A randomized controlled trial of antenatal pelvic floor exercises to prevent and treat urinary incontinence. A randomized controlled trial of pelvic floor muscle exercises to treat postnatal urinary incontinence. Promoting urinary continence in women after delivery: randomised controlled trial. Nursing intervention to enhance efficacy of home practice of pelvic floor muscle exercises in treating mixed urinary incontinence. A randomized controlled trial of the effectiveness of pelvic floor therapies for urodynamic stress and mixed incontinence. Effectiveness of early pelvic floor rehabilitation treatment for post-prostatectomy incontinence. Return to continence after radical retropubic prostatectomy: a randomized trial of verbal and written instructions versus therapist-directed pelvic floor muscle therapy. Effectiveness of multidimensional exercises for the treatment of stress urinary incontinence in elderly community-dwelling Japanese women: a randomized, controlled, crossover trial. Short-term efficacy of group pelvic floor training under intensive supervision versus unsupervised home training for female stress urinary incontinence: a randomized pilot study.
the aim of the study was to evaluate the effect of antenatal pelvic floor muscle exercise (PFME) in the prevention and treatment of urinary incontinence during pregnancy and postpartum period.
                three hundred women were randomly assigned to the PFME group and control group. Urinary symptoms were measured by Urogenital Distress Inventory-6 (UDI-6), Incontinence Impact Questionnaire-7 (IIQ-7), and question of self-reported urinary incontinence. Questionnaire scores of the PFME and the control groups were compared and analyzed.
                during late pregnancy and the postpartum period, the PFME group had significantly lower total UDI-6 and IIQ-7 scores; their self-report rate of urinary incontinence was also less than the control group. Additionally, we found whether in PFME or control, women who delivered vaginally were more likely to develop postpartum urinary leakage than women who delivered by cesarean section.
                PFME applied in pregnancy is effective in the treatment and prevention of urinary incontinence during pregnancy, and this effect may persist to postpartum period. A randomized controlled trial was carried out to evaluate the extent to which a program of reinforced pelvic floor muscle exercises (PFME) reduces urinary incontinence 1 year after delivery. Two hundred and thirty women who were incontinent 3 months postpartum were randomized to either a control group doing standard postnatal pelvic floor muscle exercises (n = 117) or to an intervention group (n = 113) who saw a physiotherapist for instruction at approximately 3, 4, 6 and 9 months postpartum. Results collected 12 months after delivery included prevalence and frequency of incontinence and PFME, sexual satisfaction, perineometry measurements and pad tests. Twenty-six (22%) of the control group and 59 (52%) of the intervention group withdrew before the final assessment. The prevalence of incontinence was significantly less in the intervention group than in the control group (50% versus 76%, P=0.0003), and this group also did significantly more PFME. There were no significant differences between the groups as regards sexual satisfaction, perineometry measurements or pad test results. To test the effectiveness of a physiotherapist delivered intervention designed to prevent urinary incontinence among women three months after giving birth.
                Prospective randomised controlled trial with women randomised to receive the intervention (which entailed training in pelvic floor exercises and incorporated strategies to improve adherence) or usual postpartum care.
                Postpartum wards of three tertiary teaching hospitals in the Hunter region, New South Wales, Australia.
                Women who had forceps or ventouse deliveries or whose babies had a high birth weight (> or =4000 g), or both-676 (348 in the intervention group and 328 in the usual care group) provided endpoint data at three months.
                Urinary incontinence at three months measured as a dichotomous variable. The severity of incontinence was also measured. Self report of the frequency of performance of pelvic floor exercises was recorded.
                At three months after delivery, the prevalence of incontinence in the intervention group was 31.0% (108 women) and in the usual care group 38.4% (125 women); difference 7.4% (95% confidence interval 0.2% to 14.6%, P=0.044). At follow up significantly fewer women with incontinence were classified as severe in the intervention group (10.1%) v (17.0%), difference 7.0%, 1.6% to 11.8%). The proportions of women reporting doing pelvic floor exercises at adequate levels was 84% (80% to 88%) for the intervention group and 58% (52% to 63%) for the usual care group (P=0.001).
                The intervention promoting urinary continence reduced the prevalence of urinary incontinence after giving birth, particularly its severity, and promoted the performance of pelvic floor exercises at adequate levels; both continence and adherence to the programme were measured at three months after delivery in women who had forceps or ventouse deliveries or babies weighing 4000 g or more. This study was conducted to evaluate nursing intervention to enhance the efficacy of a home-based pelvic floor muscle exercise (PFME) in treating mixed urinary incontinence among a community-based population. Eighty-eight women with mixed incontinence were recruited for this study and were asked to practice PFME at home as instructed. A registered nurse monitored the study group via telephone checkups twice a week. The Symptoms (LUTS) Questionnaire and a disease-specific questionnaire of impact index were used for repeat measurements before intervention, at 3 and 6 months after PFME. Symptoms such as frequency, nocturia, urge incontinence, and urinary stress incontinence improved significantly in the study group at 6 months. Quality of life with regard to worry about pads/towels leakage and getting wet also improved in the study group at 6 months. Nursing intervention can significantly improve the efficacy of a home-based PFME program in community women with mixed storage symptoms. To assess the efficacy and cost-effectiveness of pelvic floor muscle therapies (PFMT) in women aged > or = 40 years with urodynamic stress incontinence (USI) and mixed UI.
                In a three-arm randomized controlled trial in Leicestershire and Rutland UK, 238 community-dwelling women aged > or = 40 years with USI in whom previous primary behavioural intervention had failed were randomized to receive either intensive PFMT (79), vaginal cone therapy (80) or to continue with primary behavioural intervention (79) for 3 months. The main outcome measure was the frequency of primary UI episodes, and secondary measures were pad-test urine loss, patient perception of problem, assessment of PF function, voiding frequency, and pad usage. Validated scales for urinary dysfunction, and impact on quality of life and satisfaction were collected at an independent interview.
                All three groups had a moderate reduction in UI episodes after intervention but there was no statistically significant difference among the groups. There were marginal improvements in voiding frequency for all groups, with no statistically significant difference among them.
                In women who have already had simple behavioural therapies (including advice on PFM exercises) for urinary dysfunction, the continuation of these behavioural therapies can lead to further improvement. The addition of vaginal cone therapy or intensive PFMT does not seem to contribute to further improvement. The improvement in pelvic floor function was significantly greater in the PFMT arm than in the control arm although this did not translate into changes in urinary symptoms. Urinary incontinence after radical prostatectomy is a significant clinical problem. In this prospective study we investigate the effectiveness of early pelvic floor muscle training (PFMT) on a large population, that had undergone radical retropubic prostatectomy (RRP) at our department.
                300 consecutive patients who had undergone RRP for clinically confined prostate cancer were randomized in two groups after catheter removal. One group of 150 patients took part in a structured PFMT program. This began before discharge and consisted of Kegel exercises. The remaining 150 patients constituted the control group, they were not formally instructed in PFMT. Incontinence was assessed objectively using the 1 hour and 24 hour pad test, as well as with the ICS-Male questionnaire. All patients who were incontinent after 6 months underwent urodynamic evaluation.
                In the treated group, 19% (29 patients) achieved continence after 1 month, and 94.6% (146 patients) after 6 months. In the control group 8% (12 patients) achieved continence after 1 month, and 65% (97 patients) after 6 months (p<0.001). Patient age did not correlate with continence in the control group (p>0.05), although a significant correlation was revealed within the treated group (p<0.01). Overall, 93.3% of the total population achieved continence after one year.
                After RRP an early supportive rehabilitation program like PFMT significantly reduces continence recovery time. To test the effectiveness of weekly postoperative pelvic floor muscle training (PFMT) versus supportive telephone contact by a urology nurse for men at 4 weeks after radical prostatectomy.
                This was a randomized controlled trial in three Canadian centers. At 4 weeks after surgery, standardized verbal and written instruction about PFMT was provided to all subjects. Randomization occurred after initial instruction. Continence was defined as 8 g or less of urine loss on a 24-hour pad test. Primary outcome was grams of urine loss on pad test; secondary outcomes were International Prostate Symptom Score (IPSS), Incontinence Impact Questionnaire (IIQ-7) score, cost, and perception of urine loss as a problem. Data were obtained at baseline (preoperatively) and at weeks 4, 8, 12, 16, and 28 and 1 year after surgery.
                A total of 216 men were enrolled; 11 were dry or withdrew at 4 weeks. Ninety-nine were randomized to the control group and 106 to the treatment group. There were no group differences at baseline for prostate-specific antigen level (mean [standard deviation] 8.4 [10.4] ng/mL; 7.6 [4.6] ng/mL), Gleason score (6.3 [0.86]), IPSS, IIQ-7 score, pad test, or voiding diary. At 8 weeks 23% of the control group and 20% of the treatment group were continent; at 12 weeks, 28% and 32%; 16 weeks, 40% and 44%; 28 weeks, 50% and 47%; and at 52 weeks, 64% and 60%, respectively. There were no significant differences between groups at any time point for the outcome variables.
                Verbal instruction and written information with telephone support seemed to be as effective as intensive PFMT. Less-intense therapy may be more cost-effective. To evaluate the effectiveness of pelvic floor muscle (PFM) and fitness exercises in reducing urine leakage in elderly women with stress urinary incontinence (UI).
                Randomized, crossover, follow-up trial.
                Urban community in Japan.
                Seventy women aged 70 and older who reported urine leakage one or more times per month; 35 were randomly assigned to intervention and the other 35 to control.
                The intervention group attended an exercise class aimed at enhancing PFMs and fitness. Duration of the exercise was 60 minutes per session twice a week for 3 months. After 3 months of exercise, the intervention group was followed for 1 year.
                Body mass index (BMI), urine leakage, walking speed, and muscle strength were measured at baseline, after the intervention, and at follow-up.
                In the intervention group, maximum walking speed and adductor muscle strength increased significantly after the intervention; there were no significant changes in the control group. After 3 months of exercise, 54.5% of the intervention group and 9.4% of the control group reported being continent. Within the cured group of UI, a significantly higher proportion had decreased their BMI at 3 months (P=.03) and increased walking speed at 3 (P=.04) and 12 (P=.047) months.
                Decrease in BMI and increase in walking speed may contribute to the treatment of UI, although the data do not support a positive correlation between strengthening of adductor muscle and improvement of UI, which needs more research. Current management guidelines propose pelvic floor muscle training (PFMT) as first line treatment for female stress urinary incontinence (SUI). The aim of this study is to compare the efficacy of group PFMT under intensive supervision to that of individual home therapy in women with SUI.
                Thirty women with clinical and urodynamic diagnosis of SUI were randomized in two equal-number groups. Following a common demonstration course, Group A women received a detailed schedule for home training, while Group B in addition attended a weekly hospital group visit. At 12 weeks both groups were assessed for changes in subjective and objective outcomes.
                Twenty-two women, (10 Group A, 12 Group B) with a mean age of 47.3 years completed the study. Although significant (P<0.05) improvements were noted in both groups in quality of life scores, number of incontinence episodes/week, 24-hr frequency, and endurance, repetitions and fast contractions upon vaginal assessment of the PFMs, comparative analysis at the end of the study demonstrated significantly better results for women in Group B, who also improved in daily pad usage, underwear wetting, modified Oxford grading of the PFMs and hold with cough. Consequently, significantly more women in Group B reported improvement in their continence (100% vs. 20% in Group A).
                Group PFMT under intensive supervision produced significantly better improvements in primary and secondary outcomes in the short-term compared to individual, unsupervised home application of PFMT.
                Copyright (c) 2007 Wiley-Liss, Inc.
There is some evidence that for women having their first baby, PFMT can prevent urinary incontinence up to six months after delivery. There is support for the widespread recommendation that PFMT is an appropriate treatment for women with persistent postpartum urinary incontinence. It is possible that the effects of PFMT might be greater with targeted rather than mixed prevention and treatment approaches and in certain groups of women (for example primiparous women; women who had bladder neck hypermobility in early pregnancy, a large baby, or a forceps delivery). These and other uncertainties, particularly long-term effectiveness, require further testing.