The effectiveness of pelvic floor muscle training in the management of female stress urinary incontinence: case series study

Introduction. Pelvic floor muscle training (PFMT) programs are prescribed to increase strength, endurance and coordination of the pelvic floor muscles and are defined as a program of repeated voluntary pelvic floor muscle contraction. They have been principally recommended in the management of stress urinary incontinence (SUI)1. SUI is defined as the involuntary urinary leakage due to effort or exertion or from sneezing or coughing and it is usually related to increased urethral mobility and/or poor intrinsic sphincter function2. The primary outcome of our study is to evaluate the change in the endurance of the pelvic floor muscles after PFMT programs in female stress urinary incontinence. The secondary outcome is the increase in the number of possible repeatable contractions and in the strength of pubococcygeus muscle. Materials and methods. From January 2012 to May 2012 we treated five patients with a history of stress urinary incontinence (SUI) at the outpatient clinic of physical and rehabilitation medicine. All women had a negative history of neuromuscular disease and were not using hormone replacement therapy. Each patient underwent an evaluation protocol before (T0) and after five weeks of treatment (T1). We evaluated the pelvic floor muscle (PFM) strength as the maximum voluntary contraction of the pubococcygeus muscle (PC test 0-3), pubococcygeus muscular endurance, as the maintenance of muscle contraction in seconds and the number of possible repeatable contractions before fatigue by digital palpation. We measured quality of life using the King’s Health Questionnaire (KHQ) and Incontinence Impact Questionnaire (short form, IIQ-7). The exercise protocol for the PFMT, supervised by a physiatrist, consisted of slow contractions (tonic fibers) and rapid contractions (phasic fibers) practiced in the supine, sitting and standing positions, three times a week 1-h session for a period of five weeks and it was adapted to the capacity of each patient during each treatment. Each patient was asked to repeat the exercise protocol for a total of 3 times a day. All women were first instructed on the anatomy and function of the PFMs and on how to contract them properly. They were asked to contract PFMs as strongly as possible trying not to use gluteal, abdominal, and adductor muscles. Results. The patients enrolled in our study had a mean age of 58.6 yr (range 50-65) with a mean body mass index of 25.64. Regarding the obstetric history, the average number of vaginal deliveries was 2.2 and in all of the cases was performed an episiotomy. Moreover, two patients underwent an hysterectomy and one had both cystocele and rectocele. Menopause occurred in 4 of the 5 patients at a mean age of 53.7 y.o. and, in one case, was surgical. The SUI occurred on an average age of 55.4 y.o. Endurance at T0, was on average 3” on the right side and 3.6” on the left side, while, at T1, 7.2” and 7.8” respectively. The number of contractions increased, on average, from 6.2 at T0 to 13 at T1. Before treatment, a mean score at PC Test of 1.6 on the right and 1.6 on the left was observed, while after the treatment it was 2 on the right and 2.2 on the left. In addition, at T0, 4 patients contracted the abdominal muscles and two of them also gluteus and hamstring muscles, while, at T1, all of them were able to contract the PFMs alone. Conclusions. Based on our study, pelvic floor muscle training is easy to perform and results in an improvement in the endurance of the pelvic floor muscle and in the number of possible repeatable contractions. Moreover we observed a reduction of the frequency and the amount of leakage with a positive effect on the quality of life. Bibliography 1. Hay-Smith EJ, Herderschee R, Dumoulin C, Herbison GP.: Comparisons of approaches to pelvic floor muscle training for urinary incontinence in women. Cochrane Database Syst Rev. 2011 Dec 7;(12). 2. Abrams P, Andersson KE, Birder L, Brubaker L, Cardozo L, Chapple C, et al.; Fourth International Consultation on Incontinence Recommendations of the International Scientific Committee: Evaluation and treatment of urinary incontinence, pelvic organ prolapse, and fecal incontinence. Neurourol Urodyn. 2010;29(1):213-40.