First-line treatment: Pelvic-floor muscle training examined

This study examined the effectiveness of pelvic-floor muscle training in treating urinary incontinence.

The authors of this study concluded that pelvic-floor muscle training is an effective first-line treatment option for urinary symptoms of any type.

Pelvic-floor muscle training is often the first, and most commonly used, treatment for urinary incontinence. Exercising the pelvic muscles correctly improves their strength and coordination, which is important to prevent urine leakage. However, evidence regarding the actual effectiveness of pelvic-floor muscle training remains inconsistent. This study examined the effectiveness of supervised pelvic-floor muscle training in treating different types of urinary incontinence (UI). 

A total of 271 women with UI were included in this study. Women were instructed on pelvic-floor muscle training and asked to perform pelvic-floor exercises three times per day. Urinary symptoms were recorded before and after the study. Women were also referred to additional therapy if deemed necessary (including electrical stimulation if the strength of pelvic-floor muscles was poor and bio-feedback if awareness of muscle contraction was poor). Group sessions, lifestyle counseling and vaginal cones were also used.

Nearly half (49%) of the women in this study had stress UI (involuntary urine leakage during exertion, sneezing, coughing, lifting or any other physical activity). 15% of women had urge UI (involuntary urine leakage accompanied by a sudden and compelling desire to pass urine), and 36% of women presented with mixed UI (both stress and urge symptoms).

Of the women with stress UI, 56% achieved continence by the end of the study. Similarly, 51% of women with mixed UI reported improved symptoms after treatment with pelvic-floor muscle training. 27 out of the 41 women with urge UI (66%) also achieved significant control over urinary symptoms. Overall, the severity of urinary symptoms before treatment was not found to effect pelvic-floor muscle training outcomes. 

The researchers concluded that pelvic-floor muscle training is an effective first-line treatment option, regardless of the type of incontinence or initial severity of symptoms.

There were significant drawbacks with the way data regarding symptoms and treatments was collected and analyzed in this study. These findings should, therefore, be interpreted with caution. Large controlled randomized trials are needed to confirm these results.