Determining the optimal pelvic floor muscle training regimen for women with stress urinary incontinence

Abstract

Pelvic floor muscle (PFM) training has received Level-A evidence rating in the treatment of stress urinary incontinence (SUI) in women, based on meta-analysis of numerous randomized control trials (RCTs) and is recommended in many published guidelines. However, the actual regimen of PFM training used varies widely in these RCTs. Hence, to date, the optimal PFM training regimen for achieving continence remains unknown and the following questions persist: how often should women attend PFM training sessions and how many contractions should they perform for maximal effect? Is a regimen of strengthening exercises better than a motor control strategy or functional retraining? Is it better to administer a PFM training regimen to an individual or are group sessions equally effective, or better? Which is better, PFM training by itself or in combination with biofeedback, neuromuscular electrical stimulation, and/or vaginal cones? Should we use improvement or cure as the ultimate outcome to determine which regimen is the best? The questions are endless. As a starting point in our endeavour to identify optimal PFM training regimens, the aim of this study is (a) to review the present evidence in terms of the effectiveness of different PFM training regimens in women with SUI and (b) to discuss the current literature on PFM dysfunction in SUI women, including the up-to-date evidence on skeletal muscle training theory and other factors known to impact on women's participation in and adherence to PFM training.

Pelvic floor muscle exercise as the best stress urinary incontinence prevention method in women practising competitive sport

“…Trening mięśni dna miednicy (PFMT) otrzymał najwyższy poziom dowodów naukowych -A -w leczeniu WNM u kobiet na podstawie metaanalizy licznych randomizowanych badań kontrolnych (RCT) i jest zalecany w wielu opublikowanych wytycznych [26].…”

“…PFMT received the highest level of scientifi c evidence -A -in treating SUI in women on the basis of meta-analysis of numerous randomised control tests (RCT) and many published guidelines recommend it [26].…”

Effectiveness of an illustrated home exercise guide on promoting urinary continence during pregnancy: a pragmatic randomized clinical trial

“…Assim, é razoável supor que os efeitos do tratamento serão melhores se o programa de TMAP, além de ser baseado em princípios fisiológicos confiáveis e de garantir uma contração perineal correta antes do início da realização dos exercícios, contar com estreita supervisão e apoio dos profissionais de saúde envolvidos para manter a adesão ao tratamento 26 . Suposição essa que, apesar de ter sido confirmada em estudo prévio 27 , não encontrou respaldo nos resultados de uma revisão sistemática 28 sobre a eficácia dos exercí-cios para o AP no tratamento da IU e nos resultados do presente estudo, visto que, apesar de o aumento da FMP ter sido significantemente superior no Gsup, não houve diferença significativa entre os resultados do Gsup e do Gobs quanto à IU.…”

Pelvic Floor Muscle Exercise after Delivery with or without the Biofeedback Method: An Intervention Study

“…There is evidence that PFME results in the increased strength of the pelvic floor muscles and that incontinence can be improved or cured [21][22][23]. In addition, intensive PFME during pregnancy prevents UI during and after delivery [22,23].…”