Impact of supervised physiotherapeutic pelvic floor exercises for treating female stress urinary incontinence

Abstract

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 floor 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 floor 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 floor 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 satised with their treatment. In the supervised group, 66.8% of patients did not want any other treatment. CONCLUSION: Supervised pelvic floor muscle exercises presented better results in objective and subjective evaluations than did unsupervised exercises.

The effect of outpatient physical therapy intervention on pelvic floor muscles in women with urinary incontinence

“…Urinary incontinence (UI) affects over 200 million people worldwide and is considered a public health problem 1 . It is classified as stress UI (SUI) if there is involuntary loss of urine when coughing or sneezing; urge UI (UUI) if there is an abrupt and sudden urge to urinate that cannot be postponed; or mixed UI (MUI) if it is associated with both situations mentioned above, which may also result from emotional aspects 2 .…”

“…The factors involved in the pathophysiology of UI include the following: extra-abdominal pressure on the bladder neck, the presence of a short urethra, decreased estrogen and injury of the sphincter mechanism, pudendal nerve, fascia and pelvic floor muscles (PFM) 1 .…”

“…He reported that restoration of tone and muscle function could occur 20 to 60 days after the start of treatment 1 .…”

Insights from Brazilian medical journals

“…Multidisciplinary approaches as well as new effective therapies are very welcome. In a randomized, controlled trial it was demonstrated that exercises directed to pelvic floor muscles, electrical stimulation, and vaginal cones are effective treatments for women with urodynamic stress urinary incontinence 36,37 .…”

Perineal Muscle Strength During Pregnancy and Postpartum: the Correlation Between Perineometry and Digital Vaginal Palpation

“…About one third of adult women have Urinary Incontinence (1)(2) (UI), which can impair a woman's physical, sexual, domestic, and professional and leisure activities (2)(3)(4) . Pregnancy, vaginal delivery, parity, duration of the second stage of labor, difficulty in fetal extraction during a cesarean section, newborn's weight, perineal trauma and other mechanical, endocrinal and neural factors can lead to reduction or loss of the pelvic floor muscle tone causing genitourinary disorders (1)(2)(3)(4)(5)(6)(7)(8)(9)(10) . Altered PFMS has been the focus of studies and research due to the evolution of equipment and exams that make its evaluation and prognosis more precise (10) .…”