Can pelvic-floor muscle training improve outcomes of other treatments?

This study evaluated a possible benefit of combining pelvic-floor muscle training with other active treatments used for urinary incontinence.

Researchers concluded that there is not enough evidence to support, or refute, a benefit of adding pelvic-floor muscle training to other active treatments. 

Pelvic-floor muscle training is often the first, and most commonly used, treatment for urinary incontinence (UI). Exercising the pelvic muscles improves their strength and coordination, which is important to prevent urine leakage. Other treatments for UI include drug therapies, pessaries, behavioral therapies, electrical or magnetic stimulation, and surgery such as vaginal sling procedures. The focus of this review is to evaluate the benefits of adding pelvic-floor muscle training to any of these other treatments.

Thirteen trials, including a combined total of 1749 women, were included in this study. All women had either stress, urge or mixed UI. Outcomes of pelvic-floor muscle training coupled with another type of active treatment were compared to those of active treatment alone.

Overall, there were no significant differences in treatment effectivity when pelvic-floor muscle training was added to another active treatment.

Two low-quality trials investigated electrical stimulation. Their findings indicate a possibility that pelvic-floor muscle training combined with electrical stimulation could be beneficial. Women were about twice as likely to report that their urinary symptoms had improved with combined treatment, compared to electrical stimulation alone.

Another low-quality study suggested a marginal benefit when pelvic-floor muscle training was added to treatment with vaginal cones.

One moderate-quality study observed a significant benefit in women who did a combination of pelvic-floor muscle training with Heat and Steam Sheet (a heat-generating sheet applied to the lower abdomen and lower back). Women were nearly 2.5 times more likely to report an improvement in UI symptoms with combined treatment, compared to Heat and Steam Sheet therapy alone.

Other findings involving pessaries, bladder training, and drug therapy were inconclusive, due to the quality of the studies being very low. No evidence from controlled trials was available regarding other active treatments, such as surgical procedures or lifestyle interventions (like weight loss).

This review concluded that there is not enough high-quality evidence to establish whether there is a benefit of combining pelvic-floor muscle training with other active treatment. 

These results should be interpreted with caution, since most of the trials included were small and of low quality.