Medium-term efficacy of pelvic floor muscle training for female urinary incontinence in daily practice

Abstract

The purpose of this paper is to assess the efficacy of physiotherapy and quality of life in women treated for urinary incontinence by specialized physiotherapists in daily community-based practices. Three hundred and fifty-five women were treated in five physiotherapy practices between January 2000 and December 2004. After a minimum follow-up of 12 months, these women received a questionnaire at home. With the questionnaire, we collected demographic data, data on the efficacy of treatment, satisfaction with the result, and the Urogenital Distress Inventory, and Incontinence Impact Questionnaire. Additional information was derived from the medical files. One hundred and eighty-seven women responded. Fifty percent of women were satisfied with the result of physiotherapy. After a mean follow-up of 32 months, 123 out of 130 women (94.6%), who only had physiotherapy, recorded to experience incontinence episodes daily to several times a week. Women who underwent additional incontinence surgery after insufficient physiotherapy recorded significantly less urinary incontinence symptoms and a better quality of life. Pelvic floor muscle training for urinary incontinence is effective in half of the women. If not successful, women seem to benefit significantly from incontinence surgery.

Ten-year follow-up after conservative treatment of stress urinary incontinence

“…Women who initially do well with PFMT tend to continue to do well if they continue to train [7,8,19], but many women discontinue the treatment. In most studies, more than half of the women had stopped training at follow-up [6,8,10,19]. There were 81% who stopped training after 8 years in a study by Kondo et al [20], 85% after 10 years in our study, and 72% after 15 years in the study by Bø et al [13].…”

“…About half of the women completing a 3-6 months course of PFMT are statistically significantly improved [3][4][5][6] and obtain a reduction of about one leakage episode per day [2]. Conflicting medium-term (3-6 years) results have been reported, but on balance the published studies show a significant disimprovement with time [4,[7][8][9][10][11].…”

“…The "perineal lock" was given as the main cause of success in the study by Cammu et al [12] and as a partial cause of success by Bø et al [13]. However, few women are wholly continent after PFMT; 75% [9] to 95% [6] are not dry. Despite this, a significant proportion of patients are reasonably satisfied, e.g., almost half of patients in a study by Lamers and van der Vaart were satisfied despite 95% having some degree of leakage [6].…”

“…However, few women are wholly continent after PFMT; 75% [9] to 95% [6] are not dry. Despite this, a significant proportion of patients are reasonably satisfied, e.g., almost half of patients in a study by Lamers and van der Vaart were satisfied despite 95% having some degree of leakage [6]. There are a number of possible explanations for this, such as the women adapting to their leakage problem and choosing to live with it, the problem not being perceived as warranting surgical treatment, fear of surgical treatment, a reduced level of activity leading to less leakage, or the women believing that leakage is unavoidable.…”

Evaluation and surgery for stress urinary incontinence: A FIGO working group report

“…Most algorithms recommend nonsurgical treatment first and then surgical treatment for failures or patients refusing nonsurgical treatment. There are many different types of conservative therapies to treat SUI; however, none have been found to be consistently more effective than pelvic floor muscle training (PFMT) …”