Involuntary reflexive pelvic floor muscle training in addition to standard training versus standard training alone for women with stress urinary incontinence: study protocol for a randomized controlled trial

Abstract

BackgroundPelvic floor muscle training is effective and recommended as first-line therapy for female patients with stress urinary incontinence. However, standard pelvic floor physiotherapy concentrates on voluntary contractions even though the situations provoking stress urinary incontinence (for example, sneezing, coughing, running) require involuntary fast reflexive pelvic floor muscle contractions. Training procedures for involuntary reflexive muscle contractions are widely implemented in rehabilitation and sports but not yet in pelvic floor rehabilitation. Therefore, the research group developed a training protocol including standard physiotherapy and in addition focused on involuntary reflexive pelvic floor muscle contractions.Methods/designThe aim of the planned study is to compare this newly developed physiotherapy program (experimental group) and the standard physiotherapy program (control group) regarding their effect on stress urinary incontinence. The working hypothesis is that the experimental group focusing on involuntary reflexive muscle contractions will have a higher improvement of continence measured by the International Consultation on Incontinence Modular Questionnaire Urinary Incontinence (short form), and — regarding secondary and tertiary outcomes — higher pelvic floor muscle activity during stress urinary incontinence provoking activities, better pad-test results, higher quality of life scores (International Consultation on Incontinence Modular Questionnaire) and higher intravaginal muscle strength (digitally tested) from before to after the intervention phase. This study is designed as a prospective, triple-blinded (participant, investigator, outcome assessor), randomized controlled trial with two physiotherapy intervention groups with a 6-month follow-up including 48 stress urinary incontinent women per group. For both groups the intervention will last 16 weeks and will include 9 personal physiotherapy consultations and 78 short home training sessions (weeks 1–5 3x/week, 3x/day; weeks 6–16 3x/week, 1x/day). Thereafter both groups will continue with home training sessions (3x/week, 1x/day) until the 6-month follow-up.To compare the primary outcome, International Consultation on Incontinence Modular Questionnaire (short form) between and within the two groups at ten time points (before intervention, physiotherapy sessions 2–9, after intervention) ANOVA models for longitudinal data will be applied.DiscussionThis study closes a gap, as involuntary reflexive pelvic floor muscle training has not yet been included in stress urinary incontinence physiotherapy, and if shown successful could be implemented in clinical practice immediately.Trial registrationNCT02318251; 4 December 2014First patient randomized: 11 March 2015Electronic supplementary materialThe online version of this article (doi:10.1186/s13063-015-1051-0) contains supplementary material, which is available to authorized users.

Pelvic floor muscle activity during fast voluntary contractions in continent and incontinent women

“…Ratamess et al recommend that concurrent to a typical strength training program, a power component should be incorporated. Referring to a rehabilitative PFM perspective, it makes sense to first start with a period of sensorimotor training, dominantly performed by slow twitch fibers, continued by strength training, focusing on slow and fast twitch fibers that is finally continued by speed training, focusing on fast contractions to improve fast twitch fibers capability …”

“…Referring to a rehabilitative PFM perspective, it makes sense to first start with a period of sensorimotor training, dominantly performed by slow twitch fibers, continued by strength training, focusing on slow and fast twitch fibers that is finally continued by speed training, focusing on fast contractions to improve fast twitch fibers capability. 40 Considering that FVC peak activity reached >90 %MVC, the load can be regarded sufficient for power training. In fact, even lower loads than that have been recommended as a power training strategy, with loads of 30-60% of 1 repetition maximum (RM), performed at a fast contraction velocity.…”

Evaluation of pelvic floor kinematics in continent and incontinent women during running: An exploratory study

“…Running should therefore not only be regarded negatively due to the possible manifestation of SUI, but also as a potential training stimulus, leading to reflex activity of the PFMs. This was also suggested for an ongoing SUI physiotherapy study, in which the training protocol includes involuntary reflexive muscle contractions …”

The effectiveness of pelvic fl oor exercises on symptoms in females with stress urinary incontinence

“…Researchers also employed different type of exercises protocol for primiparous women and their sexual effi cacy by employing 8 weeks of pelvic fl oor exercises and found improvement in the outcome measure and strength of pelvic fl oor muscles (Luginbuehl et al 2015, Malhotra et al 2018. Aforementioned studies employed for Pelvic fl oor exercises combination with additional treatment but there is limited study on the age group 30 -60 years of ages.…”