Background
Pelvic floor
muscle training is the most commonly used physical therapy treatment for
women with stress urinary incontinence (SUI). It is sometimes also
recommended for mixed and, less commonly, urgency urinary incontinence.
Objectives
To determine the
effects of pelvic floor muscle training for women with urinary
incontinence in comparison to no treatment, placebo or sham treatments,
or other inactive control treatments.
Search methods
We
searched the Cochrane Incontinence Group Specialised Register, which
contains trials identified from the Cochrane Central Register of
Controlled Trials (CENTRAL) (1999 onwards), MEDLINE (1966 onwards) and
MEDLINE In-Process (2001 onwards), and handsearched journals and
conference proceedings (searched 15 April 2013) and the reference lists
of relevant articles.
Selection criteria
Randomised
or quasi-randomised trials in women with stress, urgency or mixed
urinary incontinence (based on symptoms, signs, or urodynamics). One arm
of the trial included pelvic floor muscle training (PFMT). Another arm
was a no treatment, placebo, sham, or other inactive control treatment
arm.
Data collection and analysis
Trials
were independently assessed by two review authors for eligibility and
methodological quality. Data were extracted then cross-checked.
Disagreements were resolved by discussion. Data were processed as
described in the Cochrane Handbook for Systematic Reviews of Interventions. Trials were subgrouped by diagnosis of urinary incontinence. Formal meta-analysis was undertaken when appropriate.
Main results
Twenty-one
trials involving 1281 women (665 PFMT, 616 controls) met the inclusion
criteria; 18 trials (1051 women) contributed data to the forest plots.
The trials were generally small to moderate sized, and many were at
moderate risk of bias, based on the trial reports. There was
considerable variation in the interventions used, study populations, and
outcome measures. There were no studies of women with mixed or urgency
urinary incontinence alone.
Women with SUI who were in the PFMT
groups were 8 times more likely than the controls to report that they
were cured (46/82 (56.1%) versus 5/83 (6.0%), RR 8.38, 95% CI 3.68 to
19.07) and 17 times more likely to report cure or improvement (32/58
(55%) versus 2/63 (3.2%), RR 17.33, 95% CI 4.31 to 69.64). In trials in
women with any type of urinary incontinence, PFMT groups were also more
likely to report cure, or more cure and improvement than the women in
the control groups, although the effect size was reduced. Women with
either SUI or any type of urinary incontinence were also more satisfied
with the active treatment, while women in the control groups were more
likely to seek further treatment. Women treated with PFMT leaked urine
less often, lost smaller amounts on the short office-based pad test, and
emptied their bladders less often during the day. Their sexual outcomes
were also better. Two trials (one small and one moderate size) reported
some evidence of the benefit persisting for up to a year after
treatment. Of the few adverse effects reported, none were serious.
The
findings of the review were largely supported by the summary of
findings tables, but most of the evidence was down-graded to moderate on
methodological grounds. The exception was 'Participant perceived cure'
in women with SUI, which was rated as high quality.
Authors' conclusions
The
review provides support for the widespread recommendation that PFMT be
included in first-line conservative management programmes for women with
stress and any type of urinary incontinence. Long-term effectiveness of
PFMT needs to be further researched.
- Chantale Dumoulin1,*,
- E. Jean C Hay-Smith2,
- Gabrielle Mac Habée-Séguin3
Editorial Group:
Cochrane Incontinence Group
Published Online: 14 MAY 2014
Assessed as up-to-date: 15 APR 2013
DOI: 10.1002/14651858.CD005654.pub3
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