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Evidence summaries

Pelvic Floor Muscle Training for Urinary Incontinence in Women

Pelvic floor muscle training is effective for women with stress, urge, or mixed incontinence compared with no treatment, placebo, or inactive control treatments. Level of evidence: "A"

Pelvic floor muscle training is recommended as first-line treatment for urinary incontinence in women.

The recommendation is strong because exercise has low costs, rarely has any harms compared to drug treatments, increases quality of life, and may be beneficial for sexual function.

A Cochrane review [Abstract] 1 included 31 studies with a total of 1 817 women. Most studies were at moderate to high risk of bias, however, the evidence is upgraded by large magnitude of effect. There was considerable variation in interventions used, study populations, and outcome measures. Women with stress urinary incontinence who were in the pelvic floor muscle training (PFMT) groups were 8 times more likely than the controls to report that they were cured) and 6 times more likely to report cure or improvement (table T1). Women with any type of urinary incontinence, who did PFMT, were 5 times more likely to report cure and 2 times more likely to report cure or improvement than controls (table T2). PFMT women also experienced fewer incontinence episodes per day, and reported better continence specific quality of life.

Pelvic floor muscle training compared to control for stress urinary incontinence in women

OutcomesRelative effect(95% CI)Risk with no treatment, placebo or controlRisk with PFMT (95% CI)№of participants(studies) Quality of evidence
Participant-perceived cure after treatmentTreatment duration: 3-6 monthsRR 8.38(3.68 to 19.07)60 per 1000505 per 1000(222 to 1000)165(4) High
Participant-perceived cure or improvement after treatmentTreatment duration: 3-6 monthsRR 6.33(3.88 to 10.33)114 per 1000720 per 1000(442 to 1000)242(3) Moderate
Number of leakage episodes in 24 hours (bladder diary)Treatment duration: 8 weeks to 6 months-The mean number of leakage episodes in 24 hours ranged from 1.07 to 3.61 episodesMD 1.23 episodes lower(1.78 lower to 0.68 lower)432(7) Moderate

Pelvic floor muscle training compared to control for urinary incontinence (all types) in women

OutcomesRelative effect(95% CI)Risk with no treatment, placebo or controlRisk with PFMT (95% CI)№of participants(studies) Quality of evidence
Participant-perceived cure after treatmentTreatment duration: 2-3 monthsRR 5.34(2.78 to 10.26)62 per 1000329 per 1000(171 to 632)290(3) Moderate
Participant‐perceived cure or improvement after treatmentTreatment duration: 6 - 8 weeks 288 per 1000 RR 2.39(1.64 to 3.47)687 per 1000(471 to 998)166(2) Moderate
Number of leakage episodes in 24 hours (bladder diary)Treatment duration: 2 - 3 months-The mean number of leakage episodes in 24 hours ranged from 1.06 to 2.50MD 1 episode lower(1.37 lower to 0.64 lower)349(4 Moderate)

An RCT 2 assessed the efficacy of group-based PFMT relative to individual PFMT in older women (n=362). After an individual session conducted to learn how to contract pelvic floor muscles, participants completed 12-week PFMT as part of a group of 8 women or in individual sessions. Median percentage reduction in urinary incontinence episodes was 70% (95% CI 44% to 89%) in individual PFMT compared with 74% (95% CI 46% to 86%) in group-based PFMT.

    References

    • Dumoulin C, Cacciari LP, Hay-Smith EJC. Pelvic floor muscle training versus no treatment, or inactive control treatments, for urinary incontinence in women. Cochrane Database Syst Rev 2018;(10):CD005654. [PubMed]
    • Dumoulin C, Morin M, Danieli C et al. Group-Based vs Individual Pelvic Floor Muscle Training to Treat Urinary Incontinence in Older Women: A Randomized Clinical Trial. JAMA Intern Med 2020;180(10):1284-1293. [PubMed]

Primary/Secondary Keywords