Twenty women with pure genuine stress urinary incontinence were randomly allocated to 6 months of pelvic floor training or intravaginal electrical stimulation. The result was evaluated with a pad test and patients' rating of efficacy. Patients not cured by the first treatment given were offered the other one. A long-term follow-up was done 4 years after concluding treatment.The group of patients initially treated with pelvic floor exercises (n = 10) were significantly improved according to the pad test (P < 0.01). This corresponded very well to the subjective result, one patient being cured, five reporting insignificant symptoms, and the remaining four an improvement. The results were similar in patients allocated to intravaginal electrical stimulation (n = 10) (P < 0.05): one patient cured, four having insignificant symptoms, three improved, and two unchanged. We did not find any significant difference of results between thc two groups of treatment (P < 0.10). Follow-up after 4 years in 19 patients revealed that 1 patient was furthcr improved, 8 patients were unchanged and 5 had deteriorated. Five women were operated during the follow-up period. Pelvic floor training is an adequate method for treatment of stress urinary incontinence. Even patients with severe incontinence may show a very good result. However, a sustained effect presupposes continuing exercise and during the follow-up period of 4 years a quarter of the patients had to be operated upon to obtain permanent cure. The study also indicated that patients undergoing both treatments were further improved during the second course of treatment.
Summary. The object of this study was to evaluate the function of the pelvic floor and urethral sphincters in women with genuine stress incontinence before and after treatment. A total of 20 patients were randomized to 6 months' pelvic floor training or electrical stimulation. They were assessed by comprehensive analysis of pressure recordings in the urethra, vagina and anus. There were few significant correlations between subjective effect, pad tests and urodynamic results. Urethral, vaginal and anal profilometry is of limited value for assessment of training effects.Pelvic floor training has been used in female genuine stress incontinence since its first advocacy by Kegel [12]. The laboratory methods used for objective evaluation of the effect of pelvic floor contraction seem inadequate. The Kegel perineometer has the important disadvantage of recording changes in abdominal pressure as well as the force exerted by the pelvic floor, implying the lack of a possibility of reading the "genuine" pelvic floor pressure during different exercises. Assessment of the contraction by electromyograph (EMG) recordings obtained from the pelvic floor muscles is not valid for a long-term study since variation in the positioning of the recording electrode would make comparisons difficult. By measuring resting and squeeze pressures in all three channels affected by the pelvic floor muscles, i.e. the urethra (including cough profiles), vagina and anal canal, we attempted to obtain a measure of the state of the pelvic floor and urethral sphincters in women with genuine stress incontinence before and after conservative treatment by means of pelvic floor training and intravaginal electrical stimulation. Patients and methodsA total of 20 patients with genuine stress urinary incontinence who had not been surgically treated and were consecutively referred for therapy were offered conservative treatment as an alternative to surgery. Their ages were 34 -64 years (mean, 47.2 years). After they had given oral and written informed consent, they were randomized to pelvic floor training or electrical stimulation by means of the Contelle device [8]. The period of treatment was 6 months. Patients who were not cured after undergoing 6 months of one of these modes of treatment were offeted the other one. The training program was conducted by an experienced physiotherapist and was in essence based on the following:1. Relaxing and co-ordinating exercises to identify the proper muscles (submaximal contractions in short sequences). 2. Exercises to strengthen the muscles, whereby the patient was instructed to contract them maximally in short sequences. These exercises were also performed against resistance. 3. Training carried out in specific provocative situations such as jumping or coughing. Details of the training program have been presented elsewhere [9].The state of the pelvic floor was assessed by digital vaginal examination. The effect of treatment was assessed by a short provocative pad test [9]. Electrical stimulation was delivered by the new ...
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.