Article

Effect of home-based Kegel exercises on quality of life in women with stress and mixed urinary incontinence

Journal of Obstetrics and Gynaecology

September 2014
35(4):1-4

DOI:10.3109/01443615.2014.960831

Source
PubMed

Authors:

Sabri Cavkaytar

Dr. Zekai Tahir Burak Women's Health Research and Education Hospital

Mahmut Kuntay Kokanali

Dr. Zekai Tahir Burak Women's Health Research and Education Hospital

Hasan Onur Topçu

Dr. Zekai Tahir Burak Women's Health Research and Education Hospital

Orhan Aksakal

Dr. Zekai Tahir Burak Women's Health Research and Education Hospital

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The aim of this study was to assess the effects of home-based Kegel exercises in women with stress and mixed urinary incontinence. A total of 90 women with urodynamically proven urinary stress (SUI) and mixed (MUI) incontinence awaiting anti-incontinence surgery were recruited in the urogynaecology clinic of Ankara Zekai Tahir Burak Women's Health Research and Education Hospital. Of these, 18 women were excluded due to low compliance and the remaining 72 were divided into two groups according to urodynamic diagnosis (SUI group, n = 38; MUI group, n = 34). Age, BMI, menopausal status and medical history of the women were recorded. The women took Kegel exercise, consisting of 10 sets of contractions/day; each set included 10 repetitions, for at least 8 weeks. To evaluate the pelvic floor muscle strength, the modified Oxford grading system was used before and after Kegel exercising. The Incontinence Impact Questionnaire (IIQ-7); Urogenital Distress Inventory (UDI-6) and the Patient Global Impression of Improvement (PGI-I) questions were compared before and after 8 weeks of Kegel exercising. The age, BMI, gravidity, menopausal status, macrosomic fetus history, hypertension and asthma were similar between the groups. There were statistically significant lower scores in both IIQ-7 and UDI-6 before and after Kegel exercises within each group (p < 0.001). The mean change of the IIQ-7 and UDI-6 score was statistically significantly higher in the SUI group than in the MUI group (p = 0.023 and p = 0.003, respectively). Results of the Oxford scale were also statistically significantly higher after Kegel exercises within each group (p = < 0.001). In total, 68.4% of the women in the SUI group and 41.2% of the women in the MUI group reported improvements which were statistically significant (p = 0.02). We conclude that home-based Kegel exercises, with no supervision, have been found effective in women with SUI and MUI. The improvement was more prominent in women with SUI.

Vaginal Bipolar Radiofrequency Treatment of Mild SUI: A Pilot Retrospective Study

Article

Full-text available

Jan 2022

Background and Objectives: This retrospective study investigates the action of a bipolar, temperature controlled, endovaginal RF handpiece for the treatment of mild, moderate, and severe stress urinary incontinence with a minimally invasive approach. Stress urinary incontinence (SUI) is a common condition resulting in involuntary urine leakage, with an associated social and psychological impact. SUI is the most common type of urinary incontinence in women. Materials and Methods: We retrospectively studied 54 patients for this study. The bipolar radiofrequency energy used in all patients was 50 W, with temperatures maintained between 41 °C and 44 °C. Two sessions were performed four weeks apart. In order to monitor all patients before the first treatment and 4 months after the second treatment, the International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF) was used. Paired Student’s t test was used to elaborate the statistical data. Results: The average frequency of urine leak improved from “2–3 times a week” (2.1 ± 1.3 points before the treatment) to “once a week” (0.8 ± 1.3 points 4 MFU post-treatment). The average volume improved from “small/moderate quantity” (3.2 ± 1.6 points before the treatment) to “none” (0.9 ± 1.4 points 4 MFU post-treatment). No adverse events or side effects were found. Conclusion: Our preliminary results represent a good starting point to check the effectiveness and validity of the bipolar radiofrequency temperature-controlled method in the treatment of SUI.

Effect of Kegel's Exercise on Severity of Urinary Incontinence and Quality of Life among Menopausal Women

Article

Full-text available

Jan 2021

Urinary incontinence is a complex and serious condition that can affect menopausal women. It is not only a serious medical condition but also an undeniable psychosocial problem and it has a severe impact on a woman's quality of life. Aim of the study: was to determine the effect of kegel's exercise on severity of urinary incontinence and quality of life among menopausal women. Research design: A quasi experimental research design with a pretest-posttest control group was utilized. Settings: The study was conducted at obstetric and gynecological outpatient clinic and Urological outpatient clinic at National Medical Institution in Damanhour, Albehera Governorate. Subjects: A purposive sample of 80 menopausal women with urinary incontinence was selected according to eligibility criteria. They were divided into two equal groups 40 (study group and control group). Tools of data collection: Four tools were used for data collection namely: A structured interview schedule, the PRAFAB-Questionnaire scale, Brink digital pelvic muscle scale and the king's health questionnaire. Results: the study results revealed that there was a statistically significant difference between the study and control groups in favor of the former in relation to severity of urinary incontinence, pelvic floor muscle strength and quality of Life after twelve weeks of intervention where P = .000. Conclusion: The study concluded that Kegel's exercise has significant positive effect on strengthens pelvic floor muscle, reducing severity of UI and significantly improves the quality of life of menopausal women with urinary incontinence.

The Effect of Eight-Week Kegel Exercise on Quality of Life in Postmenopausal Females with Urinary Incontinence

Article

Full-text available

Jun 2024

Introduction: Urinary incontinence (UI) is the leakage of urine which is often uncontrollable and can negatively impact on the quality of life (QoL). The aim of this study was to determine the effects of an eight-week of Kegel exercise as a complementary therapy on QoL in postmenopausal females with UI. Methods: The study design was a quasi-experimental pre-test post-test with a control group trial. The participants were Iranian women aged between 60 to 95 years with UI problems referring to medical centers in Najafabad city in Isfahan Province, Iran. Twenty four female UI patients were recruited and randomly divided into Kegel exercise (n = 12) and control group (n = 12). The Kegel group received exercise three times a week for eight-week, and the control group continued their routine life. The Questionnaire for Urinary Incontinence Diagnosis and the World Health Organization Quality of Life questionnaire were used for data collection. The variables were measured before and after the Kegel protocol in both groups. Descriptive statistics and analysis of covariance were used to assess variable differences between groups (p < 0.05). Results: The mean age of UI patients was 70.83 ± 7.61 years old. Analysis of variance demonstrated a significant decrease in stress urinary incontinence symptoms (F = 61.88, p = 0.01), urge urinary incontinence symptoms (F = 111.56, p = 0.01), and UI symptoms (F = 88.20, p = 0.01), and significant increase in physical health (F = 28.93, p = 0.01), psychological health (F = 15.35, p = 0.01), social relationships (F = 18.83, p = 0.01), environment health (F = 155.51, p = 0.01), QoL (F = 132.07, p = 0.01) in Kegel exercise group. Conclusion: Kegel exercise can be an effective complementary therapy for improving QoL in postmenopausal female suffering from UI. Healthcare providers should consider recommending Kegel exercise as part of comprehensive treatment approach for postmenopausal female with UI to help alleviate symptoms and enhance their overall QoL.

Applicability of kegel exercises in different urinary incontinences in women: Systematic review

Article

Mar 2024

Introduction: Urinary incontinence (UI) is the involuntary loss of urine. The condition also happens when there are small daily leaks. Objective: The aim of this study was to conduct a systematic review that verified the efficacy of Kegel's exercise in UI in women. Methodology: This is a systematic review, in which searches were conducted for articles related to the theme "Kegel Exercise in Urinary Incontinence in Women" in the PubMed, LILACS and SCIELO databases, the search was carried out starting on March 1, 2023 and ending on June 1 of the same year and the selection of articles was for the last 5 years. The inclusion criteria were full-text articles that talked about UI in women and the applicability of Kegel's exercise in treatment and studies with intervention, exclusion criteria were articles from the proposed period and which did not corresponded with the inclusion criteria. Altogether, 191 articles were found, after removal of articles off the subject and repeated 7 studies remained to be evaluated on the PEDro scale, among them 6 were suitable for use in the study. Results: To evaluate the articles, the PEDro scale consists of 11 questions containing yes or no answers that help validate the quality of clinical trial studies, the scores of the articles evaluated and elected in this scale of the study was 70%, in all, 6 articles were analyzed by the PEDro scale. Conclusion: Finally, it is concluded that the use of kegel exercises for the treatment of UI in women is effective, and should also be used as a method of prevention for possible incontinences, thus strengthening the pelvic floor with the exercises.

Health Belief Scale for Urinary Incontinence and Kegel Exercise: A Reliability and Validity Study

Article

Sep 2023
J WOUND OSTOMY CONT

PURPOSE The aim of this study was to develop an instrument based on the Health Belief Model that measures urinary incontinence awareness and beliefs regarding pelvic floor muscle (Kegel) exercises. DESIGN Evaluation of validity and reliability of the novel instrument and analysis of sociodemographic variables based on responses to this 49-item scale. SUBJECTS AND SETTING The sample used to validate the instrument (n = 527) was drawn from patients cared for at the gynecology and obstetrics and urology polyclinic at Ondokuz Mayıs University Hospital. A majority of participants were female (n = 431, 81.8%) and their average age was 33.8 years (SD 12.3). The university is located in Samsun, a city located in northern Turkey. Data were collected between October 2019 and December 2020. METHODS The Health Belief Scale for Urinary Incontinence and Kegel Exercise's validity was analyzed using a content validity index approach with 8 experts. Psychometric measurements were obtained using exploratory factor analysis and Cronbach's α reliability analysis. Exploratory factor analysis incorporated principal component analysis and varimax rotation. t Tests and 1-way analysis of variance were used to compare subdimensions of the Health Belief Scale for Urinary Incontinence and Kegel Exercise with some variables (sex, education status, marital status, make Kegel exercises regularly, etc). RESULTS Results supported a scale having 49 items and 6 subscales per factor analysis explaining 59.8% of total variance. With exploratory factor analysis, the Kaiser-Meyer-Olkin coefficient was 0.899 and Barlett test result was χ² = 18389.424 ( P = .001). Cronbach's α coefficients for the scale varied between 0.79 and 0.94. Factor loadings per underlying dimensions ranged from 0.42 to 0.84. CONCLUSION The Health Belief Scale for Urinary Incontinence and Kegel Exercise is a valid and reliable instrument.

Optimal Duration for Supervised Pelvic Floor Muscle Training in Stress Urinary Incontinence Women: A Prospective Study

Article

Full-text available

Mar 2023

Objectives: We evaluated the optimal duration of pelvic floor muscle training (PFMT) in stress urinary incontinence (SUI) patients. Methods: This cross-sectional study was conducted at Cipto Mangunkusumo Hospital from November 2018 to June 2019. We recruited 55 subjects diagnosed with SUI based on the questionnaire for urinary incontinence diagnosis (QUID) score >4 and more than 2 grams of 1-hour pad test. Considering the inclusion and exclusion criteria, we taught and supervised them for PFMT and evaluated them every four weeks to observe the urogenital distress inventory-6 (UDI-6), incontinence impact questionnaire-7 (IIQ-7), 1-hour pad test, and perineometer score. We used the Wilcoxon test to evaluate the improvement at a significance level of P<0.05. Results: Our subjects were mostly obese (65%), 30-55 years old (60%), and had >2 children (90%). There were improvements in UDI-6 and IIQ-7 for every four weeks up to 12 weeks of PFMT (P<0.05, 95% CI). Pelvic floor muscle strength only improved significantly (P=0.001 and P=0.006, respectively) after eight weeks of PFMT. Also, the 1-hour pad test score decreased significantly after four weeks of training (P<0.001). Discussion: SUI distress and symptoms decrease after four weeks of Kegel exercises and continue to improve until 12 weeks of therapy. However, the 1-hour pad test reaches clinical and statistical significance during the first month of exercise with no further improvement clinically. Pelvic floor muscle strength increased significantly after eight weeks of training.

Ejercicio y educación mejoran equilibrio y la calidad de vida en mujeres con incontinencia urinaria de esfuerzo

Article

Full-text available

Dec 2021

Introducción: La incontinencia urinaria por esfuerzo (IUE) tiene una alta prevalencia en mujeres adultas, afectando variables psicológicas, sociales y funcionales como la disminución de capacidad de equilibrio, debido a una escasa contribución en los movimientos del tronco hacia una corrección postural. Objetivo: Determinar los efectos de un programa basado en ejercicio muscular de piso pélvico y educación sobre el equilibrio estático y la calidad de vida en mujeres con IUE. Materiales y métodos: Participaron 18 mujeres con IUE durante 12 semanas en 10 sesiones de ejercicio muscular de piso pélvico y educación (hábitos de higiene, micción, ingesta de líquidos). Pre y post-intervención se evaluó equilibrio estático mediante oscilografía postural y calidad de vida mediante el International Consultation on Incontinence Questionnaire Short-Form (ICQ-SF). Los datos fueron analizados con la prueba no paramétrica de Wilcoxon. Resultados: Se encontró una disminución significativa en el área de desplazamiento del centro de presión en el subtest ojos abiertos (p=0,027) y en el Subtest ojos cerrados (p=0,006). Disminuyó la sintomatología asociada a IUE (p=0,0001). Conclusiones: Pos-intervención mejora equilibrio estático y calidad de vida, confirmando los efectos positivos de este programa que pueden servir de orientación a profesionales de la salud que trabajan con mujeres con IUE.

Effects of Kegel Exercises and Mindfulness Meditation on Postoperative Erectile Function in BPH Patients Undergoing HoLEP: A Prospective Study

Preprint

Full-text available

Oct 2024

Background This trial aimed to evaluate the combined effects of mindfulness meditation and Kegel exercises on the postoperative recovery of erectile function, psychological health, and urinary symptoms in patients undergoing holmium laser enucleation of the prostate (HoLEP) for sexually active benign prostatic hyperplasia (BPH). Methods This multicenter, prospective, single-blind, randomized controlled trial included 113 sexually active patients aged 50–70 years who were diagnosed with BPH. The participants were randomized into two groups: the intervention group, which followed a regimen of Kegel exercises combined with mindfulness meditation, or the observation group, which received standard postoperative care. Time to recovery of erectile and activity function and International Index of Erectile Function (IIEF) scores at 1, 3 and 6 months postoperatively. The secondary outcomes focused on psychological health and symptom improvement, both of which were assessed via the International Prostate Symptom Score (IPSS) and the Self-Assessment Scale for Anxiety (SAS), with all these variables measured both preoperatively and at 1, 3 and 6 months postoperatively. Results Compared with the observation group, the intervention group presented a significantly shorter recovery time for erectile and sexual activity (p < 0. 05). The IIEF scores at 1, 3 and 6 months postoperatively were significantly greater in the intervention group than in the observation group (p < 0.05). The mental health and IPSS scores also significantly improved in the intervention group (p < 0.05). Conclusions Combining Kegel exercises with mindfulness meditation significantly improved erectile function recovery, psychological health, and urinary symptoms in sexually active BPH patients undergoing HoLEP.

Intravaginal electrical stimulation for the treatment of pelvic floor dysfunction: a systematic review and meta-analysis

Article

Full-text available

Aug 2024

Background Intravaginal electrical stimulation (IVES) has been explored as a potential treatment for pelvic floor disorders (PFDs), although its efficacy remains a subject of debate. We aim to conducted a comprehensive meta-analysis of relevant trials. Methods This meta-analysis was performed under the PRISMA 2020 guideline. We meticulously searched for randomized controlled trial (RCT) studies in various databases, including PubMed, Cochrane Library, EMBASE, and ClinicalTrials.gov, spanning from inception to March 6, 2023. All studies included one treatment group of intravaginal electrical stimulation and the diseases spectrum of the studies involved different kinds of PFDs, including urinary incontinence, overactive bladder, etc. Risk of bias charts were used to assess the risk of bias in the studies and forest plots were used the demonstrate the overall effects. Results Our analysis encompassed a total of 13 RCT studies. In most of the assessed PFD cure outcomes, the results demonstrated positive effects of IVES therapy, as indicated by the following findings: daily voiding frequency (MD = −1.57, 95% CI = −3.08 to −0.06, I² = 68%,), nocturia (MD = −1.07, 95% CI = −2.01 to −0.13, I² = 71%), Pad test, and Urinary incontinence. Nevertheless, the data concerning the impact of IVES therapy on the quality of life of individuals with PFDs did not confirm these positive results. Discussion In light of the insufficiency in both the quality and quantity of the included studies, it is premature to draw a definitive conclusion regarding the efficacy of IVES therapy for treating PFDs. Nonetheless, our study does provide several pieces of evidence in support of the potential therapeutic effects of electrical stimulation therapy in this context. We recommend that further research in this area be conducted to provide more conclusive insights into the efficacy of IVES therapy for PFDs. Systematic review registration https://www.crd.york.ac.uk/prospero/, identifier: CRD42023442171.

Qualitative Research: Women’s Experiences After a Standard Exercise Program: Adherence to Pelvic Floor Muscles Exercise

Article

Full-text available

Apr 2024

Therapeutic exercise for pelvic floor muscle (PFM) training and other supplementary exercise modalities, like involuntary fiber exercises, are part of the conservative treatment for pelvic floor dysfunction (PFD). Adherence to the exercises and incorporation of expert health advice into daily life is crucial for the conservative treatment's long-term success. This study aimed to determine the level of adherence to home-based exercises among women with a diagnosis of PFD following an intense in-person exercise program. The research was based on an interpretive paradigm and was a qualitative design. Participants were interviewed in both individual and group settings using a semi-structured approach one month following the end of their exercise sessions. The interviews were meticulously recorded, transcribed word-for-word, and then evaluated using thematic categories. Fifteen females were questioned. Several factors, both internal (such as the women's self-awareness and beliefs) and external (such as professional or instrumental feedback), influence the degree to which the women stick to their home PFM exercise programs. As a result, women may be more inclined to stick to their physiotherapy treatment plans if they incorporate home exercises and easy movements that everyone can do together. A better understanding of the pelvic region, the significance of pelvic floor muscle (PFM) treatment, and the possibility of PFD deteriorating can help women stick to the exercises.

Effect of home-based core exercises on postpartum stress urinary incontinence during COVID-19 pandemic in Jeddah city: a randomised control trial

Article

Full-text available

Mar 2024

Introduction Introduction. Postpartum stress urinary incontinence affects many women worldwide; it may exist during pregnancy or postpartum with a risk of permanence increasing five years later. This study aimed to determine the effect of home-based core exercises on postpartum stress urinary incontinence during the COVID-19 pandemic, in Jeddah city. Methods Randomised control trial was conducted on 26 postpartum women aged 25–40 years with mild or moderate grade stress urinary incontinence and a body mass index (BMI) less than 30 kg/m2. Participants were randomly divided into two equal groups (A & B). Group A performed home-based core exercises and pelvic floor muscle training for twenty-four sessions three times weekly for eight weeks; each session lasted 30 minutes. Group B performed home-based PFMT only. The assessment of pelvic floor muscles (PFMs) was measured with the Modified Oxford Grading Scale, while the 1-hour pad test and International Consolation on Incontinence questionnaire-short form (ICIQ UI- SF) total score served to assess incontinence severity before and after treatment. Results The results showed a significant improvement in PFMs strength and endurance in both groups and there was a highly significant difference between groups, favouring the study group (A). There was a highly significant difference between the groups in the 1-hour pad test and ICIQ-SF total score, favouring the study group (A). Conclusions Home-based core exercises for postpartum SUI women were an effective method to improve PFMs strength and endurance and minimise SUI symptoms.

Supportive Exercises For Cancer Patients

Chapter

Full-text available

Feb 2024

Hajer Alhinai

Cancer is a major health issue that significantly contributes to mortality worldwide. In 2023, an estimated 1,958,310 new cancer cases were projected in the United States. Individuals with cancer may suffer from physical impairments, fatigue, psychological and social issues that reduce their quality of life. Cancer treatments (post-operation, chemotherapy, or radiotherapy) can cause several side effects. Exercises or physical activity are safe and offer a positive impact before, during, and after cancer treatment, encompassing aerobic, resistance, balance, flexibility exercises and others. Exercises improve quality of life, muscle power, and cardiovascular fitness, while also preventing other diseases and reducing the risk of cancer recurrence and death. The aim of this chapter is to clarify exercises’ role in cancer patients. The choice of exercises depends on the diagnosis and patient tolerance, considering contraindications. Physical activity programs should be informed by guidelines, and individualized in intensity, duration, type, and frequency to achieve maximum positive impact.

Comparing the Effects of Hypopressive “Exercise”and Kegels Exercise for Pelvic Organ Prolapse among “Patients with” Spontaneous Vaginal Delivery

Article

Full-text available

Jan 2024

Background: This study was designed to inspect the effectiveness of Hypopressive exercise and Kegels exercisefor pelvic organ prolapse among patients with spontaneous vaginal delivery. Pelvic organ prolapse is when one ormore organs of the pelvis slip down from their normal position and bulge into vagina. Hypopressive exercises helpto rectify the prolapse and minimizes its severity. Kegels exercises are usually done for pelvic floor muscle training.Purpose: To compare the effectiveness of Hypopressive and Kegels exercise for pelvic organ prolapse amongspontaneous vaginal delivery.Materials and Methods: Total of 42 participants were selected from C3 Care Cure Comfort clinic according toinclusion and exclusion criteria, and the participants were explained about the treatment and written consentwere obtained. The subjects underwent study for a time period of 4 months from April 2023-July 2023 and resultswere obtained. The participating subjects were randomly allocated into two groups, Hypopressive exercise group“and” Kegels exercise group. All the subjects underwent pre-test measurement with modified oxford scale andpelvic floor impact questionnaire at the beginning of the treatment.Results: statistical analysis of data showed significant differences not only in the Hypopressive group but also inthe Kegels exercise group. The Hypopressive group was significantly higher than Kegels exercise group, with a pvalue of <0.0001.Conclusion: Hypopressive exercise is more effective than Kegels exercise for pelvic organ prolapse amongspontaneous vaginal delivery. The study was done for a short period of time with a small group of people.

An Osteopathic Approach to Urinary Incontinence Including Biopsychosocial Aspects and Multiple Modalities for a Holistic Approach to Optimize Ongoing Care

Article

Dec 2023

Urinary incontinence is a nuanced and stigmatized condition that causes significant challenges for a large number of people in the United States and imposes a large financial and community burden. We provide an overview of major categorizations of incontinence by type as well as potential etiologies. We discuss how this condition impairs self-image, interferes with socialization, and can lead to depression and isolation; these elements inter-relate with access to care and implementation of the therapeutic options, further exacerbating patient suffering. We recognize the key components of patient evaluation regarding history and physical examination. Medicinal, surgical, and assistive device use are reviewed. Osteopathic manipulative treatments addressing the structures of the pelvis are also reviewed in detail. We illustrate how these techniques can be used to optimize outcomes. Utilizing a holistic approach to mitigate the multiple challenges that this condition presents can lead to greater success, reduced distress, and improved patient satisfaction.

Training of Pelvic Floor Muscle Training Improves the Severity and Quality of Urine Incontinence and Increases Social Participation of Older Women in Southern Iran

Article

May 2024
Curr Aging Sci

Background Aging and gender are risk factors for urine incontinence, which can lead to psychological, physical, and social complications. Objective This community-based study investigates the effectiveness of pelvic floor muscle training on the severity and quality of urine incontinence and social participation of older women. Methods This quasi-experimental community-based study was performed with the participation of 60 older women referring to the Public Health Center in Kerman City, southern Iran. The experiment group was trained with pelvic floor muscle training in 7 training sessions with distance health education in the second half of 2021. Before and after the intervention, data were collected based on: demographic, severity and quality of urine incontinence, and social participation inventories. Data were analyzed using a t-test and ANOVA (P ≤ 0.05). Results The mean scores of severity and quality of urine incontinence and social participation in the experiment and control groups before receiving the intervention were not statistically significant (P ≥ 0.05). But after that, a statistically significant difference was observed between the groups (P <0.05), which showed an improvement in the severity and quality of urine incontinence scores as well as SP in the experiment group. Conclusions Tele-training of the Kegel exercise, even during the pandemic, can play an important role in improving incontinence and social participation in older women. Therefore, this training can be used to prevent and improve urine incontinence in public health centers in the community.

A Delphi consensus to standardize the technique of anatomical endoscopic enucleation of prostate: a study by ESUT endoscopic enucleation of prostate study group

Article

Full-text available

Jul 2023
WORLD J UROL

Purpose Our objective was to establish a standardized technique for Anatomical Endoscopic Enucleation of Prostate (AEEP) utilizing a consensus statement to provide robust recommendations for urologists who are new to this procedure. Methods The participants were electronically sent a questionnaire in three consecutive rounds. In the second and third rounds, the anonymous aggregate results of the previous round were presented. Experts’ feedback and comments were then incorporated to refine existing questions or to explore more controversial topics in greater depth. Results Forty-one urologists participated in the first round. In the second round, all Round 1 participants received a 22-question survey, resulting in a consensus on 21 items. In the third round, 76% (19/25) of the second-round respondents also participated, reaching a consensus on 22 additional items. The panelists consensually agreed on detaching the urethral sphincter at the beginning of the enucleation and not at the end of the enucleation. To prevent incontinence, it was recommended that the apical mucosa be preserved through various approaches between 11 and 1 o’clock while gently disrupting the lateral lobes in their apical part, avoiding an excess energy delivery approximation to the apical mucosa. Conclusion To optimize laser AEEP procedures, urologists must follow expert guidelines on equipment and surgical technique, including early apical release, using the 3-lobe technique for enucleation, preserving apical mucosa with appropriate approaches, gently disrupting lateral lobes at their apical regions, and avoiding excessive energy delivery near the apical mucosa. Following these recommendations can lead to improved outcomes and patient satisfaction.

Upaya Meningkatkan Pengetahuan dan Keterampilan Perempuan Menopause tentang Senam Kegel dalam Pencegahan dan Penanggulangan Dispareunia

Article

Full-text available

Apr 2023

The increasing number of menopausal women has an impact on health problems, including dyspareunia which can be treated by Kegel exercises. Posbindu is a place to get to learn about and develop healthy lifestyle, however in Posbindu RW 01 and 03 Pajajaran Subdistrict there is no educational program related to Kegel exercises and menopause. The purpose of this community service is to increase the knowledge and skills of postmenopausal women regarding Kegel exercises in the prevention and treatment of dyspareunia. The method used was training and mentoring for Posbindu cadres RW 01 and RW 03 Pajajaran Village, the working area of the Pasirkaliki Health Center in Bandung, which was carried out from May to September, the evaluation was carried out 2 times, namely the pretest and post test. The targets were 20 posbindu cadres and 40 menopausal women. The results show an average increase in knowledge of cadres of 19.16 points and skills of 92.49 points. The average knowledge of postmenopausal women also increased by 20.83 points, and skills increased by 90.82 points. Cadres after being trained feel more confident in providing education and becoming Kegel exercise instructors. In conclusion, training and mentoring for cadres can motivate menopausal women to do Kegel exercises as a prevention and treatment of dyspareunia. It is recommended that the Pasirkaliki Health Center continue coaching the implementation of Kegel exercises at Posbindu RW 01 and RW 03, and disseminate them to other cadres in their working areas.

Analysis of pelvic floor electromyography in women screened 42 days postpartum: A cross-sectional study

Article

Full-text available

May 2023
MEDICINE

To investigate the characteristics of pelvic floor surface electromyography parameters on the basis of Glazer assessment in women 42 days postpartum, and to analyze the predictive value of surface electromyography (sEMG) in postpartum stress urinary incontinence. This is a retrospective study. Three thousand twenty-nine females in total who were screened 42 days postpartum in Jinniu District Maternal and Children's Health Hospital of Chengdu from January 2019 to December 2020 were selected, and were randomly allocated into stress urinary incontinence (SUI) (n = 509) and the non-SUI group (n = 2520). Pelvic floor surface electromyography was performed by the same physiotherapists. The evaluation parameters included the average EMG value in the pre-resting baseline, the maximum sEMG value, the rising time, the descent time in the fast-twitch phase, and the average sEMG value in the slow-twitch phase. Mean value and modifiability of EMG value in post-resting stage. The disparities of the mentioned parameters hereinabove in the SUI and non-SUI groups were made comparison, and the relationship between stress urinary incontinence and sEMG parameters was analyzed by multiple logistic regression analysis. The prevalence of SUI was 16.8% in women 42 days after delivery. Body mass index and vaginal delivery were risk factors for SUI. Among the sEMG parameters of the SUI group and the non-SUI group, the maximum EMG values in the fast-twitch phase (28.81 ± 14.41 vs 30.41 ± 15.15), the rising time in the fast-twitch phase (0.55 ± 0.36 vs 0.51 ± 0.30), and the Phase descent time (0.76 ± 0.76 vs 0.68 ± 0.65), mean slow-twitch phase EMG (17.82 ± 10.10 vs 19.69 ± 15.62), slow-twitch phase variability (0.28 ± 0.12 vs 0.26 ± 0.10), are statistically different (P < .05). In the SUI group, body mass index (estimated parameter = 0.029, P = .023), mean EMG during slow-twitch phase (estimated parameter = -0.013, P = .004) were relevant to stress urinary incontinence after delivery. The sEMG based on Glazer protocol indicates the activity of slow-twitch muscle fibers in SUI patients are decreased, and there is a correlation with the occurrence of stress urinary incontinence. sEMG can be applied as a quantitative evaluation tool of the pelvic floor analysis in postpartum SUI.

Effect of Kegel exercises on distress symptom and quality of life in elderly Pakistani female with urinary incontinence- a randomized control trial

Article

Full-text available

Mar 2023

Background: The stress urinary incontinence was the reason the affected women experienced anxiety and depression. the more severe the symptoms of stress urinary incontinence were, the more negative impact to aspects of quality of life was seen. Objective: To determine the effects of Kegel exercises on distress symptom and quality of life in elderly Pakistani female patients with stress urinary incontinence. Methodology: A single-blinded, randomized control trial was conducted on n=50 female patients having stress urinary incontinence at department of physiotherapy, Haleema Siraj Hospital Rawalpindi from January 2021 to June 2022. The participants with the age above 55 years were recruited through non-probability convenient sampling technique and divided into experimental and control group; n=25 participants in each group. The experimental group received Kegel exercise as an intervention for three months and 3-4 time/day. While control groups didn’t received any intervention but continue the regular medicines. Both groups was evaluated pre and post interventionally (after 3-months) by using urinary distress inventory (UDI) for distress symptoms and incontinence impact questionnaire (IIQ) for quality of life. SPSS version 21 was used for data analysis. Independent t-test was used for between group comparisons of mean differences. Results: The mean age of the study participants was 65.00±8.90 years. Between group analysis, showed that symptom distress {MD=16.21, 95%CI (3.10 to 14.55) on urinary distress inventory (short Form), and life quality {MD=8.83, 95%CI (3.10 to 14.55) on incontinence impact questionnaire significantly greater in experimental group as compared to the control group. Conclusion: Kegel exercises significantly improved distress symptoms and quality of life in females with stress incontinence. Keywords: Elderly, incontinence, Kegel exercises, stress incontinence.

Mitigating Symptoms and Enhancing Quality of Life among Women with Stress Urinary Incontinence

Article

Full-text available

Oct 2021

Effect of Kegel Exercises on Lower Urinary Tract Symptoms in Young Gymnasts: A Prospective Cohort Study

Article

Jan 2023

Importance: Lower urinary tract symptoms (LUTS) have been shown to exist in young athletes. The use of pelvic floor muscle training as a preventive strategy at an early age may be useful to avoid possible pelvic floor dysfunction in the future. Objectives: The aim of the study was to describe LUTS in underaged gymnasts. We also aimed to evaluate the effects of a 12-week Kegel exercise intervention for LUTS and urinary incontinence (UI) and their relationship to bother. Study design: A quasi-experimental (nonrandomized, noncontrolled) pre-post study was conducted. Nineteen gymnasts with a mean age of 13.21 ± 1.84 were selected from a gymnastics club in Madrid, Spain. Outcomes of LUTS and quality of life were measured using the International Consultation on Incontinence Questionnaire-Female Lower Urinary Tract Symptoms validated questionnaire at baseline and at the end of the 12-week intervention. Results: The participants presented with certain LUTS such as urgency UI (57.7%) or stress UI (47.4%), which negatively affect their daily lives by feeling annoyed in various aspects (when practicing gymnastics, getting up during the night to urinate or feeling bladder pain among others). No significant differences in LUTS and quality of life variables were observed after the exercise intervention (P > 0.05). Conclusions: A high prevalence of LUTS was observed in a sample of underaged high-level gymnasts. The 12-week Kegel exercise intervention did not significantly reduce the presence of pelvic floor problems and even intensified some of them, probably because of an increased awareness. Pelvic floor muscle training as a preventive strategy at an early age seems to be necessary to avoid possible pelvic floor dysfunction in the future.

Effect of monopolar capacitive resistive radiofrequency in treating stress urinary incontinence: A pilot randomized control trial

Article

Full-text available

Jan 2023

Objective To assess the effectiveness of 448 kHz monopolar capacitive resistive radiofrequency (MCRR) in the treatment of females with stress urinary incontinence (SUI). Materials and methods Forty females with SUI complaints were separated randomly into two equal groups. Group A with 20 females received the MCRR therapy for 20 min and performed pelvic floor exercises for 20 min. Group B with 20 females received placebo treatment by applying the same application as in Group A without emitting any waves for 20 min, three times a week, for 4 weeks. The patients in both groups were instructed to pause the treatment during their menstruation; the patients were instructed to maintain home pelvic floor exercises. Both groups were assessed by a perineometer that was used to assess the strength of the pelvic floor muscles (PFM), the visual analogue scale (VAS), and the Incontinence Symptom Severity Index to assess the frequency of urinary incontinence symptoms as described by each patient before treatment and after 4 weeks of treatment. Results There was a significant reduction (p < 0.05) in VAS and the Incontinence Symptom Severity Index and a significant increase in the strength of the PFM in both groups post-treatment compared with the pre-treatment. Regarding between-subject effects, there was a significant difference in VAS, the Incontinence Symptom Severity Index, and the perineometer between both groups (p < 0.05), and this significant improvement favored Group A. Conclusion MCRR and pelvic floor exercises are more effective methods for the treatment of SUI than just pelvic floor exercises of females with SUI. Clinical Trial Registration ClinicalTrials.gov. Identifier: NCT04612205.

The role of visceral therapy, Kegel's muscle, core stability and diet in pelvic support disorders and urinary incontinence -including sexological aspects and the role of physiotherapy and osteopathy

Article

Full-text available

Dec 2022
Ginekol Pol

Proper diet and physical activity are a form of prevention of female genital prolapse disorders. The causal substrate of pelvic floor dysfunction is multifactorial. Fifty percent of women over the age of 50 have pelvic organ prolapse, often accompanied by urinary incontinence. It is a complicated social and medical (urogynecological and sexological) problem. The authors conducted a literature review on the role of visceral therapy, Kegel and core stability exercises and diet in pelvic support disorders and urinary incontinence. The eligible articles provided insights into sexological factors, as well as the role of osteopathy and physiotherapy. These results provide new insights into the relevance of clinical practice. In addition to standard treatment methods used in gynaecology, sexology, physiotherapy and osteopathy (e.g., visceral therapy), Kegel muscle and core stability exercises are becoming increasingly important. The aim of visceral therapy is to restore the mobility of the organs while reducing increased tension and improving blood and lymph circulation. This has the effect of reducing pain sensations, thereby influencing the function of the uterus and ovaries.

Analysis of the status quo of pelvic floor muscle and the effect of pelvic floor muscle training in second pregnant women

Article

Full-text available

Nov 2022
MEDICINE

Objective: This study aims to investigate the current situation of pelvic floor muscle (PFM) in the second trimester postpartum 42 days by detecting the electrophysiological indexes of PFM on pelvic floor rehabilitation after 2 months. Methods: In total, 198 cases of second child puerpera were selected, who were delivered in our hospital between June 1, 2020, and December 10, 2020, and underwent outpatient reexamination 42 days after delivery. Results: Except for the rest post-baseline stage values, the pelvic floor surface electromyography evaluation values significantly differed from each other at the considered time points in group A, P < .05; on day 72 in group B, no obvious improvement in the evaluation values was observed as than those on day 42 (P > .05) except for the endurance contractions stage values. However, on day 102, all values were markedly different at each considered time point (P < .05). On day 102 postpartum, the evaluation values of group A in the rest pre-baseline stage, the time before and after peak of phasic (flick) contractions stage, and the endurance contractions stage were significantly improved to those in group B with all P < .05. On day 42 after parturition, each index of the tonic contractions stage was higher after spontaneous labor than that after cesarean; the differences were all significant, P < .05, but on day 102 postpartum, all of the values exhibited no difference between the 2 modes. In only the phasic (flick) contractions stage at 42th, were the values of younger mothers obviously higher, P = .025; the other stage values for different ages of women during different time periods were not statistically significant, P > .05. Conclusions: In the short term, the effect of biofeedback plus electrical stimulation on the PFM function in second pregnant women was better than that of the Kegel exercise, but with time, there was no significant difference between the 2 training methods on the recovery of the PFM.

The The Long-term Effects of Transurethral Bladder Neck Incision in the Treatment of Female Bladder Neck Obstruction

Article

Oct 2022

Purpose: To investigate the long-term effects of transurethral bladder neck incision (TUBNI) for female primary bladder neck obstruction (PBNO). Materials and Methods：We retrospectively reviewed seventy women diagnosed with bladder neck obstruction by video-urodynamic study (VUDS). TUBNI was performed for each patient, with incisions made at 2 different sites on the bladder neck. Postoperatively, patients were assessed by international prostate symptom score (IPSS), quality of life (QOL) and uroflowmetry. Results：Follow-up data were available for 4-108 months (median 42 months) postoperatively. During follow-up, the IPSS, QOL, time to maximum uroflow rate, postvoid residual urine volume decreased significantly after TUBNI compared with preoperative [13.0 (10.0, 15.0) versus 3.0 (3.0, 8.0), P＜.001], [5.0 (5.0, 5.0) versus 2.0 (1.0, 3.0), P＜.001], [9.0 (5.0, 37.0) versus 6.1 (4.2, 8.7), P＜.001], [77.5 (23.5, 165.8) versus 0.0 (0.0, 30.0), P＜.001]. The maximum uroflow rate, average uroflow rate and the voided volume increased significantly compared with preoperative [7.0 (4.0, 10.3) versus 19.8 (12.8, 25.2), P＜.001], [3.0 (2.0, 5.0) versus 8.0 (4.9, 10.7), P＜.001] and [156.5 (85.0, 211.3) versus 261.3 (166.2, 345.6), P＜.001]. Several complications were identified after surgery, including bladder neck reobstruction, urethral stricture, and stress urinary incontinence, the corresponding number was 5 (7.1%), 7(10%) and 7(10%). Successful operation was achieved in 60/70 (85.7 %) patients. Conclusion：PBNO is a very rare yet easily treatable condition. VUDS is the primary diagnostic tool for the diagnosis of bladder neck obstruction in women, while TUBNI can effectively relieve obstruction symptoms and improve the quality of life for patients.

Impact of Urinary Incontinence on Quality-Of-Life among Females Receiving Pelvic Floor Muscles Strengthening Exercises for Urinary Incontinence

Article

Full-text available

Sep 2022

Background: Among women urinary incontinence (UI) is the most familiar problem and complain of lower urinary symptoms in urinary incontinence has found between 15% and 55%. It is a symptom with a lot of influence on quality of life of women majorly in their community-based, confidential and sexual domains. Aim: To see the impact of urinary incontinence on quality of life among females receiving pelvic floor muscles strengthening exercises for urinary incontinence. Study design: Cross-sectional study. Methodology: Patients (n=165) females with urinary incontinence were enrolled. The effect of urine incontinence on female quality of life, as well as the effect of pelvic floor muscle strengthening exercises on urine incontinency. The study inquired about the respondents' backgrounds, daily routines, and the impact of incontinence on their social relationships, as well as the effects of urine incontinence on emotional and mental health. All female volunteers who have been dealing with urine incontinence for a few months will be included in the study. Analysis of data was done by SPSS v.26. Results: They were having physiotherapy for urine incontinency and it had not affected their quality of life but shown a positive effect in their household, social and personal activities. When the standard scoring method of IIQ-7 questionnaire applied the results of 0=Not at all,1= slightly, 2= moderate, 3= greatly, total mean of 7 items was 2.60 and 85% out of 100 get recovered and their quality of life improved by physiotherapy. Conclusion: It was concluded that the females who were receiving pelvic floor muscles strengthening exercises had good quality of life and urinary incontinence had not affected their quality of life (IIQ-7 score = 2.60) and had good impact on their quality of life. Keywords: Urine Incontinency, Quality of Life, Physiotherapy and Pelvic Floor Muscles.

Sexually Induced Orgasm to Improve Postpartum Pelvic Floor Muscle Strength and Sexual Function in Primiparous Women After Vaginal Delivery: A Prospective Randomized Two-Arm Study

Article

Sep 2022
J SEX MED

Background: Postpartum pelvic floor dysfunction is known to affect the quality of life of women and the methods to treat it are more complex with majority requiring training under supervision. Aim: To compare the efficacy of sexually induced orgasm along with Kegels exercises versus Kegels exercises alone as a treatment method to enhance postpartum pelvic floor muscle strength and sexual function in primiparous women undergoing uncomplicated vaginal deliveries. Methods: The prospective randomized two-arm study was conducted on sexually active primiparous women who had undergone uncomplicated vaginal deliveries. Those with risk factors for female sexual dysfunction and pelvic floor muscle dysfunction were excluded. Participants in Group 1 were advised daily Kegel's exercises, whereas, those in Group 2 were advised to initiate self-initiated/partnered sexual activity-induced orgasms along with daily Kegel's exercises. Their pelvic floor muscle strength on voluntary contraction, ability to relax pelvic floor voluntarily, and sexual function (using FSFI-6) were assessed monthly for 6 months and the analysis was done using G* Power software (© 2021 Heinrich-Heine-Universität Düsseldorf, Germany). Main outcome measure: Postpartum pelvic floor strength and sexual function in 2 groups of women under study. Results: The study period was from January 2020 to December 2020. The Group 1 had 26 participants (mean age 29.69 ± 2.2 years) and Group 2 had 29 participants (mean age 30.07 ± 2.57 years). The sexual function as well as ability to relax pelvic floor were significantly better in Group 2 compared to Group 1 at each monthly intervals whereas strength of pelvic floor muscles during voluntary contraction was significantly higher in Group 2 compared to Group 1 at the end of 6 months and it was statistically significant at a P value of .05. Clinical implications: Novel method of using naturally occurring sexually induced orgasms for postpartum pelvic floor rehabilitation can revolutionize postpartum pelvic floor training in women, as it can be practiced at home with ease, along with easily performable Kegel's exercises. Strengths and limitations: Use of prospective randomization and minimization of confounding factors is the strength of the study. The small sample size is the limitation of the study. Conclusions: Postpartum pelvic floor muscle strength and sexual function in primiparous women who have undergone uncomplicated vaginal deliveries can be significantly improved with the addition of sexually induced orgasm as a therapeutic tool along with physical exercises such as Kegels exercises in these women. Bhat GS, Shastry A. Sexually Induced Orgasm to Improve Postpartum Pelvic Floor Muscle Strength and Sexual Function in Primiparous Women After Vaginal Delivery: A Prospective Randomized Two-Arm Study. J Sex Med 2022;XX:XXX-XXX.

The effect of the Incontinence Health Belief Development Program on women’s urinary incontinence awareness and health beliefs: a randomized controlled trial

Article

Sep 2022

Introduction and hypothesis: This study is aimed at determining the effects of the Incontinence Health Belief Development Program (IHBDP) on the urinary incontinence awareness and health beliefs of women in the pre-menopausal period. Methods: This randomized controlled study was conducted in 160 eligible women. The pre-test and post-test data of the study were collected from experimental and control groups using the Socio-Demographic Characteristics Information Form, the Incontinence Awareness Scale, the Health Belief Scale on Urinary Incontinence and Kegel Exercise, and the Broome Pelvic Muscle Self-Efficacy Scale. The IHBDP was implemented with members of the experimental group for 5 weeks. Results: The women in the experimental group showed a significant difference in mean scores at the end of the program on the UI Awareness Scales, the Health Belief Scale on UI, and the Kegel Exercise compared with pre-training scores (p<0.05). In the experimental group, the factor scores and the total score of the Broome Pelvic Muscle Self-Efficacy Scale also increased. Furthermore, a statistically significant total score increase (p<0.05) was observed at the end of the program (79.8±8.8) compared with before the program (35.2±19.6). Conclusions: The training given to the women in the pre-menopausal period based on the Health Belief Model appears highly effective in raising awareness about UI, fostering beliefs about Kegel exercises and increasing pelvic floor muscle self-efficacy.

Impact of Kegel Exercises and Transcutaneous Tibial Nerve Stimulation on Low Back Pain in Women with Stress Urinary Incontinence: A Randomized Controlled Trial

Article

Full-text available

Jan 2022

Background: Low back pain (LBP) was evidenced to be associated with stress urinary incontinence (SUI), both of which are common problems in women. Aim: This study aimed to determine the impact of Kegel exercises and transcutaneous tibial nerve stimulation (TTNS) on LBP in women with SUI. Methods: Forty-five females complaining of LBP associated with SUI were randomly chosen from the outpatient clinic at Deraya University. Their ages varied from 35 to 45 years, their body mass index (BMI) was 25-30 kg/m 2 , with a number of parities ≤ three normal vaginal deliveries.

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.

The CO2 ablative laser treatment in perimenopausal patients with vulvovaginal atrophy

Article

Sep 2021
Ginekol Pol

Objectives: The aim of the study was to evaluate the effectiveness of CO₂ fractional laser therapy on perimenopausal urogenital symptoms. Material and methods: This prospective, open-label study included 205 patients who received three CO₂ laser treatments. Clinical assessment was checked at baseline as well as at six weeks and 12 months post-treatment. The following scores were measured Vaginal Health Index Score (VHIS), International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form (ICIQ-UI SF) and assessment of the severity of selected urogenital symptoms. Results: Significant improvements in dryness, dyspareunia, burning, vaginal laxity, urinary incontinence, as were the results on the VHIS and ICIQ-UI SF at six weeks post-treatment (p < 0.05 for all scores), which were maintained through the follow-up visit at 12 months. No complications were observed either during or after laser therapy. Conclusions: CO₂ ablative laser treatment can be effective in reducing vulvovaginal atrophy symptoms such as vaginal laxity, dryness, painful sexual intercourse, burning, and decreases the severity of stress urinary incontinence and urge incontinence symptoms. Positive results were maintained at 12 months after the laser treatment.

Is hyacinth exercise better than pelvic floor exercise alone for urinary incontinence: A randomized trial

Article

Full-text available

Aug 2021

Urinary Incontinence (UI) negatively impact women’s physical, psychological and health-related quality of life. Pelvic strengthening exercise is the first line management in UI. We hypothesized that Hyacinth exercise is better than Pelvic Floor Exercise (PFE) in strengthening pelvic floor muscles, thus reducing female urinary incontinence. This randomized controlled trial involved 180 women with UI. Participants were taught on either Hyacinth exercise or PFE alone. Improvement in urinary symptoms and pelvic muscle strength were evaluated using a validated female pelvic floor questionnaire and objectively measured at 2 months and 6 months. Significant improvement in urinary symptoms and pelvic muscle strength post treatment at 2 months and 6 months was seen in both groups with p≤0.001. Although earlier improvement seen in Hyacinth group, it did not reach level of significant when compared, between the two exercises. Mean bladder score (PFE vs Hyacinth arm) 9.13±6.54 vs. 8.74±5.21, p=0.93 (2 months) and 5.80±4.15 vs. 5.79±4.22, p=0.92 (6 months). Although there was no statistical difference between the two groups for our primary and secondary outcomes, Hyacinth group demonstrated earlier improvement in urinary symptoms at 2 months.

Effectiveness of Specific Lumbar Stabilization Exercise for LBP among Postpartum Women: A Quasi-Experimental Study

Article

Jun 2021

Background: Postpartum back pain is common, with up to 75% of women experiencing back pain immediately following birth due to ligament laxity and postural changes. Besides the lack of pelvic floor muscles strength, urine leakage problem during coughing and sneezing also arises in this condition. The purpose of this study was to explore the effect of stabilization exercise (SE) and Kegel exercise. Objective: To evaluate the pain intensity in rest and different functional activities before and after introducing spinal stabilization exercises in postpartum women with low back pain and also find out the effect of Kegel exercise. Study Design: A Quasi-Experimental (one group) pretest-posttest design was used. Methodology: 27 patients who were fulfill inclusion criteria within this study period with postpartum low back pain, attended at Gynecological and Women's Health unit, CRP, Mirpur, Dhaka was purposively chosen to conduct the study. Spinal stabilization exercise was applied to the participants to find out the effectiveness of this exercise. Kegel exercise was also introduced who have urine leakage problem among 27 patients. Participants received the exercise for 45 minutes, 2 times a week & total 6 weeks. Besides this they performed the exercises at home 5 times a day also. A numeric pain rating scale was used to measure pain intensity in different functional activities such as swiping, squatting, chair sitting, heavy weight lifting, walking, and journey by bus or rickshaw, and stair climbing. Pain score was analyzed by calculating the "Wilcoxon Signed Ranked Test". Results: Results showed that relative improvement occurs in all participants in the experimental group. Pain scores on numeric pain rating Scale on different functional activities such as during toilet sitting, stair climbing, walking, during weight lifting, were relatively reduced which was also statistically significant (p≤ .05). Participants who have a urine leakage problem also recover from this problem. Conclusions: Lumbar stabilization exercises has effect on reducing pain and improving functional activities, and to solve the urine leakage problem Kegel exercise effective.

POST HYSTERECTOMY PHYSIOTHERAPEUTIC PROTOCOL FOR CORE MUSCLES AND PELVIC FLOOR MUSCULATURE STRENGTHENING IN CASE OF ADENOMYOSIS

Article

Jul 2021

Chitrakshi Choubisa

Adenomyosis is an important gynecological condition. It is considered a benign uterine disorder that shows a pathological demonstration of the endometrial gland and stroma in the uterine myometrium. A 42 years old female patient presented with excessive bleeding during menses and irregular menstrual cycle with dysmenorrhea, for 7-8 months. The patient complains of pain for 7-8 months in the lower abdomen region, in the iliac fossa on both left and right side, and is insidious in onset. The patient went to a private hospital where she got diagnosed with adenomyosis and suggest removal of the uterus. The investigation was done which includes CBC, KFT, LFT, and USG abdomen and pelvis which reviled that patient is having Adenomyosis. Vaginal hysterectomy is the least invasive type of hysterectomy, which is having lesser costs and risks which can also be done in women having uterus weighing more than 280g. For managing postoperative complication of hysterectomy various physiotherapy intervention could be given which includes pelvic strengthening exercises, core strengthening, breathing exercises, and yoga poses. The study concluded that hysterectomy may result in post-surgical manifestations which can be effectively managed by early physiotherapy intervention which impacts on quality of life of the patient.

The Efficacy of Pilates on Urinary Incontinence in Korean Women: A Metabolomics Approach

Article

Full-text available

Feb 2021

Pilates has been known as exercise intervention that improves the function of pelvic floor muscle (PFM) associated with impacting urinary incontinence (UI). This study investigated the effect of Pilates on UI in Korean women by determining the change in functional movement of PFM (FMP) and metabolic profiles. UI group with Pilates (UIP, n = 13) participated in 8-weeks Oov Pilates program, and 8 subjects were assigned to Control and UI group with no Pilates (UINP), respectively. Before and after 8 weeks, plasma samples were collected from all participants, and ultrasonography was used to measure the functional change of PFM for calculating FMP ratio. Plasma samples were analyzed by mass spectrometry to identify the change of metabolic features. After 8-weeks intervention, FMP ratio was remarkably decreased in UIP (48.1% ↓, p < 0.001), but not in Control and UINP (p > 0.05). In metabolic features, L-Glutamine (m/z: 147.07 [M + H]+), L-Cystathionine (m/z: 240.09 [M + NH4]+), L-Arginine (m/z: 197.1 [M + Na]+), and L-1-Pyrroline-3-hydroxy-5-carboxylate (m/z: 147.07 [M + NH4]+) were significantly elevated solely in UIP (p < 0.001). Our study elucidated that Pilates can ameliorate the FMP and enhance the specific metabolic characteristics, which was potentially associated with invigorated PFM contractility to effectively control the bladder base and continence.

Do young women have an accurate perception about their pelvic floor muscle contraction? An agreement study about self-perception and physical evaluation of the pelvic muscles contraction by the PERFECT scheme

Article

Apr 2024

Background: Many women have difficulty in activating the pelvic floor muscles (PFM). This is a concerning factor for health professionals and public government institutions, as an unhealthy PFM could be associated with the presence of PFM dysfunctions. Therefore, the aim of the study was to analyze the agreement between the perception of young women about their PFM contraction and the results of a physical assessment, according to the strength, endurance, and contraction repetitions. Method: Cross-sectional study with 43 university students between 18 to 35 years old. Examiner A filled out a semi-structured questionnaire to assess the self-perception of the ability to contract the PFM. The physical exam was performed by bidigital vaginal palpation, conducted by Examiner B blinded to the answers of the previous stage, and according to the PERFECT scheme (P = power; E = endurance; R = repetitions of item “E;” F = fast contractions). Data was assessed by the Cohenʼs linear weighted kappa (Kw). Results: The agreement between the self-perception and the physical evaluation of the PFM function presented a very poor agreement for all the items of the PERFECT scheme (P(Kw)= 0.12; E(Kw)= 0.07; R(Kw)= 0.09; F(Kw)= 0.04). Conclusion: Young women do not have sufficient knowledge about PFM contraction and function. It should concern health government and institutions, as a poor PFM awareness might increase the difficulty to identify signs and symptoms related to PFM dysfunctions and reduces demand for and adherence to PFM treatment programs. Key-words: Pelvic floor, Women’s Health, Muscle function

Effects of sports therapy on improvement of menopausal symptoms, psychological status, and body morphology in perimenopausal women

Article

Mar 2024

Objective The aim of this study was to increase the treatment rate of perimenopausal women by providing evidence-based nonpharmaceutical treatments through developing scientific evidence-based sports therapy and verifying its effectiveness. Methods In a cross-over design, a total of 33 women were assigned to two different sequences of intervention: sports therapy and telephone intervention (n = 17) or telephone intervention and sports therapy (n = 16). A self-reported clinical symptom survey was conducted before and after the experimental and control periods using the following measures: the Menopause Rating Scale, Patient Health Questionnaire 9, and Patient Health Questionnaire 15. Results There were significant differences in the changes in the scores for Menopause Rating Scale total (exercise phase, 17.8 ± 5.5 at baseline [B] and 13.5 ± 4.2 at follow-up [F]; control phase, 15.9 ± 6.0 [B] and 15.4 ± 5.3 [F]; P < 0.01), somatic symptoms (exercise phase, 9.5 ± 2.6 [B] and 6.6 ± 2.0 [F]; control phase, 8.5 ± 2.8 [B] and 8.0 ± 1.3 [F], P < 0.01), and urogenital symptoms (exercise phase, 4.9 ± 1.7 [B] and 4.1 ± 1.4 [F]; control phase, 4.3 ± 1.6 [B] and 4.4 ± 1.5 [F]; P < 0.01) between the exercise and control phases. There were also significant differences in the changes in the scores for PHQ-9 (exercise phase, 4.6 ± 4.4 [B] and 3.6 ± 3.3 [F]; control phase, 4.5 ± 3.8 [B] and 5.5 ± 4.6 [F]; P = 0.008) and PHQ-15 (exercise phase, 7.2 ± 4.4 [B] and 5.5 ± 3.5 [F]; control phase, 6.8 ± 4.4 [B] and 7.2 ± 4.9 [F]; P = 0.009) between the two phases. Conclusions Sports therapy would improve menopause symptoms, especially somatic and urogenital symptoms. In addition, sports therapy would improve depressive moods in perimenopausal women.

Effects of Pilates and Conventional Treatment Methods in The Management of Stress Urinary Incontinence Among Women: Life Sciences- Physiotherapy

Article

Full-text available

Nov 2023

Stress Urinary Incontinence is a common condition among women that requires attention. The main aim of thisstudy was to compare the effects of Pilates and conventional treatment methods in managing stress urinary incontinence amongwomen. This study is an experimental design, comparative pre-post-test type. 30 female subjects with stress urinaryincontinence were randomly divided into groups, Group A and Group B, with 15 subjects in each group. Group A receivedPilates exercises, and Group B subjects received conventional Kegel's exercises. The study duration was 12 weeks. The pad test,cough stress test, and International Consultation on Incontinence (ICIQ) Questionnaire were outcome measures. The results ofthis study revealed that on comparing the Mean values of Group A & Group B on the International Consultation onIncontinence Questionnaire (ICIQ) and Pad test, Group A (Pilates Exercise) showed 4.46 and 4.93 post-test values which weremore effective than Group B (Conventional kegel's Exercise) at 8.60 and 9.46 at P ≤ 0.001. The Pilates group experienced ahighly significant improvement on the cough stress test compared to the conventional group at P< 0. 001.Pilates exercises wereproven highly effective in managing stress urinary incontinence among women. This study is one of its kind, which demonstratedthe effect of Pilates and its clinical usage for the effective management of Stress Urinary Incontinence.

Neuromodulation effect of laser acupuncture on female stress urinary incontinence: a randomized controlled trial

Article

Full-text available

Feb 2022

Although the impact of electroacupuncture or needle acupuncture on stress urinary incontinence (SUI) was previously investigated, there are no previous studies that have investigated the neuromodulatory impact of laser therapy on neurogenic acupoints in women with SUI. The aim of this study was to determine the neuromodulation mechanism of laser therapy on neurogenic acupoints in women with SUI. A prospective, randomized, controlled trial, pre, and post-experimental study was carried out. Thirty women with SUI were equally assigned into two equal groups (control and study groups). The control group received pelvic floor exercises for 6 weeks (n=15), while the study group received the same pelvic floor exercises for 6 weeks in addition to laser acupuncture on neurogenic acupoints (n=15). Before and after rehabilitation, pelvic floor muscle strength (PFMS) was assessed with the XFT-0010 Pelvic Muscle Trainer device, SUI severity was assessed with the Severity Index (SI) for urinary incontinence, and the impact of SUI on quality of life (QOL) was assessed with the International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form (ICIQ-SF). Comparison between the two groups after treatment showed a significant improvement in PFMS and significant reductions in scores of SI for urinary incontinence and ICIQ-SF (p<0.05). The neuromodulatory impact of laser application on neurogenic acupoints significantly increases the strength of pelvic floor muscles and significantly decreases the incontinence level and its impact on QOL in women with SUI.

Effect of anterior vaginal wall prolapse repair by modified transvaginal mesh surgery: a retrospective cohort study

Article

Full-text available

Feb 2023
ARCH GYNECOL OBSTET

Objective To explore clinical outcomes and complications of modified Transvaginal mesh (M-TVM) for advanced anterior vaginal wall prolapse in 1 year follow-up. Methods 574 patients underwent TVM surgeries from 2019 to 2020 were collected and divided into TVM group and M-TVM group, all preoperative and postoperative data was obtained and compared between the two groups. Results 285 women were involved eventually, including 181 in TVM group and 104 in M-TVM group. No significant difference of general conditions was found between these two groups. After long-term follow-up, patients in TVM group were more likely to suffer from pelvic pain than M-TVM group (P = 0.046). Meshes seemed much wider in M-TVM group (4.5 ± 0.69 cm) than in TVM group (3.0 ± 0.91 cm). No matter TVM or M-TVM, surgeries can significantly change point Aa and Ba when compared to preoperative data. Compared to TVM group, point C and D were significant changed in patients in M-TVM group after surgery (P < 0.001) Conclusion M-TVM is a commendable procedure that can significant correct anterior prolapse with mesh extended wider, and also supply stable apical support at the same time.

Effectiveness of Kegel exercise and lubricant gel for improving sexual function in menopausal women: A randomized trial

Article

Jul 2022
EUR J OBSTET GYN R B

Background There are different approaches to improving sexual function among menopausal women including Kegel exercise and using lubricant gel. However, it is not clear which of these methods could be more effective. This study aimed to compare the effectiveness of these two methods on sexual function in menopausal women. Methods The present randomized trial was conducted on 150 menopausal women in Dezful, Iran. Eligible women were randomly assigned to two interventions (Kegel exercise and lubricating gel) and one control groups. The Kegel exercise group received training on the exercise method; the lubricant gel group was given the lubricating gel and taught how it should be used, while the control group received no intervention. The interventions continued for 12 weeks, and sexual function was assessed at four times: baseline, one month, two months, and three-months follow-up. Chi-square test, one-way analysis of variance, repeated measures, analysis of covariance, and logistic regression analyses were applied. Results No significant difference was found between groups regarding demographic and obstetrics variables. After adjusting for the baseline sexual function score, covariate analysis showed a significant improvement in sexual function in Kegel and gel groups as compared to the control group. Similarly, within-group comparison using repeated measures analysis showed that sexual function in both Kegel and gel groups improved during the study follow-up periods while women in the control group showed no changes in their sexual function. Finally, logistic regression analysis indicated a significantly higher odds ratio for better sexual function in both Kegel and gel groups. However, the odds of better sexual function for the Kegel group (OR = 4.19, 95% CI: 1.81-9.72, P = 0.001) was higher than the gel group (OR = 3.7, 95% CI: 1.42-7.52, P = 0.005). Conclusion Both Kegel exercise and gel were effectively improved sexual function in menopausal women. However, the findings indicated that sexual function was more likely to be improved after using Kegel exercise than using lubricant gel. Trial Registration IRCT20150128020854N7. Registered 30 September 2019, https://fa.irct.ir/user/trial/40878/view.

Medicare Patient Referral Networks to Pelvic Floor Physical Therapy Across the United States

Article

Mar 2022
J Pelvic Med Surg

Objective: The purpose of this study is to evaluate the distribution of referrals to pelvic floor physical therapy throughout the United States and to identify specialties with the highest and lowest referral rates. Referral networks to pelvic floor physical therapy were identified, and factors associated with referral connections were determined. Methods: This retrospective network analysis of referrals examined U.S. Centers for Medicare and Medicaid Services data from 2009 to 2017. Pelvic floor physical therapists were identified, and their patient-sharing networks were modeled using social network analytics. Results: There were 18,740 Medicare beneficiaries referred to pelvic floor physical therapists between 2009 and 2017. The mean number of referrals to each physical therapy provider or practice was 82 (SD ±46.3). Half of the referrals were made by a general acute care hospital. The remainder were referred by female pelvic medicine and reconstructive surgeons, nurse practitioners, colorectal surgeons, internal medicine, and obstetrician-gynecologists.The number of individual pelvic floor physical therapists, as well as the referrals, increased each year. The geographic representation of the patient referral networks is illustrated. The map reveals that pelvic floor physical therapists often work in groups and treat patients in their geographic vicinity. In this study, we demonstrate intensely fractured referral networks. Conclusion: Our network analysis of pelvic floor physical therapy referrals in Medicare patients across the United States shows fractured networks with dense geographic connections in some areas, whereas sparse in others. Multidisciplinary approaches and early referrals to pelvic floor physical therapy are recommended as some ways to amend these fractured networks.

CO2 Laser and radiofrequency compared to a sham control group in treatment of stress urinary incontinence (LARF study arm 3). A randomized controlled trial

Article

Mar 2022

Introduction and hypothesis: Female stress urinary incontinence (SUI) is a prevalent condition, and conservative treatment options are needed. Were evaluated CO2 laser and radiofrequency as treatment for SUI. Methods: One hundred thirty-nine women with SUI were eligible and randomized in a three-arm double-blind randomized controlled trial into radiofrequency (RF), laser (LS) and sham control (SCT) groups, with 3-monthly outpatient treatment sessions. One hundred fourteen women were included, 38 in each group, during a 12-month follow-up. The primary outcomes were: subjective improvement of SUI, evaluated on a Likert scale, and objective cure, which was a composite outcome defined according to negative stress tests, voiding diary and pad test. Questionnaires were also applied. The sample size was calculated to provide 80% power to identify a 20% difference between groups, p < 0.05. Results: Subjective improvement and objective cure of SUI were identified respectively in 72.6% and 45.2% in LS and in 61.7% and 44.7% in RF, both significantly higher than the 30.0% and 14.0% in SCT. Considering only mild cases (pad test < 10 g), objective cure was achieved in 66.7% in LS, 63.6% in RF and 22.2% in SCT. Significant reduction in the number of episodes of urinary incontinence was found according to voiding diaries (p = 0.029) and pad weight (p = 0.021). A significant reduction in urgency and urinary loss during sexual intercourse was observed only with LS and RF. Improvement in quality of life was also verified by the I-QoL and ICIQ-SF in favor of the energy-treated groups. Conclusions: CO2 laser and radiofrequency are outpatient options for SUI treatment, with no major complications. They had similar results and presented better results than in the sham control group.

Physical Therapy and Continence Inserts

Chapter

Jan 2022

The focus of this chapter is to explore nonsurgical and non-medicinal treatments of stress urinary incontinence (SUI), mixed urinary incontinence (MUI), and urgency urinary incontinence (UUI). Extensive literature search was performed for the identification of original research and review articles that allow for generalizations and specific outcomes to be described. We will begin with a review of incontinence prevention and an overview of the current state of preventative strategies for incontinence with a primary focus on stress urinary incontinence during and following pregnancy. The remainder of the chapter will focus on nonsurgical devices for SUI, impact of pelvic floor muscle therapy (PFMT) on the management of both SUI and UUI with specific consideration to urge suppression technique, Kegels, counterbracing maneuvers, and development of individualized training regiments.KeywordsStress urinary incontinenceUrge urinary incontinencePelvic floor muscle trainingPreventionPessariesNonsurgical managementCounterbracingUrge suppression

Effect of Nursing Instructional Program on Genitourinary Syndrome and Stress Level Among Premature Ovarian Insufficiency Women

Article

Jan 2022

The Impact of Radiofrequency on Pelvic Floor Distress, Restoration, and Sexual Function Among Women Suffering from Pelvic Floor Disorders

Article

Full-text available

Mar 2022

Background & Objective: Pelvic floor disorders (PFDs) are common devastating situations among women globally. The present study aimed to evaluate the clinical efficacy of radiofrequency (RF) on pelvic floor distress, restoration, and sexual function among women with PFDs. Materials & Methods: This pre-post intervention study was performed on forty-three women with PFDs, who referred to a teaching pelvic floor clinic. Patients underwent RF three times fortnightly. Women were examined at three time points of baseline, one month post-intervention, and in a three months follow-up. In addition, a biofeedback evaluation was performed by a physiotherapist at the first session and follow-up. All women were asked to complete the Female Sexual Function Index and Pelvic Floor Distress Inventory questionnaires at the first session and in follow-up assessments. Descriptive statistics, the paired samples t-test, and the Friedman test were used to analyze the data. Results: The mean and standard deviation of the age and gravidity of participants were 40.3±8.01 years and 2.65±1.3, respectively. We observed that 81.4% of women had a history of vaginal delivery. A significant improvement was found in the levator muscle tonicity by manual examination in the three-month follow-up (P<0.001). Moreover, maximal pelvic floor contraction measured by biofeedback improved (P=0.075). There were significant improvements in female sexual function and pelvic floor distress, including pelvic organ prolapse, colorectal-anal distress, and urinary distress after RF therapy (P<0.001). Conclusion: The findings of the current investigation showed that RF could be applied for pelvic floor restoration and is likely to improve sexual function and pelvic floor distress.

The role of diaphragmatic breathing exercise on urinary incontinence treatment: A pilot study

Article

Oct 2021

Objective The main aim of this pilot study was to examine the effect of diaphragmatic breathing exercise on urinary incontinence treatment. The secondary purpose was to compare the effect of pelvic floor muscle exercises and diaphragmatic breathing exercises on urinary incontinence women. Design Participants were randomized into two groups: pelvic floor muscle exercises (Group PFM n = 20) and diaphragmatic breathing exercises (Group DB n = 20). Exercise programs consisted of 1 set of contractions per day and each set included 30 repetitions for 6 weeks. Women were asked to complete forms of Incontinence Impact Questionnaire (IIQ-7) and the Urogenital Distress Inventory (UDI-6), Incontinence Quality of Life (I-QOL), and Overactive Bladder (OAB-V3) before starting the program and again at the end of the 6-week program. Results IIQ-7, I-QOL, and OAB-V3 scores significantly improved in both groups, after exercises. There were no difference between groups in the post-exercise scores. Total score of the UDI-6 was statistically significantly decreased higher in the DB exercises group. UDI-6 Urge Symptoms decreased statistically significantly only in the DB exercises group. Even though there was a decrease in the PFM group, but it was not significant. Conclusion Diaphragmatic breathing exercises may be an alternative to pelvic floor muscle exercises in the treatment of urinary incontinence. ClinicalTrials.gov ID NCT04991675.

The Lost Penis Syndrome: A New Clinical Entity in Sexual Medicine

Article

Full-text available

Oct 2021

Introduction The “lost penis syndrome” (LPS) is a term often used in non-clinical settings to describe the subjective perception of the loss of cutaneous and proprioceptive feelings of the male organ during vaginal penetration. Although deserving clinical attention, this syndrome did not receive any consideration in the medical literature. Notwithstanding, it represents a relatively unexceptional condition among patients in sexual medicine clinics, and it is often reported together with other sexual dysfunctions, especially delayed ejaculation, anejaculation, male anorgasmia and inability to maintain a full erection. Objectives To draft a new conceptual characterization of the LPS, defined as a lack of penile somesthetic sensations during sexual penetration due to various causes and leading to several sexual consequences in both partners. Methods Based on an extensive literature review and physiological assumptions, the mechanisms contributing to friction during penovaginal intercourse, and their correlation to LPS, have been explored, as well as other nonanatomical factors possibly contributing to the loss of penile sensations. Results Efficient penile erection and sensitivity, optimal vaginal lubrication and trophism contribute to penovaginal friction. Whenever one of these processes does not occur, loss of penile sensation defined as LPS can occur. Sociocultural, psychopathological and age-related (ie, couplepause) factors are also implicated in the etiology. Four types of LPS emerged from the literature review: anatomical and/or functional, behavioral, psychopathological and iatrogenic. According to the subtype, a wide variety of treatments can be employed, including PDE5i, testosterone replacement therapy and vaginal cosmetic surgery, as well as targeted therapy for concomitant sexual comorbidity. Conclusion We held up the mirror on LPS as a clinically existing multifactorial entity and provided medical features and hypotheses contributing to or causing the occurrence of LPS. In the light of a sociocultural and scientific perspective, we proposed a description and categorization of this syndrome hypothesizing its usefulness in daily clinical practice. Colonnello E, Limoncin E, Ciocca G, et al. The Lost Penis Syndrome: A New Clinical Entity in Sexual Medicine. Sex Med Rev 2021;XX:XXX–XXX.

Training women's pelvic floor muscles during pregnancy and postpartum at primary health centers: a best practice implementation project

Article

Jul 2021

Introduction and aims: Pelvic floor muscle training (PFMT) enhances muscle strength and coordination, and prevents urinary incontinence associated with giving birth. The goal was to improve women's PFMT during pregnancy and postpartum in La Rioja, Spain. Methods: This evidence implementation project used the JBI evidence implementation framework. First, we conducted the PFMT baseline audit: to assess the criteria for midwife training, we sent a questionnaire to all midwives. To measure the criteria for PFMT and urinary incontinence risk assessment, we reviewed the medical records of 60 women selected through consecutive sampling and 15 other women at risk of urinary tract infections (UTIs) for the inclusion criteria in a PFMT program. Second, we used the Getting Research into Practice guidelines to identify barriers to the fulfillment of each criterion and design and implement strategies to improve compliance. Finally, we repeated the audit to measure compliance and verify the changes. Results: The midwives received updated PFMT, optimizing compliance with the first criterion from 67 to 100%. The remaining criteria - providing PFMT for pregnant women, identifying women at high risk of incontinence, and facilitating a supervised PFMT program for women at high risk of UTIs - went from 0% compliance to 17, 96, and 67%, respectively. Conclusion: This project was effective in building consensus, improving midwives' practice, and facilitating mothers' PFMT. The project continued during the novel coronavirus [coronavirus disease 2019 (COVID-19)] epidemic in Spain as the midwives, women, and managers were involved in the change because of a well designed registration system and the use of online tools for communication between midwives and women.

EFFECTIVENESS OF KEGEL’S EXERCISES IN ELDERLY MALE AND FEMALE WITH URINARY INCONTINENCE

Article

Full-text available

Dec 2020

Objective: to determine the effectiveness of Kegel exercises in elderly male and female patients with stress urinary incontinence. Methodology: A quasi experimental study was conducted at In Department of urology of Shaheed Mohtarma Benazir Bhutto medical university, Chandka medical college Larkana Sindh from January 2017 to June 2019. The non-probability convenient sampling technique was used for sample selection. The n=43 patient with the age above 55 years was included in the study. Patient with neurological, cognitive and male with prostate problem were excluded from the study. Both male and female were received intervention of Kegel exercise (KE) for three months and 3-4 time/day. The urinary distress inventory (UDI) and Incontinence impact questionnaire was used for urinary distress and quality of life. The data was obtained at baseline, at 6th week and after 12th week. The mean±SD, n(%), Mean difference (MD), p-value (p<0.05) and effect size (Cohen’s d & partial eta square was use to describe the data. For within group analysis Repeated Measure ANOVA was used and for between the groups analysis independent t-test was used. SPSS ver 21 was used for data analysis. Results: The mean age of the study participants was 64.97±9.36 year. Within group analysis showed large significant improvement in both, males and females (p<0.05). However, between group differences showed significant improvement with larger effect size in males as compared to females (p<0.05). Conclusion: Kegel exercises are effective therapy for urinary incontinence in both genders. But Kegel exercises are more effective in males for urinary incontinence in improving urinary distress and quality of life. Keywords: Geriatric population, Kegel exercises, Urinary incontinence

Pelvic floor muscle training versus no treatment, or inactive control treatments, for urinary incontinence in women

Article

Full-text available

Jan 2014

https://doi.org/10.1002/14651858.CD005654.pub3

Pelvic Floor Muscle Training Versus no Treatment, or Inactive Control Treatments, for Urinary Incontinence in Women: A Short Version Cochrane Systematic Review With Meta-Analysis

Article

Full-text available

Nov 2014
NEUROUROL URODYNAM

Background Pelvic floor muscle training (PFMT) is a commonly used physical therapy for women with urinary incontinence (UI).Objectives To determine the effects of PFMT for women with UI in comparison to no treatment, placebo or other inactive control treatments.Search Methods Cochrane Incontinence Group Specialized Register, (searched 15 April 2013).Selection CriteriaRandomized or quasi-randomized trials in women with stress, urgency or mixed UI (based on symptoms, signs, or urodynamics).Data Collection and AnalysisAt least two independent review authors carried out trial screening, selection, risk of bias assessment and data abstraction. Trials were subgrouped by UI diagnosis. The quality of evidence was assessed by adopting the (GRADE) approach.ResultsTwenty-one trials (1281 women) were included; 18 trials (1051 women) contributed data to the meta-analysis. In women with stress UI, there was high quality evidence that PFMT is associated with cure (RR 8.38; 95% CI 3.68 to 19.07) and moderate quality evidence of cure or improvement (RR 17.33; 95% CI 4.31 to 69.64). In women with any type of UI, there was also moderate quality evidence that PFMT is associated with cure (RR 5.5; 95% CI 2.87–10.52), or cure and improvement (RR 2.39; 95% CI 1.64–3.47).Conclusions The addition of seven new trials did not change the essential findings of the earlier version of this review. In this iteration, using the GRADE quality criteria strengthened the recommendations for PFMT and a wider range of secondary outcomes (also generally in favor of PFMT) were reported. Neurourol. Urodynam. © 2014 Wiley Periodicals, Inc.

Pelvic floor muscle training versus no treatment, or inactive control treatments, for urinary incontinence in women

Article

Full-text available

Nov 2010

Background: Pelvic floor muscle training is the most commonly used physical therapy treatment for women with stress urinary incontinence (SUI). It is sometimes also recommended for mixed and, less commonly, urgency urinary incontinence. Objectives: To determine the effects of pelvic floor muscle training for women with urinary incontinence in comparison to no treatment, placebo or sham treatments, or other inactive control treatments. Search methods: We searched the Cochrane Incontinence Group Specialised Register, which contains trials identified from the Cochrane Central Register of Controlled Trials (CENTRAL) (1999 onwards), MEDLINE (1966 onwards) and MEDLINE In-Process (2001 onwards), and handsearched journals and conference proceedings (searched 15 April 2013) and the reference lists of relevant articles. Selection criteria: Randomised or quasi-randomised trials in women with stress, urgency or mixed urinary incontinence (based on symptoms, signs, or urodynamics). One arm of the trial included pelvic floor muscle training (PFMT). Another arm was a no treatment, placebo, sham, or other inactive control treatment arm. Data collection and analysis: Trials were independently assessed by two review authors for eligibility and methodological quality. Data were extracted then cross-checked. Disagreements were resolved by discussion. Data were processed as described in the Cochrane Handbook for Systematic Reviews of Interventions. Trials were subgrouped by diagnosis of urinary incontinence. Formal meta-analysis was undertaken when appropriate. Main results: Twenty-one trials involving 1281 women (665 PFMT, 616 controls) met the inclusion criteria; 18 trials (1051 women) contributed data to the forest plots. The trials were generally small to moderate sized, and many were at moderate risk of bias, based on the trial reports. There was considerable variation in the interventions used, study populations, and outcome measures. There were no studies of women with mixed or urgency urinary incontinence alone.Women with SUI who were in the PFMT groups were 8 times more likely than the controls to report that they were cured (46/82 (56.1%) versus 5/83 (6.0%), RR 8.38, 95% CI 3.68 to 19.07) and 17 times more likely to report cure or improvement (32/58 (55%) versus 2/63 (3.2%), RR 17.33, 95% CI 4.31 to 69.64). In trials in women with any type of urinary incontinence, PFMT groups were also more likely to report cure, or more cure and improvement than the women in the control groups, although the effect size was reduced. Women with either SUI or any type of urinary incontinence were also more satisfied with the active treatment, while women in the control groups were more likely to seek further treatment. Women treated with PFMT leaked urine less often, lost smaller amounts on the short office-based pad test, and emptied their bladders less often during the day. Their sexual outcomes were also better. Two trials (one small and one moderate size) reported some evidence of the benefit persisting for up to a year after treatment. Of the few adverse effects reported, none were serious.The findings of the review were largely supported by the summary of findings tables, but most of the evidence was down-graded to moderate on methodological grounds. The exception was 'Participant perceived cure' in women with SUI, which was rated as high quality. Authors' conclusions: The review provides support for the widespread recommendation that PFMT be included in first-line conservative management programmes for women with stress and any type of urinary incontinence. Long-term effectiveness of PFMT needs to be further researched. Link : https://doi.org/10.1002/14651858.CD005654

Pelvic floor maximal strength using vaginal digital assessment compared to dynamometric measurements

Article

Full-text available

Jun 2004

To compare vaginal digital assessment with dynamometric measurements for determining the maximal strength of the pelvic floor muscles (PFM). Eighty-nine women aged between 21 and 44 participated in the study. An experienced physiotherapist evaluated the maximal strength of the PFM of these women using the modified Oxford grading system (six categories, range 0-5) and dynamometric measurements. The mean maximal forces obtained for all women with the instrumented speculum for each category of digital assessment were compared using ANOVAs. Spearman's rho coefficients were calculated to assess the correlation between the dynamometric and the digital assessments. According to their symptoms and pad test results, 30 women were continent and 59 had stress urinary incontinence (SUI). Based on dynamometric measurements, important overlaps were observed between each category of digital assessment. The ANOVAs indicated that force values differ across categories (F = 10.08; P < 0.001), although contrast analyses revealed no differences in the mean maximal forces between adjacent digital-assessment categories (1-2, 2-3, 3-4, 4-5). Mean force values differed significantly only between non-adjacent levels in digital assessment, for example, between 1 and 3; 1 and 4; 1 and 5; 2 and 4; 2 and 5 (P < 0.05). Significant correlations were found between the two measurements with coefficients of r = 0.727, r = 0.450, and r = 0.564 for continent, incontinent, and all women, respectively (P < 0.01). Even if the dynamometric mean forces of the PFM increased across subsequent categories of digital assessment, the force values between two adjacent categories do not differ. This limitation of digital assessment should be considered by clinicians and researchers when choosing treatment orientation and evaluating treatment outcomes.

Validation of the short forms of the Incontinence Impact Questionnaire (IIQ-7) and the Urogenital Distress Inventory (UDI-6) in a Turkish population

Article

Full-text available

Jan 2007

To validate the Turkish versions of the IIQ-7 and UDI-6 for use in Turkish-speaking populations. After establishing the test-retest reliability and internal consistency in a pilot study, 302 patients were enrolled in the study and general and subscale scores of the questionnaires were calculated. All participants underwent an urodynamic assessment. Both instruments showed a high internal consistency (Cronbach's alpha for the IIQ-7 and UDI-6 was 0.87 and 0.74, respectively) and test-retest reliability (Spearman's rho was 0.99 for both of the scales (P < 0.001). 55.6% of the participants showed urodynamic abnormality and/or leakage. 39.7% had urodynamic stress incontinence (USI) and 15.9% had detrussor overactivity (DOA) +/- USI. The mean scores of each IIQ-7 and UDI-6 were significantly higher in the USI, and DOA +/- USI groups compared with normal women. Women with DOA +/- USI scored highest in the IIQ-7 and UDI-6. The irritative subscale scores of the 1st and 2nd items of the UDI-6 were significantly higher in the DOA +/- USI group. The stress subscale scores of 3rd and 4th items of UDI-6 were significantly higher in the USI group. Women with postvoid residual (PVR) urine values greater than 50 ml had significantly higher obstructive subscale scores compared to the ones who had less residual volumes. The Turkish translated versions of the IIQ-7 and UDI-6 are reliable, consistent and valid instruments for assessing symptom severity and the impact on QOL in Turkish speaking women with urinary incontinence.

Hidden female urinary incontinence in urology and obstetrics and gynecology outpatient clinics in Turkey: What are the determinants of bothersome urinary incontinence and help-seeking behavior?

Article

Full-text available

Jul 2007

The purpose of this study was to assess the prevalence of female urinary incontinence (UI) and risk factors of bothersomeness and help-seeking behavior of hidden female UI in urology and obstetrics and gynecology outpatient clinics. This multicentric and cross-sectional study was conducted as a part of the Turkish Overactive Bladder Study. Female patients (n = 5,565) who were referred with complaints other than UI and overactive bladder symptoms were surveyed using the International Consultation on Incontinence Questionnaire Short Form (ICIQ-SF) with supplementation of five more questions. The crude prevalence of UI was found to be 35.7%. The prevalence of frequent and severe incontinence was 8.2 and 6.8%, respectively. The mean age of incontinent patients was significantly higher (p < 0.001). The prevalence of stress, urge, and mixed UI was 39.8, 24.8, and 28.9%, respectively. More than half (53%) of incontinent patients were not bothered by UI, and only 12% of incontinent patients had previously sought medical help for their problem. Frequency, severity, and type of UI were independent factors for predicting bothersome UI, while only bothersomeness increased help-seeking behavior. The ICIQ-SF score of 8 has been found to be the best cutoff value to delineate the bothersome UI. Although the crude prevalence of female UI was found to be high, bothersome UI was not so common. The majority of incontinent female patients did not seek medical help. Frequency, severity, and mixed type of UI were found to be the determinants of bothersome UI for which the ICIQ-SF cutoff score of 8 was obtained.

An International Urogynecological Association (IUGA)/International Continence Society (ICS) Joint Report on the Terminology for Female Pelvic Floor Dysfunction

Article

Jun 2009

Epidemiology of urinary incontinence (UI) and other lower urinary tract symptoms (LUTS), pelvic organ prolapse (POP) and anal incontinence (AI)

Article

Jan 2013

Pelvic floor re-education: Principles and Practice

Book

Jan 2008

The second edition of Pelvic Floor Re-education provides a comprehensive overview of the subject, along with other aspects of the clinical assessment and management of pelvic floor disorders. Starting with the latest theories on the anatomy, pathophysiology, and possible causes of pelvic floor damage, the importance of pelvic floor evaluation is looked at in order to determine the type of treatment required. Practical techniques of muscle assessment and investigative methodologies are reviewed and up-to-date information on anatomy and physiology is discussed. An algorithmic approach takes the reader through the options for clinical evaluation and treatment. Several re-education techniques are assessed for pelvic floor dysfunction, including isolated muscle exercise, vagina cones, biofeedback control, and electrical stimulation. This practical book is invaluable reading for all healthcare professionals working with incontinent patients, particularly urogynecologists, obstetricians, gynecologists, and physiotherapists. It also provides a comprehensive but readable source for residents and trainees interested in the scientific and clinical fundamentals of pelvic floor re-education.

Pelvic floor muscle training improves quality of life of women with urinary incontinence: a prospective study

Article

Apr 2013
AUST NZ J OBSTET GYN

Background: Women suffering from urinary incontinence have impaired quality of life (QoL). Pelvic floor muscle training (PFMT) has been recommended to be the first-line treatment for them. Aims: This study evaluated the role of (PFMT) in women with urinary incontinence. Materials and methods: All women suffering from urinary incontinence without pelvic organ prolapse who attended the urogynaecology unit of a university hospital from January 2009 to June 2010 were recruited. Urinary symptoms and impact on QoL were assessed using the Chinese validated Urogenital Distress Inventory short form (UDI-6) and Incontinence Impact Questionnaire short form (IIQ-7) before and after PFMT. Urodynamic studies (UDS) were used to differentiate the diagnoses of urinary incontinence. Results: Three hundred and seventy-two women, aged 52.3 ± 10.8 years and practised PFMT for 9.9 ± 7.3 months, completed the study. Over 65% recorded improvement in both UDI-6 and IIQ-7. Stratified for urodynamic diagnosis, stress incontinence group and those who had no UDS abnormality had significant improvement in their urinary symptoms and QoL after PFMT. UDI-6 and IIQ-7 also improved significantly after PFMT in groups where the clinical presentation was stress incontinence, overactive bladder symptoms or mixed urinary incontinence. Age was not associated with a significant difference in the response to PFMT. Conclusions: Pelvic floor muscle training appears to be an effective first-line intervention for improving urinary symptoms and QoL of women presenting with urinary incontinence. Future studies on long-term effectiveness and cost-effectiveness are also required.

The effects of physiotherapy for female urinary incontinence: Individual compared with group treatment

Article

Feb 2001
BJU INT

Objectives To compare, in a randomized trial, the effects of individual and group physiotherapy for urinary incontinence in women referred by their general practitioner (GP). Patients and methods The study included women of all ages (mean 47.8 years) with stress, urge or mixed incontinence; 126 received individual and 404 group treatment. Both groups undertook the same pelvic floor exercises and bladder training, and received the same information. The effects were measured soon after treatment and again 9 months later. The main outcome measures were objective changes in the severity of incontinence, frequency of urine loss and frequency of nocturnal urine loss. The trial was nationwide; 25 physiotherapists and 337 GPs participated. Results There were no significant differences in effect between the groups; after individual treatment the severity of incontinence improved in 60% of the patients and the mean (95% confidence interval, CI) frequency of urine loss decreased, by −8.7 (− 6.4 to −11.1) times/week. After group therapy continence improved in 57% and the frequency of urine loss decreased, by – 8.4 ( − 6.8 to − 10.0) times/week. For women who had nocturnal urine loss (at baseline), the frequency decreased after individual treatment by −11.2 (4 to − 26.4) and after group therapy by −14 (− 9.1 to −18.9) times/month. All improvements persisted in full for up to 9 months. Conclusion Individual and group physiotherapy are equally effective for at least 9 months in improving incontinence in women. Factors should be sought that can predict the effectiveness of therapy, and thus better select those patients most likely to benefit from therapy.

Evaluation of the effect of pelvic floor muscle training (PFMT or Kegel exercise) and assisted pelvic floor muscle training (APFMT) by a resistance device (Kegelmaster device) on the urinary incontinence in women: A randomized trial

Article

Jul 2011

To evaluate the effect of pelvic floor muscle training (PFMT) or Kegel exercise with and without assistance by a resistance device (Kegelmaster device) on the urinary incontinence in women. A randomized clinical trial was performed on 91 women with the complaint of urinary incontinence. In the assisted pelvic floor muscle training (APFMT) group (n=41), after complete training, Kegelmaster device were used twice daily for 15 min each session, for a total duration of 12 weeks. In the pelvic floor muscle training (PFMT) group (n=50) after complete training, kegel exercises were done (including perineal muscle contractions for 6-8s with 6s rest in between), twice daily for 15 min each session and for a total duration of 12 weeks. These two groups were then compared according to the scores of special questionnaires for quality of life, strength of pelvic floor muscles, capability to participate in social activities, severity of urinary incontinence, and the number of involuntary urine passage, taken before, and after 1 and 3 months after finishing interventions. 85 women out of 91 women finished the study (46 in the PFMT group and 39 in the APFMT group). Strength of pelvic floor muscles, capability to participate in social activities, score of quality of life according to three world questionnaires of IQOL (incontinence Quality Of Life), IIQ (Incontinence Impact Questionnaire), UDI (Urogenital Distress Inventory), showed no difference between the two groups 1 and 3 months after interventions. Pair t test showed a significant improvement in both groups 1 and 3 months after intervention, according to IQOL score (P=0.000), UDI score (P=0.000), IIQ score (P=0.000), strength of pelvic floor muscles, (P=0.000), capability to participate in social activities (P=0.000), severity of urinary incontinence (P=0.000) and the number of involuntary urine passage (P=0.000). Pelvic floor muscle training with or without Kegelmaster show no apparent difference to each other, however, these two methods are effective for improvement of urinary incontinence in women.

An International Urogynecological Association (IUGA)/International Continence Society (ICS) Joint Report on the Terminology for Female Pelvic Floor Dysfunction

Article

Nov 2009
NEUROUROL URODYNAM

Next to existing terminology of the lower urinary tract, due to its increasing complexity, the terminology for pelvic floor dysfunction in women may be better updated by a female-specific approach and clinically based consensus report. This report combines the input of members of the Standardization and Terminology Committees of two international organizations, the International Urogynecological Association (IUGA), and the International Continence Society (ICS), assisted at intervals by many external referees. Appropriate core clinical categories and a subclassification were developed to give an alphanumeric coding to each definition. An extensive process of 15 rounds of internal and external review was developed to exhaustively examine each definition, with decision-making by collective opinion (consensus). A terminology report for female pelvic floor dysfunction, encompassing over 250 separate definitions, has been developed. It is clinically based with the six most common diagnoses defined. Clarity and user-friendliness have been key aims to make it interpretable by practitioners and trainees in all the different specialty groups involved in female pelvic floor dysfunction. Female-specific imaging (ultrasound, radiology, and MRI) has been a major addition while appropriate figures have been included to supplement and help clarify the text. Ongoing review is not only anticipated but will be required to keep the document updated and as widely acceptable as possible. A consensus-based terminology report for female pelvic floor dysfunction has been produced aimed at being a significant aid to clinical practice and a stimulus for research.

The Effects of Pelvic Floor Muscle Training on Stress and Mixed Urinary Incontinence and Quality Of Life

Article

Jul 2009

To evaluate the effects of pelvic floor muscle (PFM) training on urinary incontinence (UI) and quality of life in women diagnosed with stress or mixed UI. We completed a parallel group, randomized clinical trial evaluating the effectiveness of PFM training in women with stress or mixed UI. We recruited consecutive cases of women with stress or mixed UI from outpatient urology clinics attached to a county hospital and a university hospital in Izmir, Turkey. After baseline evaluation, 41 women were randomly assigned to either the PFM training group or the control group. Muscle training included 3 sets of daily fast and slow contractions in lying, sitting, and standing positions. Participants were also taught the knack. The intervention period was 8 weeks, and the women in the exercise group telephoned once a week to provide motivation. The untreated control group had no contact during the intervention period. Outcome measures were Incontinence Quality of Life (I-QOL) Questionnaire, episodes of leakage in 3-day bladder diary, 1-hour pad test, and PFM strength. Thirty-four women completed the trial. The mean age of women was 41.82 +/- 8.65 years in the exercise group and 44.64 +/- 6.90 years in the control group. The 2 groups were statistically similar regarding key demographic and clinical characteristics. After 8 weeks, significant differences in the 1-hour pad test, episodes of leakage in 3-day bladder diary, PFM strength, and I-QOL scores (P = .01) were noted when participants in the PFM training group were compared to control group participants. An 8-week trial of PFM training significantly increased PFM strength, improved quality of life, and reduced the frequency of UI episodes.

Progressive resistance in the functional restoration of the perineal muscles

Article

Sep 1948
AM J OBSTET GYNECOL

AH Kegel

The Structure of the Bladder and Urethra in Relation to Function

Article

Mar 1979
UROL CLIN N AM

John A Gosling

Bladder inhibition with functional electrical stimulation

Article

Jan 1976
UROLOGY

Spastic or hyperreflex bladder dysfunction can cause frequency, urgency, and incontinence. Detrusor activity was inhibited by FES (functional electrical stimulation) applied to the anal sphincter causing decreased bladder spasticity and increased bladder capacity. FES is indicated for incontinence not only because of weakness of the pelvic floor but also because of hyperreflex bladder.

Structural aspects of the extrinsic continence mechanism

Article

Oct 1988
OBSTET GYNECOL

John O. L. DeLancey

The changes in urethral pressure that occur during a cough, and microtransducer measurements of urethral pressures at rest, suggest that structures extrinsic to the urethra and vesical neck influence sphincteric function. The present study examined the structure of the extrinsic continence mechanism as it relates to these physiologic observations. Serial histologic sections of the pelvic viscera made from eight female cadavers and dissections of 34 cadavers were examined. In the proximal urethra, the anterior vaginal wall is attached to the muscles of the pelvic diaphragm and to the arcus tendineus fasciae pelvis. Contraction of the pelvic diaphragm would pull the vagina against the posterior surface of the urethra, causing an increase in posteriorly measured "pressures." Support of the urethra at rest comes from both its attachment to the arcus tendineus fasciae pelvis and the resting tone of the pelvic diaphragm muscles. Two arches of striated muscle (compressor urethrae and urethrovaginal sphincter) run over the distal urethra in the region of the perineal membrane (ie, urogenital diaphragm). Activity of these muscles could compress the urethra distally, causing the urethral pressure rise that precedes and exceeds the rise in abdominal pressure during a cough and explaining asymmetry of pressure measurements in this area. Recognition of these structural relationships can help us understand urethral pressures during a cough and directional "pressure" variations seen in patients with stress incontinence. They may also contribute to the understanding of surgical failures that occur despite successful urethral suspension.

Comparative Assessment of Pelvic Floor Function Using Vaginal Cones, Vaginal Digital Palpation and Vaginal Pressure Measurements

Article

Feb 1996

A group-comparative study to assess pelvic floor muscle function using vaginal cones, vaginal digital palpation, and vaginal pressure measurements in 30 women suffering from genuine stress urinary incontinence and in an age-matched group of continent women was undertaken. Vaginal digital palpation score and vaginal pressure during active contraction were greater (p < 0.001) in continent women (1.9 +/- 0.1 and 8.6 +/- 0.7 cm H2O, respectively) as compared with incontinent women (1.0 +/- 0.1 and 4.1 +/- 0.4 cm H2O, respectively). Continent women were able to retain a vaginal cone of greater weight (6.3 +/- 0.4; n = 9, weight ranging from 10 to 90 g) than women suffering from stress incontinence (4.7 +/- 0.5; p < 0.001). There was a better correlation between all three techniques of assessing pelvic floor function in continent as compared with incontinent women, especially in the comparisons involving vaginal cones. (Vaginal pressure measurement-vaginal digital palpation, r = 0.86/0.75; vaginal pressure measurement-vaginal cones. r = 0.57/0.10; vaginal digital palpation-vaginal cones, r = 0.60/0.18.) In some women, especially those with incontinence, heavy cones were retained in spite of a weak pelvic floor due to the transverse position of the cone in the vagina which was verified radiographically.

Reliability of pelvic floor muscle strength measurement in elderly incontinent women

Article

Jan 2002

Pelvic floor muscles (PFM) play an important role in maintaining urinary continence with increasing age. Therefore, their contractile properties need to be evaluated. The aim of the study was to examine the reliability and correlation of simple techniques to measure PFM strength in elderly women with urinary incontinence. An interview was used to evaluate the ability to stop the urinary stream during micturition and to calculate the incontinence index. A pad test was applied to objectively evaluate the severity of the disease. Functional testing included a digital examination to measure the force and duration of one contraction, a perineometer measurement (Peritron) to assess maximal contraction force and contraction force of 5 s, and a cone-retention test (Femcon) while walking for 1 min and during Valsalva's manoeuvre. This procedure was performed on three separate occasions within one week. The 37 participating women with a mean age of 62+/-8 (mean+/-SD) years had a severity index of 4.4+/-2.6 and a urine loss of 9.5+/-13.6 mg during the pad test. Sixteen women were able to completely stop the urinary stream during micturition. The digital examination showed no intratester variability. The perineometer measurement showed that the absolute difference in maximal contraction force and mean contraction force within 5 s was less than 5.3 mm Hg and 4.5 mm Hg, respectively, with a probability of 0.95. While walking and during Valsalva's manoeuvre, 19 and 20 women, respectively, held the same cone in place on all three occasions. The maximal contraction force and mean force during the 5-s contraction correlated well with the ability to stop the urinary stream and the digital examination but only weakly with the cone-retention tests. The reliability of PFM strength measurement is highest in the digital examination, followed by perineometer measurements, and then by vaginal cone tests. As PFM function is easy to assess, it should be routinely done in the assessment of urinary incontinence in elderly women.

Physiotherapy for female stress urinary incontinence: Individual therapy at the outpatient clinic versus home-based pelvic floor training: A 5-year follow-up study

Article

Sep 2004

To compare the long-term effects of individual physiotherapy at an outpatient clinic, including electrical stimulation (ES), active pelvic floor muscle exercises (PFMEs), and training with a vaginal ball (VB), with home-based active PFMEs and training with a VB, in cases of female stress urinary incontinence (SUI). Thirty-three women with SUI (outpatient clinic group [Group I, n = 16] and home group [Group II, n = 17]) participated in the 5-year follow-up study. Both groups had an active PFME program and they used a VB during daily activities for intensive pelvic floor muscle (PFM) training. Group I was also treated at the outpatient clinic with maximal interferential ES, using frequencies varying from 10 to 50 Hz, and individually instructed exercises with biofeedback were carried out at the same time, once a week, an average of nine times in the first year. After baseline examinations, both groups visited the outpatient clinic at 4 months, 12 months, and at 5 years. At 12 months, there were no statistically significant differences between the study groups in any of the outcome variables, but within the groups both the subjective and objective results were significantly better in comparison with the initial values. After 12 months, two (3%) patients in Group I continued physiotherapy and seven (41%) patients in Group II needed physiotherapy because of an unsatisfactory outcome. At 5 years, according to the urinary incontinence severity score (UISS) questionnaire, subjective discomfort had decreased in both groups (P < 0.01) and 21 of the 33 women (64%) perceived a subjective cure or improvement in their condition. The mean objective urine leakage verified by the pad test decreased from 23.0 to 1.0 g in Group I and from 13.0 to 1.0 g in Group II (P < 0.001 for both groups). The strength of PFMs tested in a standing position increased by 26% in Group I and by 19% in Group II (P values 0.001 and 0.084, respectively), and in a lying position by 28% in Group I and by 32% in Group II (P values 0.001 and 0.008, respectively). Home-based PFMEs and training with a VB proved to be equally effective as once-a-week supervised therapy, and the 5-year follow-up results demonstrated a successful response in the treatment of female SUI.

Are Fatigue and Disturbances in Pre-Programmed Activity of Pelvic Floor Muscles Associated with Female Stress Urinary Incontinence?

Article

Feb 2004

To investigate whether there is a difference between a continent versus a stress urinary incontinent group of women regarding: (i) fatigue in pelvic floor muscles, and (ii) pre-activation times between pelvic floor and abdominal muscles during coughing. Twenty-six continent and 20 stress urinary incontinent parous women were examined. Fatigue was measured with an intravaginal device. Time to 10% decline of the initial reference force (RF) was defined as time-to-fatigue. Simultaneous recordings of force developed in levator ani muscle and electromyographic activity in the external oblique abdominal muscle were performed to determine whether contraction of pelvic floor muscles precedes activity in abdominal muscles during coughing. Time-to-fatigue was identical in the two groups (10.5 sec in the continent and 11.5 sec in the incontinent group, median values). Normalized force was significantly reduced in the incontinent group. The pelvic floor muscles contracted 160 msec before the abdominal muscles in both groups. In 24% of the continent and in 30% of the incontinent women, however, abdominal muscle activity preceded activity of pelvic floor muscles. Muscular fatigue, defined as rate of force loss, does not seem to be associated with urinary stress incontinence. Moreover, muscular activity recruitment patterns were equal in both groups suggesting that other factors than disturbances of ordered muscle recruitment, that is, pelvic floor followed by abdominal muscles, may be responsible for stress urinary incontinence. It is likely that reduced normalized force, as found in the incontinent group, is an important contributing factor.

Short-term efficacy of group pelvic floor training under intensive supervision versus unsupervised home training for female stress urinary incontinence: A randomized pilot study

Article

Jul 2007

Current management guidelines propose pelvic floor muscle training (PFMT) as first line treatment for female stress urinary incontinence (SUI). The aim of this study is to compare the efficacy of group PFMT under intensive supervision to that of individual home therapy in women with SUI. Thirty women with clinical and urodynamic diagnosis of SUI were randomized in two equal-number groups. Following a common demonstration course, Group A women received a detailed schedule for home training, while Group B in addition attended a weekly hospital group visit. At 12 weeks both groups were assessed for changes in subjective and objective outcomes. Twenty-two women, (10 Group A, 12 Group B) with a mean age of 47.3 years completed the study. Although significant (P<0.05) improvements were noted in both groups in quality of life scores, number of incontinence episodes/week, 24-hr frequency, and endurance, repetitions and fast contractions upon vaginal assessment of the PFMs, comparative analysis at the end of the study demonstrated significantly better results for women in Group B, who also improved in daily pad usage, underwear wetting, modified Oxford grading of the PFMs and hold with cough. Consequently, significantly more women in Group B reported improvement in their continence (100% vs. 20% in Group A). Group PFMT under intensive supervision produced significantly better improvements in primary and secondary outcomes in the short-term compared to individual, unsupervised home application of PFMT.

Clinical evaluation of the pelvic floor Pelvic floor re-education, principles and practice

Jan 1994
39-51

J Laycock
B Schussler
Norton J P Laycock
Stanton
Sl

Laycock J. 1994. Clinical evaluation of the pelvic floor. In: Schussler B, Laycock J, Norton P, Stanton SL, editors. Pelvic floor re-education, principles and practice. London: Springer-Verlag. p 39–51.

The prevalence of urinary incontinence and its influence on the quality of life in women of reproductive and postmenopausal age groups

M Ekin
R Karayalcın
U Ozcan
E Erdemlioglu

Ekin M, Karayalcın R, Ozcan U, Erdemlioglu E. 2004. The prevalence of urinary incontinence and its influence on the quality of life in women of reproductive and postmenopausal age groups. Journal of Ankara Medical School 26:21-25.

Recommendations of the International Scientific Committee: evaluation and treatment of urinary incontinence, pelvic organ prolapse and faecal incontinence

Feb 2012
15-107

I Milsom
D Altman
R Cartwright
M C Lapitan
R Nelson
U Sillen

Milsom I, Altman D, Cartwright R, Lapitan MC, Nelson R, Sillen U et al. 2013. Epidemiology of urinary incontinence (UI) and other lower urinary tract symptoms (LUTS), pelvic organ prolapse (POP) and anal incontinence (AI). In: Abrams P, Cardozo L, Khoury S, Wein A, editors. Incontinence: 5th International Consultation on Incontinence. Recommendations of the International Scientific Committee: evaluation and treatment of urinary incontinence, pelvic organ prolapse and faecal incontinence; 23-25 February, 2012, Paris. Belgium: International Consultation on Urological Diseases (ICUD):15-107.

Incontinence: 5th International Consultation on Incontinence. Recommendations of the International Scientific Committee: evaluation and treatment of urinary incontinence, pelvic organ prolapse and faecal incontinence