Access to this full-text is provided by Wiley.
Content available from Advances in Nursing
This content is subject to copyright. Terms and conditions apply.
Review Article
Effect of Kegel Exercises on the Management of
Female Stress Urinary Incontinence: A Systematic Review of
Randomized Controlled Trials
Seong-Hi Park1and Chang-Bum Kang2
1SchoolofNursing,PaiChaiUniversity,155-40,Baejae-ro,Seo-gu,Daejeon302-735,RepublicofKorea
2Health Promotion Fund Management Team, Korea Health Promotion Foundation, Seoul, Republic of Korea
Correspondence should be addressed to Seong-Hi Park; shpark@pcu.ac.kr
Received August ; Accepted December ; Published December
Academic Editor: Caroline Sanders
Copyright © S.-H. Park and C.-B. Kang. is is an open access article distributed under the Creative Commons Attribution
License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly
cited.
Objective. e purpose of this study was to evaluate the eect of Kegel exercises on reducing urinary incontinence symptoms in
women with stress urinary incontinence. Methods. Randomized controlled trials (RCTs) were conducted on females with stress
urinary incontinence who had done Kegel exercises and met inclusion criteria in articles published between and . e
articles from periodicals indexed in KoreaMed, NDSL, Ovid Medline, Embase, Scopus, and other databases were selected, using
key terms such as “Kegel” or “pelvic oor exercise.” Cochrane’s risk of bias was applied to assess the internal validity of the RCTs.
Eleven selected studies were analyzed by meta-analysis using RevMan .. Results. Eleven trials involving women met the
inclusion criteria. All trials contributed data to one or more of the main or secondary outcomes. ey indicated that Kegel exercises
signicantly reduced the urinary incontinence symptoms of female stress urinary incontinence. ere was no heterogeneity in the
selected studies except the standardized bladder volumes of the pad test. Conclusion. ere is some evidence that, for women with
stress urinary incontinence, Kegel exercises may help manage urinary incontinence. However, while these results are helpful for
understanding how to treat or cure stress urinary incontinence, further research is still required.
1. Introduction
Stress urinary incontinence (SUI), dened as “the complaint
of involuntary leakage of urine on eort, exertion, sneezing,
or coughing” by the International Continence Society [], is
the most common type of urinary incontinence in women.
Although it is not a life-threatening condition [], SUI
aects the quality of women’s lives in many ways and may
limit women’s social and personal relationships, as well as
limiting physical activity []. Much has been written about
the prevalence of stress urinary incontinence, which aects
up to % of community-dwelling women living in the
Western world. Furthermore, its prevalence is increasing due
to an aging society [], but only a quarter of all women with
this problem seek medical support [,].
Although surgical treatment is the more eective treat-
ment for SUI, conservative treatment is now recommended
as rst-line treatment in elderly women or those with
mild symptoms []. Conservative treatments, a nonsurgical
therapy, include improving the lifestyle, bladder training,
pelvic oor muscle exercises, biofeedback, and the electrical
stimulation of pelvic muscles []. Kegel exercises are the
most popular method of reinforcing pelvic oor muscles
and are noninvasive treatment such that they do not involve
the placement of any vaginal weights/cones. ey were rst
described in by the American gynecologist Anold
Kegel. ey are the most cost-eective treatment and dier
from other therapies in that the patients can do them by
themselves anytime, anywhere, while doing other work, and
without regular hospital visits. e patients simply need to be
trained in how to contract their pelvic oor muscles. Most
studies show that Kegel exercises steadily reinforce the pelvic
muscles []. However, in practice the results of patients vary
depending on whether they exercise their pelvic oor muscles
Hindawi Publishing Corporation
Advances in Nursing
Volume 2014, Article ID 640262, 10 pages
http://dx.doi.org/10.1155/2014/640262
Advances in Nursing
aer identifying them, how earnestly they exercise, and how
much trust they place in the exercises themselves. Hence,
these study results need to be critically evaluated with respect
to actual practice []. Also, several studies have reported
systematic reviews on pelvic oor muscles exercises but have
covered the female urinary incontinence with stress, urge,
and mixed UI or have dealt with all nonsurgical treatment
including drugs [,–].
erefore, the eects of Kegel exercises on urinary incon-
tinence will be veried through a systematic review of the
results of the randomized controlled trials (RCTs) in the liter-
ature, forming a basis for the suggestion that Kegel exercises
are an economic intervention which can be understood and
performed by both patients and nurses alike.
2. Methods
is study was conducted according to the Cochrane Hand-
book for Systematic Reviews of Interventions []andthe
statement by the Preferred Reporting Items for Systematic
Reviews and Meta-Analyses (PRIMA) group [].
2.1. Eligibility Criteria for Review
(i) Participants: women with SUI.
(ii) Interventions: Kegel exercises being dened as a
program of repeated voluntary pelvic oor muscle
contractions taught and supervised by a health care
professional.
(iii) Comparators: no treatment or routine care cases, such
as advice and instruction being oered on the use of
the continence guard.
(iv) Outcomes: patient self-reported cure or improvement,
urinary incontinence symptoms from recom-mended
questionnaires, urinary incontinence episodes over
days, the pad test (-hour pad test, standardized
bladder volume on pad test), and pelvic oor muscle
pressure.
(v) Type of studies: only randomized controlled trials
being included.
2.2. Data Sources and Study Selection. KoreaMed, National
Discovery for Science Leaders (NDSL), Ovid Medline,
Embase, and Scopus were used as the main search databases,
andthewebsitesoftheKoreanUrologicalAssociation,
Korean Continence Society, Korean Society of Obstetrics
and Gynecology, Korean Society of Nursing Science, Korean
Society of Women Health Nursing, and Korean Society of
Adult Nursing were searched to include all Korean academic
journals dealing with associated elds. e search date was
April .
Among the references searched, randomized control
trials on female urinary incontinence patients undergoing
Kegel exercises as the main intervention that report one or
more major or secondary results were selected. Excluded
were studies combining Kegel exercises with biofeedback or
electrical stimulation therapy and those not published in
either English or Korean.
Aer removing overlapping references from the primary
search, papers were selected to match the inclusion and
exclusion criteria. e rst round of selection was based rst
on the title and abstract of each reference and the second on
a more in-depth analysis. e reference selection process was
rst independently performed, and then a discussion was to
beconductedincaseofdisagreement,andthethirdparty
intervention principle was applied if necessary. However, no
disagreement occurred.
2.3. Risk of Bias in Included Studies. e methodological
quality of selected studies was analyzed by two review authors
independently using risk of bias (RoB) tool developed by
Cochrane Collaboration. Disagreements were resolved by
discussion and consensus.
2.4. Data Extraction and Analysis. Relevant data, such as
the subject inclusion or exclusion criteria, baseline demo-
graphic and clinical characteristics of the study partici-
pants, treatment protocols, the follow-up period, and the
outcome variables of each study, were consolidated using a
standardized form. e magnitudes of the eects of Kegel
exercises were calculated using the pooled relative risk (RR)
for dichotomous outcome data and the mean dierence (MD)
and the standardized mean dierence (SMD) for continuous
outcome data with % condence intervals (CIs) using
the Mantel-Haenszel test. e selected eleven studies were
analyzed using Review Manager (RevMan) version .. For
all statistical comparisons, dierences with a 𝑃 < 0.05 were
considered signicant. e 𝐼-squared (𝐼2)testwasusedto
identify heterogeneity, and the chi-squared (𝜒2)testwasused
to detect statistical heterogeneity. When heterogeneity was
present (𝑃 < 0.1),thedatawereanalyzedusingtherandom
eect model. In the absence of heterogeneity, a xed eect
model was applied. 𝐼2ranges from % to %. Here, values
between % and % can be interpreted as unimportant
heterogeneity, up to % as moderate heterogeneity, and over
% as considerable heterogeneity [].
3. Results
3.1. Characteristics of Included Studies. Atotalofcan-
didate papers were obtained through electronic reference
searches, and remained aer excluding overlapping
ones. Aer exclusion of papers according to the inclusion and
exclusion criteria by titles and abstracts, papers remained
and from those were nally selected, leaving a total of
subjects. e detailed reference selection process is presented
in the ow chart (Figure ).
Kegel exercises have been regularly studied from to
by selected references. ey were most actively studied
in Europe in the s and in Brazil since , not to mention
two Korean studies, indicating a worldwide interest in Kegel
exercises as a nursing intervention. e general age of the
subjects was s to s in seven papers and s and over
in four papers. ere were subjects in total, all of whom
were middle-aged women of and over exhibiting SUI and
the studies themselves were relatively small scale, involving
between and subjects each. e Kegel exercises were
Advances in Nursing
Identication
537 of
records
identied
through
KoreaMed,
NDSL,
Ovid Medline,
Embase,
and
Scopus,
database
searching
25
additional
records
identied
through
related
Korean
journal
sources
Screening
Abstract
screened in
duplicate by two
reviewers
(126 of records
are duplication)
436 of records
screened by
abstract
Total 425 of records excluded as
follows:
- Kegel exercise is not main
Eligibility
41 of full-text
articles
assessed for
eligibility by two
reviewers
Included
11 studies
included in
qualitative and
quantitative
synthesis (meta-
analysis)
intervention =162
- Improper subjects =78
- Nonoriginal articles =75
- Irrelevant control =39
- Not designed RCT study =33
- Improper outcomes =14
- Irrelevant outcomes =12
- Others =12
F : Flow diagram of studies selection.
mainly taught by professional physical therapists and varied
bythenumberofcontractions,vetosix,andthenumberof
times a day, to . Other variations involved elevation of
the intensity of the contraction. e followups were mostly
done within three months, and only one study []showeda
drop-out rate of less than % during the follow-up period
(Table ).
3.2. Assessing Risk of Bias. Eight of the eleven selected studies
satised all assessment items (Figure )andthree[–]
were sucient for appropriate random sequence generation
but did not adequately describe allocation concealment.
e blinding of intervention and outcomes were unsatisfac-
tory in ve studies [–].
3.3. Eects of Kegel Exercises
3.3.1. Subjective Assessment of Improvement in SUI. Although
various dierence scales were used to measure patient
responses to treatment in the selected studies, whatever the
scale was, the data was included in the formal comparisons
as long as the trials stated the number of women who
perceived that they have been cured or improved, as dened
by the trials. Subjective assessments of improvements in
Advances in Nursing
T : Characteristics of the selected studies.
Year Study Location
Group
(𝑛/mean age (yr)) Interventions Dropout
𝑛,(%) Followup Outcomes
Exp. Con.
Pereira et al.
[]Brazil
. ±.
. ±.
Kegel exercises: individual training; totally
sessions, twice-weekly session of minutes
each. Each session contractions held for
seconds with seconds of rest; carried out in
the supine, sitting, and standing positions.
Control: no treatment
No weeks
(i) UI symptoms by KHO
(ii) -hour pad test
(iii) Pelvic oor muscle pressure
Pereira et al.
[]Brazil
. ±.
. ±.
Kegel exercises: group training; as above
Control: no treatment
(.) weeks
(i) UI symptoms by KHO
(ii) -hour pad test
(iii) Pelvic oor muscle pressure
Lee et al. []Korea
. ±.
. ±.
Kegel exercises: physiotherapist trained; twice a
week for minutes, sets of –
contractions a day.
Control: usual care (education)
(.) weeks (i) UI symptoms by BFLUTS
(ii) Pelvic oor muscle pressure
Castro et al. []Brazil
. ±.
. ±.
Kegel exercises: repetitions of -second
contractions with seconds of recovery time;
repetitions of -second contractions and
recovery; repetitions of -second
contractions and recovery; all the sessions were
held in groups for minutes.
Control: no treatment
(.) months
(i) UI episode for days
(ii) Standardized bladder volume
on pad test
Konstantinidou
et al. []Greece
. ±.
. ±.
Kegel exercises: -hour demonstration
program; sets of fast contractions and - sets
of slow contractions daily lying, sitting, and
standing positions.
Control: usual care
(.) weeks (i) UI episode for days
Advances in Nursing
T : C on tinue d.
Year Study Location
Group
(𝑛/mean age (yr)) Interventions Dropout
𝑛,(%) Followup Outcomes
Exp. Con.
Zanetti et al.
[]Brazil
(med)
(med)
Kegel exercises: physiotherapist trained; twice a
week, for minutes; repetitions of -second
held contractions with seconds of recovery;
repetitions of -second contractions and
recovery; repetitions of seconds of
contractions and recovery followed by
repetitions of strong contractions together with
a cough, with one-minute intervals between
each set.
Control: usual care (unsupervised)
No months (i) -hour pad test
Sung et al. []Korea
Kegel exercises: exercise video tape; intensively
programmed PFM exercise, which was
developed by Bø et al. []
Control: no treatment
No weeks (i) UI episode for days
(ii) Pelvic oor muscle pressure
Bø et al. []Norway
. ±.
. ±.
Kegel exercises: physical therapist group
training; times a day at home, – high
intensity contractions, with holding periods of
– seconds in lying, standing, kneeling, and
sitting positions and also additional training in
groups once a week for minutes
Control: no contact during intervention
(.) months
(i) Subjective assessment of
improvement in SUI
(ii) UI episode for days
(iii) Standardized bladder
volume on pad test
(iv) Pelvic oor muscle pressure
Burns et al. []USA
. ±.
. ±.
Kegelexercises:-minutevideotape;setsof
( quick and sustained) and increased by
per set over weeks until daily maximum
exercises
Control: no treatment
(.)
–
months
(i) Subjective assessment of
improvement in SUI
Lagro-Janssen et
al. []Netherland
. ±.
. ±.
Kegel exercises: general practitioner researcher
taught; squeeze pelvic muscle for seconds,
performed – sessions of pelvic muscle
contractions each day.
Control: no treatment
No months
(i) Subjective assessment of
improvement in SUI
(ii) UI episode for days
Henalla et al.
[]United Kingdom
Kegel exercises: physiotherapist trained;
seconds and repeat manoeuvre times every
hour.
Control: no treatment
No months (i) Subjective assessment of
improvement in SUI
Exp., experimental group; Con., control group; UI, urinary incontinence; KHO, King’s health questionnaire; BFLUTS, Bristol female lower urinary tract symptoms questionnaire; SUI, stress urinary incontinence.
Advances in Nursing
Random sequence generation (selection bias)
Allocation concealment (selection bias)
Blinding of participants and personnel (performance bias)
Blinding of outcome assessment (detection bias)
Incomplete outcome data (attrition bias)
Selective reporting (reporting bias)
Other bias
0 25 50 75 100
Low risk of bias
Unclear risk of bias
High risk of bias
(%)
F : Risk of bias graph.
SUI were measured in four studies [–]. As the relative
risk was . (% condence interval, . to .), each
Kegel exercise group showed more perceived symptoms of
urinary incontinence than their respective control group.
us, there was a statistically signicant dierence between
the Kegel exercise group and the control group and there was
insubstantial heterogeneity (𝐼2= 0.0%, 𝑃 = 0.540)inthe
measured studies (Figure (a)).
3.3.2. Incontinence Impact by Recommended Questionnaire.
Urinary incontinence symptoms were measured by a ques-
tionnaire in three studies [,,]. In these studies, the
symptoms were signicantly lower in the Kegel exercise
groups than in the control group (SMD −., % condence
interval, −. to −.; 𝑍 = 5.33,𝑃 < 0.001)andtherewas
no heterogeneity (𝐼2= 0.0%, 𝑃 = 0.710)(Figure (b)).
3.3.3. Urinary Incontinence Episode for 7 Days. ree studies
measured urinary incontinence episodes for days [,,]
through patient self-reported urinary diaries. Kegel exercises
reduced urinary incontinence episodes with a standardized
mean dierence (SMD) of . (% condence interval,
−. to −.)fordays.eeectsizeofthetwogroups
was statistically signicant (𝑍 = 7.74,𝑃 < 0.001), and there
was no heterogeneity (𝐼2= 0.0%, 𝑃 = 0.370)(Figure (c)).
3.3.4. Pad Test. Pad tests were conducted in ve studies by
two dierent methods. One used a -hour pad test, presenting
results as mean urine loss volumes (g), and another used a
standardized bladder volume and the third used mean pad
weight.
ree studies measured mean urine loss volumes [,
,]. Kegel exercise groups had an MD of . g (%
condence interval, −. to −.) less urine loss than
controls statistically (𝑍 = 3.62,𝑃 = 0.0003) and exhibited
no heterogeneity (𝐼2= 0.0%, 𝑃 = 0.920)(Figure (d)). One
study [] reported only the mean but found that women
doing Kegel exercises reported a mean pad weight increase
of . g less than controls (. g) with a statistical signicance
of 𝑃 = 0.002. e studies using standardized bladder volumes
[,] reported signicantly lower ones in the Kegel exercise
groupthanthecontrol(MD−., % condence interval,
−. to −.; 𝑍 = 2.43,𝑃 = 0.020)butheterogeneitywas
high (𝐼2= 91.0%, 𝑃 = 0.001)(Figure (e)).
3.3.5. Pelvic Floor Muscle Pressure. Pelvic oor muscle pres-
sure was measured in ve studies [,,,,]byusing
perineometer. Pelvic oor muscle pressures were improved
aer Kegel exercises with a standardized mean dierence
(SMD) of . (% condence interval, . to .), showing
statistical signicance (𝑍 = 6.81,𝑃 < 0.001) and low
heterogeneity (𝐼2= 36.0%, 𝑃 = 0.180)(Figure (f )).
4. Discussion
isstudywasameta-analysisoftheeectsofKegelexercises
on SUI as a nursing intervention through the systematic
consideration of the characteristics and methods of Kegel
exercises of a total of subjects over RCT studies. e
references analyzed in this study were determined consider-
ing the following. First, many studies of urinary incontinence
have analyzed the eects of applying biofeedback or electrical
stimulation together with Kegel exercises or the use of vaginal
cones, but this paper analyzed only studies of Kegel exercises
without the use of other equipment or devices to provide
insight into independent nursing intervention. Furthermore,
in order to draw reliable conclusions only randomized con-
trolled trials with high levels of evidence were analyzed.
Kegel exercises were originally devised by Dr. Arnold
Kegel in to prevent urinary incontinence in postpartum
women [] and they are one of the safest behavioral therapies
without side eects [] and complications. It treats urinary
incontinence symptoms by reinforcing weakened pelvic oor
muscle and improving elasticity. e Kegel exercise models
analyzed were within the recommended parameters of the
International Continence Society [], although there were
dierences between the papers in terms of the method of
muscle contraction and relaxation, the frequency of exercises,
Advances in Nursing
Study or subgroup
Burns et al. (1993)
Henalla et al. (1989)
Lagro-Janssen et al. (1991)
Total (95% CI)
Total events
Events
7
23
17
28
75
Tot al
43
25
26
33
127
Events
1
1
0
0
2
Tot al
39
30
25
33
127
Weight
35.3%
30.6%
17.2%
16.9%
100.0%
M-H, xed, 95% CI
6.35 [0.82, 49.32]
27.60 [4.00, 190.24]
33.70 [2.14, 532.01]
57.00 [3.62, 896.38]
26.09 [8.50, 80.11]
Experimental Control Risk ratio Risk ratio
M-H, xed, 95% CI
0.01 0.1 1 10 100
Favours experimental Favours control
Heterogeneity: 𝜒2= 2.17,df=3(P = 0.540); I2= 0.0%
Test for overall eect: Z=5.70(P < 0.001)
Bø et al. (1999)
(a) Subjective assessment of improvement in stress urinary incontinence
Study or subgroup
Lee et al. (2009)
Pereira et al. (2011)
Pereira et al. (2012)
Total (95% CI)
Mean
28.91
28.84
17.76
SD
2.9
20.54
24.7
Tot al
10
15
15
40
Mean
36.6
57.84
57.84
SD
5.71
29.47
29.48
Tot al
10
15
15
40
Weight
22.6%
40.6%
36.9%
100.0%
IV, xed, 95% CI
Experimental Control Std. mean dierence Std. mean dierence
IV, xed, 95% CI
0 2 4
Favours experimental Favours control
−4 −2
−1.63 [−2.67,−0.58]
−1.11 [−1.89,−0.33]
−1.43 [−2.25,−0.62]
−1.35 [−1.84, −0.85]
Heterogeneity: 𝜒2= 0.68,df=2(P = 0.710); I2= 0.0%
Test for overall eect: Z=5.33(P < 0.001)
(b) Urinary incontinence symptoms by recommended questionnaire
Study or subgroup
Castro et al. (2008)
Konstantinidou et al. (2007)
Lagro-Janssen et al. (1991)
Total (95% CI)
Mean
2.7
2.8
4.8
SD
3.6
2.8
5.64
Tot al
26
10
33
69
Mean
8.8
12.5
25.3
SD
6.3
7
15.23
Tot al
24
12
33
69
Weight
40.4%
14.7%
44.9%
100.0%
IV, xed, 95% CI
Experimental Control Std. mean dierence Std. mean dierence
IV, xed, 95% CI
0 2 4
Favours experimental Favours control
−1.18 [−1.79,−0.58]
−1.69 [−2.69,−0.69]
−1.76 [−2.34,−1.19]
−1.52 [−1.90, −1.13]
−4 −2
Heterogeneity: 𝜒2= 2.00,df=2(P = 0.370); I2= 0.0%
Test for overall eect: Z=7.74(P < 0.001)
(c) Urinary incontinence episode for days
Study or subgroup
Sung et al. (2000)
Henalla et al. (1989)
Total (95% CI)
Mean
0.46
0.29
SD
0.45
0.31
Tot al
15
15
30
Mean
3.64
3.65
SD
4.93
4.94
Tot al
15
15
30
Weight
50.0%
50.0%
100.0%
IV, xed, 95% CI
Experimental Control Mean dierence Mean dierence
IV, xed, 95% CI
0 25 50
Favours experimental Favours control
−3.18 [−5.69,−0.67]
−3.36 [−5.86,−0.86]
−3.27 [−5.04, −1.50]
−50 −25
Heterogeneity: 𝜒2= 0.01,df=1(P = 0.920); I2= 0.0%
Test for overall eect: Z=3.62(P = 0.0003 )
(d) One-hour pad test on pad test
F : Continued.
Advances in Nursing
Study or subgroup
Castro et al. (2008)
Total (95% CI)
Mean
8.4
8.4
SD
13.2
5.8
Tot al
25
26
51
Mean
38.7
21
SD
14.5
18.5
Tot al
30
24
54
Weight
50.3%
49.7%
100.0%
IV, random, 95% CI
Experimental Control Mean dierence Mean dierence
IV, random, 95% CI
0 50 100
Favours experimental Favours control
−30.30 [−37.63,−22.97]
−12.60 [−20.33,−4.87]
−21.49 [−38.84, −4.15]
−100 −50
Heterogeneity: 𝜏2= 141.88;𝜒2= 10.61,df= 1 (P = 0.001); I2= 91.0%
Test for overall eect: Z = 2.43 (P = 0.020)
Bø et al. (1999)
(e) Standardized bladder volume on pad test
Study or subgroup
Lee et al. (2009)
Pereira et al. (2011)
Pereira et al. (2012)
Sung et al. (2000)
Total (95% CI)
Mean
19.2
15.08
37.13
35.22
38.7
SD
3.2
4.66
19.24
18.96
7.8
Tot al
25
10
15
15
30
95
Mean
16.2
9.21
11.91
11.91
33
SD
3.8
4.45
5.57
5.57
7.3
Tot al
30
10
15
15
30
100
Weight
30.3%
9.8%
12.7%
13.2%
33.9%
100.0%
IV, xed, 95% CI
0.84 [0.28, 1.39]
1.23 [0.26, 2.21]
1.73 [0.88, 2.59]
1.62 [0.78, 2.46]
0.74 [0.22, 1.27]
1.06 [0.76, 1.37]
Experimental Control Std. mean dierence Std. mean dierence
IV, xed, 95% CI
024
Favours experimental Favours control
−4 −2
Test for overall eect: Z = 6.81 (P < 0.001)
Heterogeneity: 𝜒2= 6.23,df=4(P = 0.180); I2=36.0%
Bø et al. (1999)
(f) Pelvic oor muscle pressure
F : e results of eects of Kegel exercises.
the duration of one exercise, the number of repetitions, and
the position. In general, one should not contract the muscles
of the legs, hip, or abdomen when doing Kegel exercises
correctly, but there is no way a patient can check this without
helpandtheytendtogiveupeasilybecausetheeectsarenot
quickly apparent []. To avoid this, concomitant biofeedback
therapy using a nger or vaginal cone, or stimulation therapy,
is used to evaluate the eects of Kegel exercises. However, a
standardized guideline for Kegel exercises needs to be devel-
oped because they must be done consistently throughout life
to manage menopausal urinary incontinence, and learning
and implementing the correct method is more important
than using an assisting device in the long run.
e eects of Kegel exercises were analyzed with respect
to outcome variables, and the results of the meta-analyses
revealed statistically signicant dierences in the sizes of their
eects. e self-reports on urinary incontinence symptoms
aer doing Kegel exercises were logged in -hour urinary
activity diaries. In the four references that used these diaries,
the patients reported improvements in urinary incontinence
symptoms aer Kegel exercises, and the eects of Kegel
exercises were veried because RR was . (% CI .
to .) and there was no dierence between the references.
e Korean Continence Society endorses urination diaries as
areliablesourceofdataonlowerurinarytractsymptoms.
Papers [,,] reporting days of urinary incontinence
episodes using the same diary format consistently show a
reduction in episode frequency, . times on average (%
CI −. to −.), aer Kegel exercises.
e pad test has been used as a source of objective
outcome data for recent urinary incontinence diagnoses
because there is adequate evidence [,]thatitcanreect
changes aer urinary incontinence treatments, despite not
being standardized since patients have dierent activity levels
duringthetestperiodandthetestitself.epapersrefer-
enced in this study used various methods of measurement,
such as -hour or -hour pad tests and pad tests aer infusing
mL of normal saline into the patient’s bladder. In spite of
dierences between the papers in terms of bladder volume
pad test standardization, the eects of Kegel exercises were
consistent when using the one-hour pad test standard. e
reasons for the dierent eects in the other two papers
were not thoroughly analyzed because only two papers were
involved. However, these tests were the same in terms of
BMI, method of Kegel exercises, and follow-up period, only
diering in patient age, suggesting the cause to be the absence
of standardization of the pad test method and the eects of
other varying conditions.
Pelvic oor muscle contractility was measured using a
perineometer. e examinee lies down with knees bent, an
intravaginal tube of approximately . cm is inserted using
a vaginal balloon catheter, and air is put in using a pump.
Finally,thepelvicoormusclesarecontractedtimesandthe
averagevolumeisused.Inthevepapersmeasuringpelvic
oormusclecontractility,thevariableconsistentlyimproved
aer Kegel exercises (SMD ., % CI . to .). In other
words, all these studies showed consistent results.
is study only compared the implementation of Kegel
exercises in middle-aged women with SUI with noninterven-
tion and routine intervention such as education. Eleven RCTs
were analyzed, but there may be limitations to interpretation
of the study results because most of them were of a small scale
Advances in Nursing
andthetreatmentperiodandthefollow-upperiodswere
short, with less than three months. But the eects of Kegel
exercise on SUI were veried consistently, and all results
showed statistically signicant dierence. In conclusion, this
study provides evidence that Kegel exercises are eective
and better than no treatment in the management of women
with stress urinary incontinence because the outcome vari-
ables used for this meta-analysis showed excellent results
for decreasing the frequency of urinary incontinence and
alleviating its symptoms.
5. Conclusion
Signicantly the study showed the improvement of SUI
symptoms in middle-aged women who did Kegel exercises
and included objectively veried data, specically data from
both the pad test and vaginal perineal muscle contractility
data. Although the Kegel exercise method has not yet been
standardized, these results consistently show the reinforce-
ment of pelvic muscles and verify that Kegel exercises are
indeed a safe method of intervention. However, the references
used in this study mostly deal with short-term interventions
of about three months, and further improvement in the
prevention and management of urinary incontinence in
perimenopausal middle-aged women using Kegel exercises
requires longer-term studies.
Conflict of Interests
e authors declare that there is no conict of interests
regarding the publication of this paper.
References
[] P.Abrams,K.E.Andersson,L.Birderetal.,“Fourthinterna-
tional consultation on incontinence recommendations of the
international scientic committee: evaluation and treatment of
urinary incontinence, pelvic organ prolapse, and fecal inconti-
nence,” Neurourology and Urodynamics,vol.,no.,pp.–
, .
[] S. Charambous and A. Trantafylidis, “Impact of urinary incon-
tinence on quality of life,” Pelviperineology,vol.,no.,pp.
–, .
[] J.L.Yoon,Y.H.Lee,andB.R.Cho,AResearchfortheDevelopment
of National Health Screening Program for Korean Older Persons,
Hallym University & Korea Health Promotion Foundation,
Seoul, Korea, .
[] F. Daneshgari, “Surgical treatment of female stress urinary
incontinence, decades learned lessons,” European Urology,vol.
,no.,pp.–,.
[] T. Guarsi, A. M. Pinto-Neto, M. J. Osis et al., “Procura de servic¸o
m´
edico por mulheres com incontinˆ
encia urin´
aria,” Revista
Brasileira de Ginecologia e Obstetr´
ıcia,vol.,no.,pp.–
, .
[] H. A. Schiøtz, J.-H. Karlsen, and T. G. Tanbo, “Ten-year follow-
up aer conservative treatment of stress urinary incontinence,”
International Urogynecology Journal and Pelvic Floor Dysfunc-
tion,vol.,no.,pp.–,.
[] E.H.Yoo,“Pelvicoormusclerehabilitation,”Korean Journal of
Obstetrics and Gynecology,vol.,no.,pp.–,.
[] E.J.Hay-Smith,K.Bø,L.C.Berghmans,H.J.Hendriks,R.A.de
Bie,andE.S.vanWalwijkvanDoorn,“Pelvicoormuscletrain-
ing for urinary incontinence in women,” Cochrane Database
of Systematic Reviews,vol.,ArticleIDCD,.
[] J. Y. Hong, “e ecacy of pelvic oor muscle exercise in
patients with genuine stress incontinence,” Korean Journal of
Urology, vol. , no. , pp. –, .
[] P. M. Latthe, R. Foon, and K. Khan, “Nonsurgical treatment of
stress urinary incontinence (SUI): grading of evidence in
systematic reviews,” BJOG,vol.,no.,pp.–,.
[] T. A. Shamliyan, R. L. Kane, J. Wyman, and T. J. Wilt, “Sys-
tematic review: randomized, controlled trials of nonsurgical
treatments for urinary incontinence in women,” Annals of
Internal Medicine,vol.,no.,pp.–,.
[] K.Bø,S.Mørkved,H.Frawley,andM.Sherburn,“Evidencefor
benet of transversus abdominis training alone or in com-
bination with pelvic oor muscle training to treat female
urinary incontinence: a systematic review,” Neurourology and
Urody namics,vol.,no.,pp.–,.
[]J.P.T.HigginsandS.Green,“Cochranehandbookforsys-
tematic reviews of interventions version ... e Cochrane
Collaboration,” , http://www.cochrane-handbook.org/.
[] D. Moher, A. Liberati, J. Tetzla, and D. G. Altman, “Preferred
Reporting items for systematic reviews and meta-analyses: the
PRISMA statement,” Physical erapy,vol.,no.,pp.–
, .
[] E. Konstantinidou, A. Apostolidis, N. Kondelidis, Z. Tsimtsiou,
D. Hatzichristou, and E. Ioannides, “Short-term ecacy of
group pelvic oor training under intensive supervision ver-
sus unsupervised home training for female stress urinary
incontinence: a randomized pilot study,” Neurourology and
Urody namics,vol.,no.,pp.–,.
[] H. H. Lee, S. W. Lee, and C. H. Song, “e inuence of pelvic
muscle training program on lower urinary tract symptom,
maximum vaginal contraction pressure, and pelvic oor muscle
activity in aged women with stress urinary incontinence,”
Korean Journal of Spor t Science,vol.,no.,pp.–,.
[] M.S.Sung,Y.H.Choi,S.H.Back,J.Y.Hong,andH.Yoon,“e
eectofpelvicoormuscleexercisesongenuinestressincon-
tinence among Korean women—focusing on its eects on the
quality of life,” Yo ns ei Me di cal Jou rn al,vol.,no.,pp.–
, .
[] S. M. Henalla, C. J. Hutchins, P. Robinson, and J. MacVicar,
“Non-operative methods in the treatment of female genuine
stress incontinence of urine,” Journal of Obstetrics and Gynae-
cology,vol.,no.,pp.–,.
[] T. L. M. Lagro-Janssen, F. M. J. Debruyne, A. J. A. Smits, and
C. van Weel, “Controlled trial of pelvic oor exercises in the
treatment of urinary stress incontinence in general practice,”
BritishJournalofGeneralPractice,vol.,no.,pp.–,
.
[] K. Bø, T. Talseth, and I. Holme, “Single blind, randomised
controlled trial of pelvic oor exercises, electrical stimulation,
vaginal cones, and no treatment in management of genuine
stress incontinence in women,” British Medical Journal,vol.,
no. , pp. –, .
[]P.A.Burns,K.Praniko,T.H.Nochajski,E.C.Hadley,K.
J. Levy, and M. G. Ory, “A comparison of eectiveness of
biofeedback and pelvic muscle exercise treatment of stress
incontinence in older community-dwelling women,” Journals of
Gerontology, vol. , no. , pp. M–M, .
Advances in Nursing
[] V. S. Pereira, G. N. Correia, and P. Driusso, “Individual and
group pelvic oor muscle training versus no treatment in
female stress urinary incontinence: a randomized controlled
pilot study,” European Journal of Obstetrics Gynecology and
Reproductive Biology,vol.,no.,pp.–,.
[] V.S.Pereira,M.V.deMelo,G.N.Correia,andP.Driusso,
“Vaginal cone for postmenopausal women with stress urinary
incontinence: randomized, controlled trial,” Climacteric,vol.,
no. , pp. –, .
[] R.A.Castro,R.M.Arruda,M.R.D.Zanetti,P.D.Santos,M.G.
F.Sartori,andM.J.B.C.Gir
˜
ao, “Single-blind, random-
ized, controlled trial of pelvic oor muscle training, electrical
stimulation, vaginal cones, and no active treatment in the
management of stress urinary incontinence,” Clinics,vol.,no.
, pp. –, .
[] M. R. D. Zanetti, R. de Aquino Castro, A. L. Rotta, P. D. dos
Santos,M.Sartori,andM.J.B.C.Gir
˜
ao, “Impact of supervised
physiotherapeutic pelvic oor exercises for treating female
stress urinary incontinence,” Sao PauloMedical Journal,vol.,
no. , pp. –, .
[] M. S. Song, “Eect of pelvic oor muscle exercise for the
older women with stress incontinence,” Korean Journal of Adult
Nursing,vol.,no.,pp.–,.
[] C. M. Sampselle, “Behavioral intervention for urinary inconti-
nence in women: evidence for practice,” Journal of Midwifery
and Women’s Health,vol.,no.,pp.–,.
[] D. I. Kang, T. H. Kim, H. J. Kim et al., Guidelines on Urinary
Incontinence, Korean Incontinence Society, Seoul, Korea, .
[] A. L. Blackwell, W. Yoong, and K. H. Moore, “Criterion validity,
test-retest reliability and sensitivity to change of the St George
urinary incontinence score,” BJU International,vol.,no.,pp.
–, .
[] D.L.Floratos,G.S.Sonke,C.A.Rapidouetal.,“Biofeedback
vs verbal feedback as learning tools for pelvic muscle exercises
in the early management of urinary incontinence aer radical
prostatectomy,” BJU International,vol.,no.,pp.–,
.
Available via license: CC BY
Content may be subject to copyright.
Content uploaded by Seong-Hi Park
Author content
All content in this area was uploaded by Seong-Hi Park on Sep 23, 2015
Content may be subject to copyright.
