Pelvic floor exercises

These are effective in patients where there pelvic floor laxity or prolapse.

Pelvic floor exercises (pelvic floor muscle training (PFMT)) are effective in the management of stress incontinence, providing there is no serious degree of uterine prolapse and the exercises are followed rigorously.

• data from a Cochrane review demonstrate that PFMT is better than no treatment (1)
  • systematic review has collated data from 43 randomised controlled trials involving women with symptoms or urodynamic diagnoses of stress, urge or mixed incontinence (not specifically post partum), and which included pelvic floor muscle training in at least one arm of the trial (1)
  • PFMT reduces incontinence episode frequency by 54?72% (1)
  • subjective cure/improvement rates reported in randomised, controlled trials (RCTs) vary between 61 and 91% (1,2)
  • placebo-controlled RCTs demonstrated limited or no additional benefit of PFMT over placebo, although it should be said that it is difficult to define a placebo group for PFMT
  • reviewers concluded that pelvic floor muscle training was more effective than was no treatment or placebo for women with stress or mixed incontinence, and that more 'intensive' training (i.e. increased personal contact with a healthcare professional skilled in pelvic floor muscle training) appeared to be better than 'standard' training.
  • there seems to be no additional benefit in combining PFMT with biofeedback, vaginal cones or electrical stimulation (1,2)

A more recent meta-analysis revealed (3):

• treatment effect of PFMT on the incontinent episodes may be greater in younger women with only stress urinary incontinence
  • the analysis revealed that the number of daily contractions and the length of training period are not related to effect sizes on the condition that training includes at least daily 24 contractions and keeps for at least 6 weeks

A systemic review revealed evidence that pelvic flor muscle training reduced urinary incontinence in pregnant women and urinary and faecal incontinence in postpartum women (4).

Electrical stimulation of the pelvic floor muscles is an alternative method of 'exercising' the pelvic muscles and may be used in patients who cannot perform pelvic floor exercises satisfactorily.

Exercises performed both before and after delivery may help to prevent postpartum urinary incontinence.

Reference:

• (1) Hay-Smith EJ et al. Pelvic floor muscle training for urinary incontinence in women (Cochrane Review). In: The Cochrane Library, Issue 2, 2003. Oxford: Update Software.
• (2) K. Bo, Is there still a place for physiotherapy in the treatment of female incontinence?, EAU Update Series 1 (2003), 145-153.
• (3) Choi H et al. Meta-analysis of pelvic floor muscle training: randomized controlled trials in incontinent women.Nurs Res. 2007 Jul-Aug;56(4):226-34.
• (4) Hay-Smith J et al. Pelvic floor muscle training for prevention and treatment of urinary and faecal incontinence in antenatal and postnatal women. Cochrane Database Syst Rev. 2008 Oct 8;(4):CD007471