Paula method of circular muscle exercises for urinary stress incontinence—a clinical trial

Abstract

The aim of this study was to determine the efficacy of the Paula method of circular muscle training in the management of stress incontinence (SI). The theory behind this method states that activity of distant sphincters affects other muscles. In a pilot study, 59 women, mainly hospital employees, were randomly assigned to participate in exercises according to the Paula method or pelvic floor training. Efficacy was measured by reports of incontinence, quality of life (I-QOL), pad test, and pelvic floor muscle strength (assessed by perineometer and digital examination). Both the Paula exercises and pelvic floor training produced significant changes in urinary leakage compared to baseline as measured by the pad test [mean decrease of 5.4 g (p=0.002) and 9.5 g (p=0.003), respectively]. Women randomized to the Paula method reported improvement in I-QOL scores. The Paula method was found to be efficacious for SI in a population of Israeli women. Larger community-based studies will be required to confirm these results and enable evaluation of between-group differences.

Can the Paula method facilitate co-contraction of the pelvic floor muscles? A 4D ultrasound study

“…Data from a published RCT showed statistically significant improvement in quality of life and reduction of leakage in SUI women after both the Paula method and home PFMT [6].…”

“…The Paula method is developed and used by midwifes [6], and our population was selected to match one of the target groups for interventions using the Paula method. By including both nulliparous pregnant and postpartum women, our study sample covers women with very weak, but also presumably non-injured stronger muscles.…”

“…PFMT has shown to be effective to treat SUI and mixed incontinence in several high quality RCTs, systematic reviews and meta-analysis, and PFMT is recommended first line treatment for SUI and mixed incontinence [2][3] In spite of this there seem to be some interest in exploring alternative exercise programs to improve pelvic floor function [28][29]6]. To date there are two rationales for PFMT; 1. voluntary co-contraction of the PFM before and during increase in intra-abdominal pressure [30] and strength training [31,23].…”

“…Contraction of the ring muscles of the mouth was taught according to Liebergall-Wischnitzer et al [6], and a correct contraction was assessed by the gynaecologist and the physical therapist.…”

“…A pilot study showed that exercising according to the Paula method gave significant improvement in SUI measured by pad testing and Quality of life (QoL) comparing pre-and post test results within the Paula group [6]. No effect was found in improvement of PFM strength, neither after the Paula method nor the home PFMT.…”