6.7 ± 1.7 cm) connected by a catheter to a pressure transducer. The balloon was placed with the middle of the balloon 3.5 cm inside the introitus vagina. In fourty-seven women, mean age 44.9 years (24–64), observation of movement of the vaginal catheter during PFM contraction verified 7 inconclusive results from perineovaginal palpation and was the most valid way to distinguish between correct and incorrect PFM contraction. Vaginal pressure rise was obtained regardless of correct or incorrect PFM contraction, showing that vaginal pressure is not specific for PFM contraction. However, as the action of the PFM is elevation, a simultaneous inward movement of the vaginal catheter is present only during correct PFM contraction. Degree of influence of various muscle groups on vaginal pressure was investigated in 14 women using two different balloons, one having a silicone reinforcement of the tip. It was found that the median contraction value of muscles other than the PFM did not exceed contraction of PFM alone. No significant difference was observed using the two types of balloons. In three physical therapists EMG activity of the lower m. rectus abdominis was recorded during maximal PFM contractions. A rise in EMG activity always occurred during maximal contractions even if the women actively tried to relax the abdominal muscles. It is concluded that vaginal pressure measurement of PFM strength is valid with simultaneous observation of inward movement of the balloon catheter. Vaginal pressure rise due to simultaneous contraction of other muscles is probably not larger than pressure rise due to intended PFM contraction. Reinforced balloon tip will not change pressure recording, and rise in EMG activity of lower abdominal muscles seems unavoidable during maximal PFM contraction.

Effect of pelvic floor exercises in the treatment of genuine urinary stress incontinence in women at two hospitals

Article

Jun 1988
BJOG-INT J OBSTET GY

The results of the pelvic floor exercises for the treatment of genuine stress incontinence of urine were compared between two different hospitals geographically 50 miles apart. A perineal pad weighing test was used to assess the quantity of urine lost during exercise before and after treatment. A similar percentage of patients in the two studies responded to treatment and became either completely dry or significantly improved at the end of 3 months interval; 69% at LCH and 65% at LGH. Overall, 67% of patients achieved complete continence or a significant improvement as a result of pelvic floor exercises alone.

An objective assessment of physiotherapy in female genuine stress incontinence

Article

Jun 1987
Br J Obstet Gynaecol

Sixty women with genuine stress incontinence were consecutively assigned to one of four physiotherapy groups who were treated for 6 weeks by either (1) pelvic floor exercises (PFE) in hospital; (2) PFE and faradism; (3) PFE and interferential therapy; (4) PFE at home. Assessment before and after treatment was by 7-day bladder charts, urethral pressure profiles and perineometry. Approximately two-thirds of the hospital-treated patients (groups 1, 2 and 3) experienced marked or moderate subjective improvement and at 6 months, 27% were dry or almost dry. There was little difference in outcome between groups 1, 2 and 3 but hospital-based therapy was more effective than home treatment. Statistical analyses showed that there were significant improvements in the objective indices measured in the 45 hospital-treated patients. Successful treatment was more likely in younger patients, in those with lesser degrees of genuine stress incontinence and those who had had no previous pelvic floor surgery.

Urinary incontinence in the elderly. Bladder-sphincter biofeedback and toileting skills training.

Article

Nov 1985

Behavioral treatment of urinary incontinence was given to 39 elderly outpatients; 19 had stress incontinence, 12 detrusor motor instability, and 8 urge incontinence without instability. Biofeedback involving the bladder and sphincter was used to teach selective control of sphincter muscles or voluntary inhibition of detrusor contractions. Traditional behavioral methods used included habit training to gradually increase the voiding interval and relaxation training to cope with the urge to void. After an average 3.5 training sessions, patients with stress incontinence reduced the frequency of incontinent episodes an average of 82% (range, 55% to 100%). Patients with detrusor motor instability showed an average 85% improvement (range, 39% to 100%), and patients with urge incontinence reduced incontinence an average of 94% (range, 83% to 100%). Furthermore, 13 of the patients achieved total continence, and 19 had fewer than one accident per week after treatment.

A comparative study of perineal ultrasound scanning and urethrocystography in patients with genuine stress incontinence

Article

Feb 1988

Perineal scanning using linear array ultrasound was used as an alternative to radiologic urethrocystography in the investigation of female urinary incontinence. The posterior urethro-vesical angle (beta) and the angle of inclination (alpha) of 30 patients (age: 48 +/- 10.2 years) with genuine stress incontinence were measured by both procedures. In all cases the radiologic and ultrasound findings correlated well. Perineal scan provides similar information to that obtained by the radiographic procedure without exposure to X-rays. In contrast to urethrocystography perineal scan is fast, inexpensive, readily accessible and more acceptable to the patient.

Pelvic-Floor Musculature Exercises in Treatment of Anatomical Urinary Stress Incontinence

Article

Jun 1988

The purpose of this study was to investigate the effects of pelvic-floor musculature exercises in the treatment of women with anatomical urinary stress incontinence. Fourteen female subjects, ranging in age from 33 to 67 years, participated in a four-week pelvic-floor musculature exercise program. Subjects underwent a pretraining urodynamic evaluation and were reexamined after four weeks of exercise training. Paired t tests of subjects' pretraining and posttraining values of bladder capacity, functional urethral length, and static urethral pressure profile showed no significant differences. Multivariate regression analysis demonstrated that the covariates of weight, motivation, and age did not significantly influence subjects' bladder capacity, functional urethral length, or static urethral pressure profile. Nine of the 14 subjects had a negative result on the posttraining urinary stress test (R = 0, p less than .01). The urinary stress test result was the only variable to change significantly from pretraining to posttraining measurements. All subjects reported posttraining improvement in control of urinary incontinence. A short-term exercise program for pelvic-floor musculature produced positive changes in subjects with anatomical urinary stress incontinence.

Re-educative treatment of genuine stress incontinence

Article

Sep 1987
Am J Phys Med

Three-months re-education treatment of genuine stress incontinence was given to 26 female outpatients: 22 patients completed the treatment programme and 4 interrupted it for various reasons. The aims of the treatment were both to correct compensatory habits that patients used to conceal or reduce leakage accidents and to give specific education and strengthening of pelvic floor muscles. All patients who completed the three-months treatment definitely improved and 7 were cured. Accordingly a marked reduction or absence of weekly incontinence episodes as well as a reduction of the daily frequency of micturition was observed. On vaginal palpation a clear-cut improvement of pubococcygeous muscle contractility was detectable. Urethral closure pressure profilometry showed significant improvement of functional urethral profile length at rest and of maximal urethral closure present both at rest and during maximal voluntary contraction of the pelvic floor muscles. Micturition cystourethrography, repeated in 15 patients at the end of the treatment, showed a clear-cut improvement of bladder neck suspension defects in all but 2 patients. Follow-up assessments showed that the clinical effects were long-lasting. Possible mechanisms of this re-educative technique are discussed.

Pelvic Floor Exercise versus Surgery for Female Urinary Stress Incontinence

Article

Feb 1986

Fifty consecutive female patients with genuine urinary stress incontinence were randomized either to surgery or to a pelvic floor training program. The operative procedure was chosen according to the type of bladder suspension defect on micturition cystourethrography. The training program was given 5 times in weekly lessons and the patients were guided by trained physiotherapists. Surgery was superior to the pelvic floor training program both subjectively and objectively. However, a significant improvement was found following the training program. Forty-two percent were satisfied with the outcome of the training and did not want operation. We find physiotherapist-guided pelvic floor exercise a realistic alternative to surgery in patients with mild degrees of stress incontinence. Also patients with residual symptoms after surgery are candidates for pelvic floor training.

The role of biofeedback in Kegel exercise for stress urinary incontinence

Article

Feb 1986
AM J OBSTET GYNECOL

This study examined the effectiveness of teaching pelvic floor exercises with use of bladder-sphincter biofeedback compared to training with verbal feedback based on vaginal palpation in 24 women with stress urinary incontinence. Verbal feedback training consisted of instructing the patient to squeeze the vaginal muscles around the examiner's fingers and providing her with verbal performance feedback. Biofeedback patients received visual feedback of bladder pressure, abdominal (rectal) pressure, and external anal sphincter activity. The biofeedback group improved the strength and selective control of pelvic floor muscles; the verbal feedback group did not. Both groups significantly reduced the frequency of incontinence. The biofeedback group averaged 75.9% reduction in incontinence, significantly greater than the 51.0% reduction shown by the verbal feedback group. Twelve of 13 patients in the biofeedback group improved by 60% or better. Six patients in the verbal feedback group improved by 68% or better, and five were less than 30% improved.

The Pathophysiology of Stress Incontinence

Article

Jun 1985
UROL CLIN N AM

Genuine stress incontinence occurs when the intravesical pressure, as a result of an increase in intra-abdominal pressure, exceeds the resistance produced by the urethral closure mechanisms, in the absence of bladder activity. Other forms of incontinence may be confused with genuine stress incontinence because of the similarity in symptoms, and the ability to elicit the clinical sign of urinary loss with stress maneuvers (such as coughing and straining). Disorders associated with detrusor contraction (detrusor instability), elevated intravesical pressure (poor compliance), or increased residual urine (overflow incontinence), may have associated stress-induced symptoms. Urethral instability results from the reflex relaxation of the urethra without a detrusor contraction. These disorders should not be confused with genuine stress incontinence, which is the focus of this paper.

The effect of physiotherapy on stress incontinence

Article

Aug 1984

Physiotherapy is a safe and effective means of decreasing the symptoms and signs of stress incontinence. Fourteen out of 19 women became dry or improved sufficiently not to warrant wearing any protective garment over a 4-week treatment period. The use of a novel machine to measure pelvic floor squeeze did not improve the success of physiotherapy alone in this condition but may have an important role in instructing the patient on the correct use of the pelvic floor muscles.

Physiologic therapy of urinary incontinence

Article

Aug 1951
J Am Med Assoc

Arnold H. Kegel

Poor control of the bladder outlet is observed in approximately 5.5% of all adult women.¹ To the patient the condition is always embarrassing, often humiliating, and at times incapacitating. In the past patients with more advanced urinary stress incontinence were treated by surgical intervention, with results that were not always satisfactory. But little could be done for the great number of women with slight or moderate complaints. As operation is not indicated in such cases, temporizing procedures had to be applied that all too often resulted in dissatisfaction of patient and physician alike. In the meantime, however, it has been demonstrated that in the overwhelming majority of cases,² even with a history of childbirth injury, urinary stress incontinence is due to inherent weakness of the muscles surrounding bladder neck and vagina. This condition is amenable to correction through reeducation of muscular function and resistive exercises that can be

Jan 1988
161

DeLancey

Pelvic floor muscle exercise for the treatment of female stress urinary incontinence: III. Effects of two different degrees of pelvic floor muscle exercises

Abstract

No full-text available

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