Physiospot Womens Health

Pelvic floor muscle training in the prevention and treatment of urinary incontinence in women - what is the evidence?

Brostrøm S, Lose G

Many women suffer from urinary incontinence (UI). During and after pregnancy, women are advised to perform pelvic floor muscle training (PFMT) to prevent the development of UI. In established UI, PFMT is prescribed routinely as first-line treatment. This article argues that previous studies lack validity and that the available evidence suggests a lack of long-term efficacy of peripartum PFMT. In established UI, there seems to be a modest immediate response to PFMT. They suggest that a critical reappraisal of PFMT is needed, and judgments on the place of PFMT in current clinical practice should be reserved until further evidence, including cost-benefit analyses, has unequivocally demonstrated a clinically relevant efficacy.

Acta Obstetricia et Gynecologica Scandinavica, 2008, 87(4), 384-402

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Pelvic floor muscle training versus no treatment for urinary incontinence in women. A Cochrane systematic review.

Dumoulin C, Hay-Smith J

The aim of this systematic review was 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. The review included randomized or quasi-randomized trials in women with stress, urge or mixed urinary incontinence. Thirteen trials involving 714 women met the inclusion criteria; however, only six trials (403 women) contributed to data analysis.

This review provides support for the widespread recommendation that pelvic floor muscle training be included in first-line conservative management programs for women with stress, urge or mixed urinary incontinence.        

European Journal of Physical Medicine and Rehabilitation, 2008, 44(2), 47-63

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Results of conservative non-pharmacological therapy in female patients with urinary incontinence

Krhut J, Holanová R, Muronová I, Gärtner M

This study assesses both subjective and objective results of the conservative non-pharmacological therapy and its effect to the quality of life in the set of female patients with urinary incontinence of all types. 69 female patients suffering from urinary incontinence were treated in a complex way in accordance with principles of the so-called "Ostrava concept" of the conservative non-pharmacological therapy. Subjective results were evaluated before the therapy started and 6 months after using the visual-analog scale (VAS) while objective results were evaluated by the perineometric measurement of the pelvic floor.

Based on results obtained the conservative non-pharmacological therapy is an efficient treatment method in case of the incontinence. Due to its non-invasive character and the absence of adverse effects it should be considered to be the first choice treatment in case of female patient with urinary incontinence.

Ceska Gynekologic, 2007, 72(6), 406-9

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Bladder training versus combination of propiverine with bladder training for female urinary frequency. A prospective, randomized, comparative study.

Kim SW, Song SH, Ku JH

The objective of this study was to evaluate the effect of bladder training with or without pharmacotherapy in women with only a frequency symptom. 48 patients were randomized to either bladder training alone or propiverine combined with bladder training. All patients were treated during 3 months. After treatment, there was no significant difference of functional bladder capacity and average voided volume between the two groups and the changes of daytime frequency, functional bladder capacity and average voided volume were not significantly different in the groups. Of total patients, 15 in the bladder training group and 21 in the combination therapy group were rated as responders.

Bladder training with or without pharmacotherapy may improve the subjective and objective frequency symptom in women with only a frequency symptom. When anticholinergics combined with bladder training are compared with bladder training alone, symptomatic improvement is not superior.

Gynecologic and Obstetric Investivation, 2008, 65(2), 123-7

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Systematic review: randomized, controlled trials of nonsurgical treatments for urinary incontinence in women.

Shamliyan TA, Kane RL, Wyman J, Wilt TJ

The purpose of this systematic review was to synthesize evidence of management of urinary incontinence in women.  Moderate levels of evidence suggest that pelvic floor muscle training and bladder training resolved urinary incontinence in women. Anticholinergic drugs resolved urinary incontinence, with similar effects from oxybutynin or tolterodine. Duloxetine improved but did not resolve urinary incontinence. The effects of electrostimulation, medical devices, injectable bulking agents, and local estrogen therapy were inconsistent.

Annals of Internal Medicine, 2008, 148(6), 459-73

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The integrated continence system: A manual therapy approach to the treatment of stress urinary incontinence

Heather Grewar and Linda McLean

This article describes the integrated continence system (ICS) which was developed by the authors.  It is an evidence-based model that demonstrates how urinary incontinence is maintained through the interaction of three structural systems (intrinsic urethral closure, urethral support, and lumbopelvic stability) and three modifiable factors (motor control, musculoskeletal and behavioral). The purpose of the ICS is first, to demonstrate the important role that manual physiotherapists can play in the treatment of SUI and second, to guide clinical practice decisions in order to improve clinical outcomes among women with SUI.

Manual Therapy, 12 March 2008, online article ahead of print

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Rehabilitation versus drug therapy for urge urinary incontinence: long-term outcomes.

Kafri R, Shames J, Raz M, Katz-Leurer M

The objective of this study was to compare the residual effect of a 3-month rehabilitation treatment and a standard drug treatment for urge urinary incontinence 21 months post intervention. Forty-four women who were diagnosed with overactive bladder were divided into 2 treatment groups over 3 months: 24 women received rehabilitation and 20 women were treated with medication with oxybutynin ER (MED). Outcomes measures included frequency of urination, quality of life, and number of side effects, which were measured upon entry into the study, completion of the intervention, and at follow-up 3 and 21 months after completion of treatment. In the long-term, the women received rehabilitation maintained and even improved the achievements of the intervention period while the women were treated with medication deteriorated to baseline values in urinary frequency.

Women with urge urinary incontinence maintained improvements in the long term following rhabilitation compared with women who received oxybutynin ER.

Internationl Urogynecology Journal of Pelvic Floor Dysfunction, 2008, 19(1), 47-52

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Physiotherapy for urinary incontinence.

Neumann P, Morrison S

This article discusses the role of a physiotherapy program in treating women with urinary incontinence.  Treatment usually involves five consultations with a pelvic floor physiotherapist over 4-6 months. After an assessment of bladder function and the pelvic floor muscles, an individualised training program is prescribed. The focus of pelvic floor muscle training is to build strength, endurance, speed and the coordination of the pelvic floor muscles in different situations. An effective program has been shown to increase contractile strength as well as increased resting tone of the pelvic floor, which then provides improved support of the pelvic organs higher in the pelvis. Women may be offered an annual review by their physiotherapist in order to promote long term continence.

Australian Family Physician, 2008, 37(3), 118-121

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Urinary incontinence after stroke: identification, assessment, and intervention by rehabilitation professionals in Canada

Urinary incontinence is a common and distressing problem which may occur as a result of a stroke, and although there is evidence of new and effective rehabilitation interventions for this specific group, it is not known whether occupational therapists (OT's) and physical therapists (PT's) actual practices are best practice.

This study sought to determine the extent to which OT's and PT's identify, assess and treat UI following stroke, and to identify personal and organisational predictors of UI problem identification, best-practice assessment and intervetion.

693 OT's and 656 PT's working in stroke rehabilitation in Canada were randomly selected and interviewed with a telephone questionnaire, using general open-ended questions relating to a generated case (vignette) of a typical client who had experienced a stroke and had UI problems. 

Only 39% of OT's and 41% of PT's identified UI after stroke as a problem, with fewer thatn 20% of OT's and 15% of PT's using best-practice assessments, and only 2% of OT's and 3% of PT's used best-practice interventions.

This study concludes that Canadian OT's and PT's do not routinely identify post-stroke UI as a problem, and best-practice assessments and interventions are underused within these groups.

Stroke (2007) 38(10) 2745-51

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The diagnostic strength of the 24-h pad test for self-reported symptoms of urinary incontinence in pregnancy and after childbirth.

Wijma, J., Weis Potters, A.E., Tinga, D.J. and Aarnoudse, J.G. (2007)

The need for an accurate objective diagnostic test for measuring incontinence during pregnancy and after childbirth is growing.  Data on pad testing during pregnancy is lacking, therefore this study assessed its clinical relevance amongst this population, when compared with self reported symptoms of urinary incontinence and visual analogue scores. 

The study found that although the diagnostic value of pad testing for measuring the severity of self-reported incontinence during pregnancy was not clinically relevant, they suggest that for the purposes of research, pad tests, combined with subjective/qualitative considerations, play a critical role in allowing comparisons across studies, quantifying the amount of urine loss and establishing a measure of severity.

International Urogynaecology Journal (2007) DOI 10.1007/s00192-007-0472-z

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