Pelvic Floor Muscle Training Added to Another Active Treatment Versus the Same Active Treatment Alone for Urinary Incontinence in Women

Summary

A Cochrane review [Abstract] 1 included 13 studies with a total of 1164 women with stress urinary incontinence (SUI), urgency urinary incontinence (UUI) or mixed urinary incontinence (MUI) comparing pelvic floor muscle training (PFMT) added to another active treatment with the same active treatment alone. The majority of the trials did not report the primary outcomes cure/improvement or quality of life. There was an insignificant improvement of incontinence in two trials comparing PFMT added to electrical stimulation to electrical stimulation alone, in women with SUI, (9/26 (35%) versus 5/30 (17%); RR 2.06, 95% CI 0.79 to 5.38). In a single trial investigating women with SUI, UUI or MUI a higher proportion of women who received a combination of PFMT and heat and steam generating sheet reported cure compared to those who received the sheet alone: 19/37 (51%) versus 8/37 (22%) with a risk ratio (RR) of 2.38, 95% confidence interval (CI) 1.19 to 4.73). More women reported cure or improvement of incontinence in a low quality trial comparing PFMT added to vaginal cones to vaginal cones alone. Only one trial evaluating PFMT when added to drug therapy provided information about adverse events (RR 0.84, 95% CI 0.45 to 1.60). With regard to condition-specific quality of life, there were no statistically significant differences between women (with SUI, UUI or MUI) who received PFMT added to bladder training and those who received bladder training alone at three months after treatment either on the Incontinence Impact Questionnaire-Revised scale (mean difference (MD) -5.90, 95% CI -35.53 to 23.73) or on the Urogenital Distress Inventory scale (MD -18.90, 95% CI -37.92 to 0.12). A similar pattern of results was observed between women with SUI who received PFMT plus either a continence pessary or duloxetine and those who received the continence pessary or duloxetine alone.

A randomized controlled trial 2 assessed whether bladder training (BT) combined with high-intensity pelvic floor muscle training (BT + PFMT) results in better outcomes in the short term than BT alone on female urinary incontinence (UI). 108 women with diagnoses of stress UI (SUI, n = 50), urgency UI (UUI, n = 16), or mixed UI (MUI, n = 42) randomly assigned to 6 weeks of BT + PFMT or BT alone (control group). The primary outcome measure was self-reported improvement. Overall and in the SUI and MUI subgroups, significantly more patients in the BT + PFMT group reported cured and improved symptoms. Overall and in SUI patients, the BT + PFMT group also improved to significantly greater degree in UI severity, symptom distress, QOL, daily UI episodes, and pelvic floor muscle strength and endurance. The only parameter showing more improvement in patients with UUI was QOL, and UI severity in patients with MUI (p < 0.05).