The effect of bladder training, pelvic floor muscle training, or combination training on urodynamic parameters in women with urinary incontinence

Abstract

The purpose of this study was to compare the effect of three conservative interventions: pelvic floor muscle training, bladder training, or both, on urodynamic parameters in women with urinary incontinence. Two hundred four women with genuine stress incontinence (GSI) or detrusor instability with or without GSI (DI ± GSI) participated in a two‐site trial comparing pelvic floor muscle training, bladder training, or both. Patients were stratified based on severity of urinary incontinence, urodynamic diagnosis, and treatment site, then randomized to a treatment group. All women underwent a comprehensive standardized evaluation including multi‐channel urodynamics at the initial assessment and at the end of 12 weeks of therapy. Analysis of covariance was used to detect differences among treatment groups on urodynamic parameters. Post‐treatment evaluations were available for 181 women. No differences were found among treatments on the following measurements: maximum urethral closure pressure, mean urethral closure pressure, maximum Kegel urethral closure pressure, mean Kegel urethral closure pressure, functional urethral length, pressure transmission ratios, straining urethral axis, first sensation to void, maximum cystometric capacity, and the MCC minus FSV. The effect of treatment did not differ by urodynamic diagnosis. Behavioral therapy had no effect on commonly measured urodynamic parameters. The mechanism by which clinical improvement occurs remains unknown. Neurourol. Urodynam. 18:427–436, 1999. © 1999 Wiley‐Liss, Inc.

Does the method of cystometry affect the incidence of involuntary detrusor contractions? A prospective randomized urodynamic study

“…This physiologic mechanism was the rational one for treating patients with overactive detrusor by pelvic¯oor exercises. Several studies have shown that patients with detrusor overactivity may bene®t from behavioral modi®cation and pelvic¯oor rehabilitation techniques [Fantl et al, 1991;Elser et al, 1999]. Although the speci®c mechanisms by which the clinical improvement is achieved are still unknown, it is likely that this is at least partly due to the induced inhibition of detrusor activity by sphincteric contractions, as well as adaptive behavioral changes.…”

Influence of voluntary pelvic floor muscle contraction and pelvic floor muscle training on urethral closure pressures: a systematic literature review

“…Twenty-one studies investigating augmented MUCP were found (Table 1) [14,[17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32][33][34][35][36]. One study was excluded because the results combined values for men and women [37].…”

Identifying Continence OptioNs after Stroke (ICONS): an evidence synthesis, case study and exploratory cluster randomised controlled trial of the introduction of a systematic voiding programme for patients with urinary incontinence after stroke in secondary care

“…Eight studies were identified: two studies were unpublished and therefore no data extraction was undertaken. 108,109 Of the remaining six studies, three were completed in the USA, 80,83,94 one in Canada, 93 one in New Zealand 79 and one in the UK. 92 …”

“…Four studies used a pad test to evaluate severity of urine loss 31,71,73,76,109 (Wyman et al 31 reported in Elser et al…”

“…However, Elser et al 109 did not report data separately for each treatment group, and Bear et al 73 reported mean grams of urine loss per day, but no SDs. Results for the remaining trials using no treatment comparison groups 71,76 are illustrated in Figure 6.…”