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 (SUI) 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 (UI), 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.
| Outcomes | Relative effect(95% CI) | Risk with no treatment, placebo or control | Risk with PFMT (95% CI) | №of participants(studies) Quality of evidence |
|---|---|---|---|---|
| Participant-perceived cure after treatmentTreatment duration: 3-6 months | RR 8.38(3.68 to 19.07) | 60 per 1000 | 505 per 1000(222 to 1000) | 165(4) High |
| Participant-perceived cure or improvement after treatmentTreatment duration: 3-6 months | RR 6.33(3.88 to 10.33) | 114 per 1000 | 720 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 episodes | MD 1.23 episodes lower(1.78 lower to 0.68 lower) | 432(7) Moderate |
| Outcomes | Relative effect(95% CI) | Risk with no treatment, placebo or control | Risk with PFMT (95% CI) | №of participants(studies) Quality of evidence |
|---|---|---|---|---|
| Participant-perceived cure after treatmentTreatment duration: 2-3 months | RR 5.34(2.78 to 10.26) | 62 per 1000 | 329 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 2.50 | MD 1 episode lower(1.37 lower to 0.64 lower) | 349(4 Moderate) |
A systematic review 3 included 15 studies with a total of 2441 women of which 970 were in PFMT; 69 in extracorporeal magnetic innervation (ExMi) or with PFMT + biofeedback; 30 in electrostimulation (ES), 21 in whole body vibration training (WBVT), 23 in PFMT + abdominal muscle therapy (PFM + AMT), 326 were in PFMT + biofeedback, 93 were in vaginal cones (VC), 362 were in PFMT + education, 318 were in education, and 229 were in control groups. In all RCT, PFMT significantly reduced UI, essentially SIU (stressUI) and MUI (mixedUI), when compared with the control group before and after treatment. Overall, out of 997 PFMT or PFMT + education patients, 50.5% showed improvement in urinary incontinence, and 21.8% became continent (negative pad test). In total, 62% of patients significantly reduced their urinary incontinence or cured it and improved their pelvic floor muscle contraction.
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.
Primary/Secondary Keywords