Pelvic floor muscle training protocol for stress urinary incontinence in women: A systematic review

Abstract

Summary Introduction: Strengthening exercises for pelvic floor muscles (SEPFM) are considered the first approach in the treatment of stress urinary incontinence (SUI). Nevertheless, there is no evidence about training parameters. Objective: To identify the protocol and/or most effective training parameters in the treatment of female SUI. Method: A literature research was conducted in the PubMed, Cochrane Library, PEDro, Web of Science and Lilacs databases, with publishing dates ranging from January 1992 to March 2014. The articles included consisted of English-speaking experimental studies in which SEPFM were compared with placebo treatment (usual or untreated). The sample had a diagnosis of SUI and their age ranged between 18 and 65 years. The assessment of methodological quality was performed based on the PEDro scale. Results: Seven high methodological quality articles were included in this review. The sample consisted of 331 women, mean age 44.4±5.51 years, average duration of urinary loss of 64±5.66 months and severity of SUI ranging from mild to severe. SEPFM programs included different training parameters concerning the PFM. Some studies have applied abdominal training and adjuvant techniques. Urine leakage cure rates varied from 28.6 to 80%, while the strength increase of PFM varied from 15.6 to 161.7%. Conclusion: The most effective training protocol consists of SEPFM by digital palpation combined with biofeedback monitoring and vaginal cones, including 12 week training parameters, and ten repetitions per series in different positions compared with SEPFM alone or a lack of treatment.

Benefits of Physiotherapy on Urinary Incontinence in High-Performance Female Athletes. Meta-Analysis

“…Several authors argue that strength training of the pelvic floor muscles is effective in the treatment of SUI in women [ 15 , 16 , 17 , 18 , 19 , 20 ].…”

External electrical stimulation compared with intravaginal electrical stimulation for the treatment of stress urinary incontinence in women: A randomized controlled noninferiority trial

“…However, approximately 30% of women are unable to perform voluntary pelvic floor muscle contractions correctly despite instruction . Performance can be improved by using biofeedback to indicate when correct contractions are performed or by using electrical stimulation to improve pelvic floor muscle function and mass …”

“…PFMT can be effective at improving SUI, although more than 30% of women do not contract the muscles correctly despite instruction . Several methods to augment PFMT are available, including biofeedback, vaginal weights, and electrical stimulation …”

Game therapy a new approach to treat women facing mixed urinary incontinence: A study protocol

“…1,2 According to protocols, previous studies have recommended a 3-week-PFMT treatment frequency or more to report high cure percentual. 3,4 Oliveira et al 5 showed in a systematic review that training programs from 8 to 12 weeks seem to reduce the amount of urine leakage, and/or increase pelvic floor muscle (PFM) strength. It is emphasized that physical exercise chronic practice can be responsible for skeletal muscle adaptations, such as hypertrophy of pelvic floor (PF) area.…”