Top

Published in:

01-05-2020 | Stress Incontinence | Original Article

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

Authors: Fátima Faní Fitz, Márcia Maria Gimenez, Letícia de Azevedo Ferreira, Mayanni Magda Perreira Matias, Maria Augusta Tezelli Bortolini, Rodrigo Aquino Castro

Published in: International Urogynecology Journal | Issue 5/2020

Abstract

Introduction and hypothesis

In the literature, it is suggested that supervised pelvic floor muscle training (PFMT) might be the first option treatment for female stress urinary incontinence (SUI). However, inadequate accessibility to health care and scarce individual resources may prevent adherence to the treatment. Our study is aimed at comparing the efficacy of performing PFMT in an outpatient clinic and at home in Brazilian incontinent women, and to verify if home PFMT may be an alternative to those not able to attend the outpatient sessions.

Methods

A total of 69 women with predominant SUI were randomised into two groups: outpatient PFMT and home PFMT. The primary outcome was the cure of SUI defined as <2 g of leakage in a 20-min pad test. Secondary outcomes were: pelvic floor muscle function; urinary symptoms; quality of life; patient satisfaction; and adherence to home exercise sets. The assessments were conducted at baseline and after 3 months of treatment. Statistical analyses consisted of Student’s t, Mann–Whitney U, Chi-squared, and Wilcoxon tests, with a 5% cut-off for significance.

Results

A superior objective cure of SUI was observed in the outpatient clinic (62%) compared with the home (28%) PFMT groups (OR: 4.0 [95% CI: 1.4–11.0]; p = 0.011). Secondarily, there was no difference between groups regarding the following: satisfaction with the treatment; quality of life; function of the PFMs; and number of episodes of urine leakage per week. The home adherence to the exercises was superior in the outpatient PFMT group only during the first-month training.

Conclusions

Outpatient PFMT was associated with a higher objective cure of SUI than home PFMT. However, subjective findings show equal benefit of home PFMT providing evidence that this may be an alternative treatment to our population.

Available only for authorised users

Ortiz C. Stress urinary incontinence in the gynecological practice. Int J Gynaecol Obstet. 2004;86(Suppl 1):S6–S16. https://doi.org/10.1016/j.ijgo.2004.05.004.CrossRef

Fantl JA, Bump RC, Robinson D, McClish DK, Wyman JF. Efficacy of estrogen supplementation in the treatment of urinary incontinence: the continence program for women research group. Obstet Gynecol. 1996;88:745–9. https://doi.org/10.1016/0029-7844(96)00281-5.CrossRefPubMed

Tamanini JTN, Lebrão ML, Duarte YOA, Santos JLF, Laurentini R. Analysis of the prevalence of and factors associated with urinary incontinence among elderly people in the municipality of São Paulo, Brazil: SABE study (health, wellbeing and aging). Cad Saúde Pública. 2009;25(8):1756–62. https://doi.org/10.1590/S0102-311X2009000800011.CrossRefPubMed

Temml C, Haidinger G, Schmidbauer J, Schatzl G, Madersbacher S. Urinary incontinence in both sexes: prevalence rates and impact on quality of life and sexual life. Neurourol Urodyn. 2000;19(3):259–71. https://doi.org/10.1002/(SICI)1520-6777(2000)19:3<259::AID-NAU7>3.0.CO;2-U.CrossRefPubMed

Sen I, Onaran M, Aksakal N, et al. The impact of urinary incontinence on female sexual function. Adv Ther. 2006;23(6):999–1008. https://doi.org/10.1007/bf02850220.CrossRefPubMed

Dumoulin C, Cacciari LP, Hay-Smith EJC. Pelvic floor muscle training versus no treatment, or inactive control treatments, for urinary incontinence in women. Cochrane Database Syst Rev. 2018;10:CD005654. https://doi.org/10.1002/14651858.CD005654.pub4.CrossRefPubMed

Castro RA, Arruda RM, Zanetti MRD, Santos PD, Sartori MGF, Girão MJBC. Single-blind, randomized, controlled trial of pelvic floor muscle training, electrical stimulation, vaginal cones, and no active treatment in the management of stress urinary incontinence. Clinics (Sao Paolo). 2008;64:465–72. https://doi.org/10.1590/S1807-59322008000400009.CrossRef

Bø K, Hagen RH, Kvarstein B, Jørgensen J, Larsen S. Pelvic floor muscle exercise for the treatment of female urinary stress incontinence. III. Effects of two different degrees of pelvic floor muscle exercises. Neurourol Urodyn. 1990;9:489–502. https://doi.org/10.1002/nau.1930090505.CrossRef

Saldiva PHN, Veras M. Gastos públicos com saúde: breve histórico, situação atual e perspectivas futuras. Estudos Avançados. 2018;32(92):47–6. https://doi.org/10.5935/0103-4014.20180005.CrossRef

10.

Dal Poz MR. The health workforce crisis. Cad Saúde Pública. 2013;29(10):1924–6.CrossRef

11.

Paim J, Travassos C, Almeida C, Bahia L, Macinko J. The Brazilian health system: history, advances, and challenges. Lancet. 2011;377:1778–97. https://doi.org/10.1016/S0140-6736(11)60054-8.CrossRefPubMed

12.

Silveira MR, Cocco RG. Transporte público, mobilidade e planejamento urbano: contradições essenciais. Estudos Avançados. 2013;27(79):41–53.CrossRef

13.

Zanetti MRD, Castro RA, Rotta AL, Santos PD, Sartori M, Girão MJBC. Impact of supervised physiotherapeutic pelvic floor exercises for treating female stress urinary incontinence. Sao Paulo Med J. 2007;125(5):265–9. https://doi.org/10.1590/S1516-31802007000500003.CrossRefPubMed

14.

Felicíssimo MF, Carneiro MM, Salene CS, et al. Intensive supervised versus unsupervised pelvic floor muscle training for the treatment of stress urinary incontinence: a randomized comparative trial. Int Urogynecol J. 2010;21(7):835–40. https://doi.org/10.1007/s00192-010-1125-1.CrossRefPubMed

15.

Haylen BT, de Ridder D, Freeman RM, et al. An International Urogynecological Association (IUGA)/International Continence Society (ICS) joint report on the terminology for female pelvic floor dysfunction. Int Urogynecol J. 2010;21:5–26. https://doi.org/10.1007/s00192-009-0976-9.CrossRefPubMed

16.

Ghoniem G, Stanford E, Kenton K, et al. Evaluation and outcome measures in the treatment of female urinary stress incontinence: International Urogynecological Association (IUGA) guidelines for research and clinical practice. Int Urogynecol J. 2008;19:5–33. https://doi.org/10.1007/s00192-007-0495-5.CrossRef

17.

Bø K, Kvarstein B, Hagen R, Larsen S. Pelvic floor muscle exercise for the treatment of female stress urinary incontinence. II. Validity of vaginal pressure measurements of pelvic floor muscle strength and the necessity of supplementary methods for control of correct contraction. Neurourol Urodyn. 1990;9:479–87. https://doi.org/10.1002/nau.1930090504.CrossRef

18.

Slade SC, Dionne CE, Underwood M, et al. Consensus on exercise reporting template (CERT): modified Delphi study. Phys Ther. 2016;96:1514–24. https://doi.org/10.2522/ptj.20150668.CrossRefPubMed

19.

Slade SC, Dionne CE, Underwood M, et al. Consensus on exercise reporting template (CERT): explanation and elaboration statement. Br J Sports Med. 2016;50:1428–37. https://doi.org/10.1136/bjsports-2016-096651.CrossRefPubMed

20.

Frawley HC, Dean SG, Slade SC, et al. Is pelvic-floor muscle training a physical therapy or a behavioral therapy? A call to name and report the physical, cognitive, and behavioral elements. Phys Ther. 2017;97:425–37. https://doi.org/10.1093/ptj/pzx006.CrossRefPubMed

21.

Lose G, Rosenkilde P, Gammelgaard J, Schroeder T. Pad-weighing test performed with standardized bladder volume. Urology. 1988;32:78–80. https://doi.org/10.1016/0090-4295(88)90462-1.CrossRefPubMed

22.

Laycock J. Clinical evaluation of the pelvic floor. In: Schussler B, Laycock J, Norton P, Stanton S, editors. Pelvic floor re-education principles and practice. London: Springer; 2002. p. 42–8.

23.

Souza CC, Rodrigues AM, Ferreira CE, Fonseca ES, di Bella ZI, Girão MJ, et al. Portuguese validation of the urinary incontinence-specific quality-of-life instrument: I-QOL. Int Urogynecol J Pelvic Floor Dysfunct. 2009;20(10):1183–9. https://doi.org/10.1007/s00192-009-0916-8.CrossRefPubMed

24.

Pocock SJ. Clinical trials—a practical approach. New York: Wiley; 1983.

25.

Day S. Analysis issues, ITT, post-hoc, and subgroups. Johns Hopkins University. 2008. Accessed 20 July 2019. Available from: http://ocw.jhsph.edu/courses/BiostatMedicalProductRegulation/biomed_lec7_day.pdf.

26.

Konstantinidou E, Apostolidis A, Kondelidis N, et al. Short-term efficacy of group pelvic floor training under intensive supervision versus unsupervised home training for female stress urinary incontinence: a randomized pilot study. Neurourol Urodyn. 2007;26:486–91. https://doi.org/10.1002/nau.20380.CrossRefPubMed

27.

Bø K. Pelvic floor muscle training is effective in treatment of female stress urinary incontinence, but how does it work? Int Urogynecol J. 2004;15:76–84. https://doi.org/10.1007/s00192-004-1125-0.CrossRef

28.

DeLancey JO. Anatomy and physiology of urinary continence. Clin Obstet Gynecol. 1990;33:298–307.CrossRef

29.

Miller JM, Ashton-Miller JA, DeLancey JO. A pelvic muscle precontraction can reduce cough-related urine loss in selected women with mild SUI. J Am Geriatr Soc. 1998;46:870–4. https://doi.org/10.1111/j.1532-5415.1998.tb02721.x.CrossRefPubMed

30.

Alewijnse D, Mesters I, Metsemakers J, Adriaans J, van den Borne B. Predictors of intention to adhere to physiotherapy among women with urinary incontinence. Health Educ Res. 2001;16(2):173–86. https://doi.org/10.1093/her/16.2.173.CrossRefPubMed

31.

Kraemer WJ, Ratamess NA. Fundamentals of resistance training: progression and exercise prescription. Med Sci Sports Exerc. 2004;36(4):674–88. https://doi.org/10.1249/01.MSS.0000121945.36635.61.CrossRefPubMed

Title: Pelvic floor muscle training for female stress urinary incontinence: a randomised control trial comparing home and outpatient training
Authors: Fátima Faní Fitz
Márcia Maria Gimenez
Letícia de Azevedo Ferreira
Mayanni Magda Perreira Matias
Maria Augusta Tezelli Bortolini
Rodrigo Aquino Castro
Publication date: 01-05-2020
Publisher: Springer International Publishing
Keyword: Stress Incontinence
Published in: International Urogynecology Journal / Issue 5/2020
Print ISSN: 0937-3462
Electronic ISSN: 1433-3023
DOI: https://doi.org/10.1007/s00192-019-04081-x

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

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

Abstract

Introduction and hypothesis

Methods

Results

Conclusions

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Introduction and hypothesis

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 5/2020

Urinary metabolomics predict the severity of overactive bladder syndrome in an aging female population

Commentary on “Effect of an exercise programme for reducing abdominal fat on overactive bladder symptoms in young overweight women”

Urinary incontinence and cardiovascular disease: a narrative review

Posterior tibial nerve stimulation for overactive bladder—techniques and efficacy

Toileting behaviors and factors associated with urinary incontinence in college-aged female students in China

The world is upside down; how coronavirus changes the way we care for our patients