FES-biofeedback versus intensive pelvic floor muscle exercise for the prevention and treatment of genuine stress incontinence

Potential risk factors associated with stress urinary incontinence among Iranian women

Background:

Stress urinary incontinence (SUI) is considered as one of the major hygienic problems among women. The main aim of the study is to assess the potential risk factors associated with SUI among Iranian women.

Materials and Methods:

This study was conducted on 90 married women with history of SUI diagnosed by an urologist and were selected randomly. Their pelvic muscles contraction (PMC) and the history of the subjects were assessed for some of risk factors such as age, height, weight, body mass index (BMI), pregnancy history, miscarriage, type of delivery (normal vaginal delivery or cesarean section), number of offspring born healthy in addition to other risk factors such as chronic cough, constipation and hypothyroidism by use of POP Questionnaire. Data were analyzed using Pearson correlation coefficient and SPSS version 18 Software.

Results:

There was a significant relation between SUI and height (P < 0.05, r = 0.45), vaginal delivery (NVD) (P < 0.05, r = 0.2), number of genitourinary surgery (P < 0.05, r = 0.42), hypothyroidism and constipation (P < 0.05). An inverse relatively strong significant relation was found between SUI and cesarean section (P < 0.05, r = –0.50) No significant relation was found between SUI and weight, BMI, age, chronic cough and miscarriage, and other study parameters. An inverse significant relation between PMC and weight (P < 0.05, r = –0.52), BMI (P < 0.05, r = –0.42) and number of genitourinary surgery (P < 0.05, r = –0.18).

Conclusion:

Cesarean section had a preventive effect on SUI versus normal vaginal delivery. The rate of SUI was higher in taller women or those suffering from hypothyroidism or constipation or who had genitourinary surgery. The women with high BMI had lower pelvic floor muscles strength.

Pelvic floor muscle training decreases hip adductors isometric peak torque in incontinent women: an exploratory study

INTRODUCTION: The pelvic floor muscle (PFM) training is the most common treatment for urinary incontinence (UI), however many women performed the contraction of PFM with associated contraction of abdominal, gluteus and hip adductors muscles. OBJECTIVE: To assess the effects of pelvic floor muscle (PFM) training on isometric and isokinetic hip adductors peak torque (PT) among women suffering from urinary incontinence (UI). MATERIALS AND METHODS: It is a longitudinal and prospective exploratory study. This study included 15 physically active women aged 45 years old and over, who presented complaints of UI. The PFM function (digital evaluation and perineometry), isometric and isokinetic hip adductors PT and one hour pad test were performed before and after treatment. The PFM training was performed in group, one hour once a week for 12 sessions. RESULTS: Significant improvement of PFM function and pressure level (p = 0.003), and significant decrease of hip adductors isometric PT and one-hour pad test, were found post-treatment. Moderate negative correlations between PFM contraction pressure and hip adductors isokinetic PT for dominant side (DS) (r = -0.62; p = 0.03) and non-dominant side (NDS) (r = -0.64; p = 0.02); and between PFM fast fibers contraction and hip adductors isometric PT for DS (r = -0.60; p = 0.03) and NDS (r = -0.59; p = 0.04) were also found. CONCLUSIONS: The PFM training decreased hip adductors PT and improved PFM functions and UI.

[Effects of pelvic floor muscle training on quality of life of a group of women with urinary incontinence: randomized controlled trial]

OBJECTIVE

To evaluate the effects of Kinesiotherapy on function and level of pressure of pelvic floor muscle and quality of life (QOL) of a group of women with urinary incontinence (UI).

MATERIALS AND METHODS

This is a randomized controlled pilot trial. Thirty women (age 60.87±9.05 years) were evaluated, before and after 12 weeks of treatment, for urinary loss, pelvic floor muscle function and pressure; and quality of life (QOL). Volunteers were randomly allocated into two groups: Kinesiotherapy Group and Control Group. The Kinesiotherapy Group protocol consisted of 12 1-hour sessions with exercises to strengthen pelvic floor muscle and information for UI. The Control Group did not receive any treatment during the corresponding time. The data were analyzed by non-parametric Wilcoxon and Mann-Whitney test. The significance level was 5%.

RESULTS

The Kinesiotherapy Group presented a significant improvement in urinary loss (p=0.053), pelvic floor muscle function (p<0.006) and pressure (p=0.0014) and in some domains of Kinǵs Health Questionnaire for QOL assessment: incontinence impact (p=0.034), limitations of daily activities (p=0.025), sleep and disposition (p=0.018) and also gravity domains (p=0.004). No differences were found in the control group for any variables.

CONCLUSION

The protocol to strengthen the pelvic floor muscle used by the Kinesiotherapy Group was effective to improve the UI, QOL, function and pressure of pelvic floor muscle contraction.

Efficacy of transcutaneous functional electrical stimulation on urinary incontinence in myelomeningocele: results of a pilot study

PURPOSE

To investigate the efficacy of transcutaneous functional electrical stimulation (FES) on voiding symptoms in children with myelomeningocele (MMC) suffering from neuropathic urinary incontinence.

MATERIALS AND METHODS

Six girls and 6 boys with moderate to severe urinary incontinence secondary to MMC were included. Median age of children was 5.04 (range: 3-11) years. They underwent a urodynamic study (UDS) before and 3 months after FES with special attention to detrusor leak point pressure (DLPP) and maximal bladder capacity (MBC). Daily incontinence score, frequency of pad changing, and enuresis were also assessed before and three months after treatment. Fifteen courses of FES for 15 minutes 3 times per week were performed with low frequency (40 Hz) electrical current, duration of 250μs, with hold and rest time of 2 seconds.

RESULTS

Nine children had improvement on urinary incontinence score, while three children had no improvement. Median DLPP was significantly increased from 38.5 (range: 12-50) cm H2O to 59.5 (range: 18-83) cm H2O (P = 0.003). MBC was significantly increased from median value of 155 (range: 60-250) mL to 200 (range: 110-300) mL (P = 0.007).

CONCLUSIONS

This is a pilot study showing that FES therapy might have positive effects on improvement of voiding symptoms of MMC children with neurogenic urinary incontinence in terms of daily incontinence score and UDS parameters.

A new pelvic muscle trainer for the treatment of urinary incontinence

OBJECTIVE

To describe a new device for home treatment of urinary incontinence (UI) by comparing 3 conservative techniques and monitoring compliance and performance.

METHODS

Thirty-two patients with UI were allocated to 1 of 3 intervention groups: pelvic floor muscle exercises (PFME; n=11) alone; PFME combined with biofeedback (n=10); or PFME combined with electrical stimulation (n=11). The outcomes assessed were: changes in quality of life score (QLS), urodynamic and perineometric parameters, episodes of urine loss, subjective assessment of improvement, and actual compliance and performance with treatment.

RESULTS

Increased pelvic muscle contraction strength (P<0.05), improvement in QLS (P<0.02), and fewer episodes of urine leakage were observed in all 3 groups (P<0.05). Compliance was similar among the groups (P=0.201).

CONCLUSION

All 3 techniques were effective for home treatment of UI, with significant control of symptoms and improved quality of life. The device effectively monitored compliance and performance of exercises.

Meta-Analysis of Pelvic Floor Muscle Training

BACKGROUND

Although many studies have reported the effectiveness of pelvic floor muscle training (PFMT) for treating female urinary incontinence, the magnitude of the effect and the optimal configuration of the parameters of the training have not been clearly determined.

OBJECTIVES

The aims of this meta-analysis were: (a) to calculate the effect size of pelvic floor muscle training compared to no treatment on incontinent episodes, urine leakage amount, and perceived severity of urine loss, and (b) to identify parameters of PFMT and subjects' characteristics influencing the magnitude of the effects.

METHODS

The search for relevant literature published from 1980 to 2005 consisted of using several computerized databases, citation searching, and footnote chasing. Twelve studies met the inclusion criteria, and were reviewed and coded.

RESULTS

The overall mean weighted effect size on incontinent episodes, urine leakage amount, and perceived severity were -0.68 (Z = 5.89, p < .001), -1.48 (Z = 2.64, p = .008), and -1.66 (Z = 1.68, p = .092), respectively. The studies with women having stress urinary incontinence showed a mean weighted effect size of -0.77 (Z = 7.03, p < .001), whereas studies with women having any type of urinary incontinence showed a mean weighted effect size of -0.47 (Z = 4.40, p < .001). The mean weighted effect size for studies including subjects over 60 years mean age was -0.54 (Z = 6.21, p < .001), whereas that of studies in which the average age was younger than 60 years was -0.94 (Z = 6.58, p < .001).

DISCUSSION

The treatment effect of PFMT on the incontinent episodes may be greater in younger women with only stress urinary incontinence. It appears 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.

Pelvic Floor Muscle Biofeedback in the Treatment of Urinary Incontinence: A Literature Review

Biofeedback is efficacious in the training of the pelvic floor musculature in order to enhance continence. This article reviews the anatomy and physiology of micturition as the underlying rationale for pelvic floor muscle biofeedback in the treatment of urinary incontinence. It critically reviews 28 studies published in peer reviewed journals from 1975 to 2005 that were prospective, randomized studies with parametric statistical analyses, operationally defined patient selection criteria, treatment protocols and outcome measures. The overall mean treatment improvement for patients undergoing biofeedback for urinary incontinence was 72.61%. In 21 of 35 (60%) paired comparisons, biofeedback demonstrated superior symptomatic outcome to control or alternate treatment groups. Larger studies and a standardization of technology and methodology are required for more conclusive determinations.

Incontinence-specific quality of life measures used in trials of treatments for female urinary incontinence: a systematic review

This systematic review examined the use of incontinence-specific quality of life (QOL) measures in clinical trials of female incontinence treatments, and systematically evaluated their quality using a standard checklist. Of 61 trials included in the review, 58 (95.1%) used an incontinence-specific QOL measure. The most commonly used were IIQ (19 papers), I-QoL (12 papers) and UDI (9 papers). Eleven papers (18.0%) used measures which were not referenced or were developed specifically for the study. The eight QOL measures identified had good clinical face validity and measurement properties. We advise researchers to evaluate carefully the needs of their specific study, and select the QOL measure that is most appropriate in terms of validity, utility and relevance, and discourage the development of new measures. Until better evidence is available on the validity and comparability of measures, we recommend that researchers consider using IIQ or I-QOL with or without UDI in trials of incontinence treatments.