Impact of supervised physiotherapeutic pelvic floor exercises for treating female stress urinary incontinence
Keywords:
Urinary incontinence, Pelvic floor, Physical therapy (Specialty), Exercise, RehabilitationAbstract
CONTEXT AND OBJECTIVE: Urinary incontinence is a public health problem that affects more than 200 million people worldwide. Stress incontinence is the most prevalent type. Pelvic fl oor muscle exercises have been used for treating it, although there is no consensus regarding their application. The aim of this study was to compare the results from treating female stress urinary incontinence with pelvic fl oor muscle exercises with or without physiotherapist supervision. DESIGN AND SETTING: This was a randomized, prospective, controlled trial in the Urogynecology and Vaginal Surgery Sector, Universidade Federal de São Paulo. METHODS: Forty-four women were randomized to be treated for stress urinary incontinence with pelvic fl oor exercises for three consecutive months, into two groups: one with and the other without physiotherapist supervision. They were evaluated before and after treatment using a quality-of-life questionnaire, pad test, micturition diary and subjective evaluation. Descriptive analysis was used to evaluate the population. The homogeneity of the two groups was evaluated using the Kruskal-Wallis and Chi-squared tests. The success of the two groups after treatment was evaluated using the Wilcoxon test. RESULTS: The supervised group showed statistically greater improvement in the pad test, micturition diary and quality of life than did the control group. In the subjective evaluation, only 23.8% of the control group patients were satisfi ed with their treatment. In the supervised group, 66.8% of patients did not want any other treatment. CONCLUSION: Supervised pelvic fl oor muscle exercises presented better results in objective and subjective evaluations than did unsupervised exercises.
Downloads
References
Suzuki Y. Preface by the WHO. In: Abrams P, Khoury S, Wein A, editors. Incontinence. Plymouth: Plymbridge; 1998. p. 13.
Guarisi T, Pinto Neto AM, Osis MJ, Pedro AO, Costa Paiva LHS, Faúndes A. Procura de serviço médico por mulheres com incontinência urinária. [The search of medical care by women with urinary incontinence]. Rev Bras Ginecol Obstet. 2001;23(7):439-43.
International Continence Society. Committee on Standardiza- tion of Terminology. The standardisation of terminology of lower urinary tract function. In: Ostergard DR, Bent AE, editors. Urogynecology and urodynamics: theory and practice. 4th ed. Baltimore: Williams & Wilkins; 1996. p. 643-60.
Girão MJBC. Incontinência urinária de esforço: fisiopatologia. In: Girão MJBC, Baracat CE, Rodrigues de Lima G, editors. Uroginecologia. São Paulo: Artes Médicas; 1997. p. 34-5.
Koelbl H, Strassegger H, Riss PA, Gruber H. Morphologic and functional aspects of pelvic floor muscles in patients with pelvic relaxation and genuine stress incontinence. Obstet Gynecol. 1989;74(5):789-95.
Fischer W, Pfister C, Tunn R. Comparison between histo- logical, histochemical and clinical findings from musculature of pubococcygeal repair (PCR) in urinary incontinence. Interna- tional Urogynecology Journal. 1992;3(2):124-8. Available from: http://www.springerlink.com/content/q730867107455j14/?p=830c1fbc080c4dfe89da6f6e2bd1072d&pi=0. Accessed in 2007 (Aug 8).
Gilpin SA, Gosling JA, Smith AR, Warrell DW. The pathogen- esis of genitourinary prolapse and stress incontinence of urine. A histological and histochemical study. Br J Obstet Gynaecol. 1989;96(1):15-23.
Bourcier AP, Juras JC. Nonsurgical therapy for stress inconti- nence. Urol Clin North Am. 1995;22(3):613-27.
Wall LL, Davidson TG. The role of muscular re-education by physical therapy in the treatment of genuine stress urinary incontinence. Obstet Gynecol Surv. 1992;47(5):322-31.
Bo K, Hagen RH, Kvarstein B, Jorgensen J, Larsen S, Burgio KL. Pelvic floor muscle exercise for the treatment of female stress uri- nary incontinence: III. Effects of two different degrees of pelvic floor muscle exercises. Neurourol Urodyn. 1990;9(5):489-502. Available from: http://www3.interscience.wiley.com/cgi-bin/abstract/112210062/ABSTRACT. Accessed in 2007 (Aug 8).
Sampselle CM, Brink CA, Wells TJ. Digital measurement of pelvic muscle strength in childbearing women. Nurs Res. 1989;38(3):134-8.
Jadad AR, Moore RA, Carroll D, et al. Assessing the quality of reports of randomized clinical trials: is blinding necessary? Control Clin Trials. 1996;17(1):1-12.
Patrick DL, Martin ML, Bushnell DM, Yalcin I, Wagner TH, Buesching DP. Quality of life of women with urinary inconti- nence: further development of the incontinence quality of life instrument (I-QOL). Urology. 1999;53(1):71-6.
Lose G, Rosenkilde P, Gammelgaard J, Schroeder T. Pad-weigh- ing test performed with standardized bladder volume. Urology. 1988;32(1):78-80.
Lose G, Fantl JA, Victor A, et al. Outcome measures for research in adult women with symptoms of lower urinary tract dysfunc- tion. Neurourol Urodyn. 1998;17(3):255-62.
Wilson PD, Al Samarrai T, Deakin M, Kolbe E, Brown AD. An objective assessment of physiotherapy for female genuine stress incontinence. Br J Obstet Gynaecol. 1987;94(6):575-82.
Wong KS, Fung BKY, Fung LCW, Ma S. Pelvic floor exercises in the treatment of stress urinary incontinence in Hong Kong Chinese women. In: Proceedings of the 27th Annual Meeting of the International Continence Society. Yokohama, Japan: Sept; 1997. p. 23-6. [abstract].
Sugaya K, Owan T, Hatano T, et al. Device to promote pelvic floor muscle training for stress incontinence. Int J Urol. 2003;10(8):416-22.
Siu LS, Chang AM, Yip SK, Chang AM. Compliance with a pelvic muscle exercise program as a causal predictor of urinary stress incontinence amongst Chinese women. Neurourol Uro- dyn. 2003;22(7):659-63.
Yoon H, Song HH, Ro YJ. A comparison of effectiveness of bladder training and pelvic muscle exercise on female urinary incontinence. Int J Nurs Stud. 2003;40(1):45-50.
American College of Sports Medicine position stand. The rec- ommended quantity and quality of exercise for developing and maintaining cardiorespiratory and muscular fitness in healthy adults. Med Sci Sports Exerc. 1990;22(2):265-74.
Hay-Smith EJ, Dumoulin C. Pelvic floor muscle training versus no treatment, or inactive control treatments, for urinary incontinence in women. Cochrane Database Syst Rev. 2006;(1): CD005654.
Aksac B, Aki S, Karan A, Yalcin O, Isikoglu M, Eskiyurt N. Biofeedback and pelvic floor exercises for the rehabilita- tion of urinary stress incontinence. Gynecol Obstet Invest. 2003;56(1):23-7.