Research Article
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Individualized Pelvic Floor Muscle Training with Single Session Versus Long Term Biofeedback for Treating Stress Urinary Incontinence: A Prospective Randomized Trial

Year 2025, Volume: 15 Issue: 1, 95 - 102, 28.03.2025
https://doi.org/10.33808/clinexphealthsci.1462829

Abstract

Objective: This study was planned to compare the effects of individualized pelvic floor muscle training (PFMT) in the treatment of stress urinary incontinence (SUI) applied with a single session versus long-term biofeedback (BF).
Methods: Thirty-three female patients with SUI were randomized into two groups. Sixteen patients in the first group were given an individualized PFMT program with BF, 2 days a week for 8 weeks, and a home exercise program on the other days. Seventeen patients in the second group were given a home exercise program after individualized PFMT with BF in a single session. After 8 weeks, both groups continued the exercises as a home program for another 4 weeks. Primary outcome parameters included a 3-day bladder diary, 1-hour pad test, maximum contraction pressure, duration of sustained contractions, King’s Health Questionnaire, incontinence impact questionnaire, incontinence quality of life scale and Beck depression inventory. Patients were questioned in terms of fecal incontinence, sexual dysfunction and treatment satisfaction as a secondary outcome parameters.
Results: Thirty patients were able to complete the treatment. In the evaluations made at the 8th and 12th weeks, all of the primary outcome parameters improved in both groups (p<.001), and no statistically significant difference was found between the groups (p>.05). There was also improvement in secondary outcome parameters in both groups.
Conclusion: In the treatment of SUI, it was determined that individualized exercise program might be continued as a home program after BF was used as a single session to teach the exercises correctly in PFMT.

Ethical Statement

Approval from ethics committee and informed consents of the patients were obtained for the study.

Supporting Institution

There is no supporting Institution for this study

Thanks

We would like to thank Associate Professor Timur Köse, a faculty member at Ege University, Faculty of Medicine, Department of Biostatistics and Medical Informatics, who conducted the statistical analysis of the study.

References

  • Haylen B, de Ridder D, Freeman R, Swift S, Berghmans B, Lee J. An International Urogynecological Association (IUGA)/International Continence Society (ICS) joint report on the terminology for female pelvic floor dysfunction. Neurourol Urodyn. 2010;29(1):4–20. https://doi.org/10.1002/nau.20798
  • Patel UJ, Godecker AL, Giles DL, Brown HW. Updated prevalence of urinary ıncontinence in women: 2015–2018 National Population-Based Survey Data. Female Pelvic Medicine & Reconstructive Surgery 2022; 28(4):181-187. https://doi.org/10.1097/SPV.0000000000001127
  • Anand A, Khan SM, Khan AA. Stress urinary incontinence in females. Diagnosis and treatment modalities – past, present and the future. Journal of Clinical Urology 2023; 16(6): 622-630. https://doi.org/10.1177/20514158211044583
  • Cacciari LP, Dumoulin C, Hay-Smith EJ. Pelvic floor muscle training versus no treatment, or inactive control treatments, for urinary incontinence in women: A cochrane systematic review abridged republication. Braz J Phys Ther. 2019; 23(2):93-107. https://doi.org/10.1016/j.bjpt.2019.01.002
  • Kegel AH. Progressive resistance exercise in the functional restoration of the perineal muscles. Am J Obstet Gynecol. 1948; 56(2): 238-248. https://doi.org/10.1016/0002-9378(48)90266-x
  • Bump RC, Hurt WG, Fantl JA, Wyman JF. Assessment of Kegel pelvic muscle exercise performance after brief verbal instruction. Am J Obstet Gynecol. 1991; 165(2): 322-327. https://doi.org/10.1016/0002-9378(91)90085-6
  • Bo K, Larsen S, Oseid S. Knowledge about and ability to correct pelvic floor muscle exercises in women with urinary stress incontinence. Neurourol Urodyn. 1988;7:261–262.
  • Herderschee R, Hay-Smith E, Herbison G. Feedback or biofeedback to augment pelvic floor muscle training for urinary incontinence in women. Cochrane Database Syst Rev 2011 6:(7):CD009252. https://doi.org/10.1002/14651858.CD009252.
  • Diaz DC, Robinson D, Bosch R, Costantini E, Cotterill N, Espuna-Pons M. Initial assesment of urinary incontinence in adult male and female patients. In: Abrams P, Cardozo L, Wagg A, Wein A, editors. International Consultation on Incontinence. 6th Ed. Tokyo: ICUD ICS; 2017. p. 500–35.
  • Vij M, Srikrishna S, Robinson D, Cardozo L. Quality assurance in quality of life assessment measuring the validity of the King’sHealth Questionnaire. Int Urogynecol J. 2014;25(8):1133- 1135. https://doi.org/10.1007/s00192-014-2370-5
  • Kaya S, Akbayrak T, Çelenay T, Dolgun A, Ekici G, Beksaç S. Reliability and validity of the Turkish King’s Health Questionnaire in women with urinary incontinence. Int Urogynecol J. 2015;26 (12):1853–1859. https://doi.org/10.1007/s00192-015-2786-6
  • Uebersax J, Wyman J, Shumaker S, McClish D, Fantl J& the CP for WRG. Short forms to assess life quality and symptom distress for urinary incontinence in women: The incontinence impact questionnaire and the urogenital distress inventory. Neurourol Urodyn. 1995;14(2):131-139. https://doi.org/10.1002/nau.1930140206.
  • Cam C, Sakalli M, Ay P, Cam M, Karateke A. Validation of the Short Forms of the Incontinence Impact Questionnaire (IIQ-7) and the Urogenital Distress Inventory (UDI-6) in a Turkish Population. Neurourol Urodyn. 2007; 26 (1):129–133. https://doi.org/10.1002/nau.20292
  • Patrick D, Martin M, Bushnell D. Quality of life of women with urinary incontinence: Further development of the incontinence quality of life instrument (I-QOL. Urology 1999;53 (1):71–76. https://doi.org/10.1016/s0090-4295(98)00454-3
  • Eyigor S, Karapolat H, Akkoç Y, Yeşil H, Ekmekci O. Quality of life in patients with multiple sclerosis and urinary disorders: Reliability and validity of Turkish-language version of Incontinence Quality of Life Scale. J Rehabil Res Dev. 2010; 47(1):67–71. https://doi.org/10.1682/jrrd.2009.08.0132
  • Beck AT, Steer RA, Brown GK. 1996. Beck Depression Inventory-Second Edition Manual. San Antonio, TX: The Psychological Corporation.
  • Kapci EG , Uslu R, Turkcapar H, Karaoglan A. Beck Depression Inventory II: Evaluation of the psychometric properties and cut-off points in a Turkish adult population. Depress Anxiety 2008;25(10):E104-110. https://doi.org/10.1002/da.20371
  • Dumoulin C, Adewuyi T, Bradley C, Burgio K, Hagen S, Hunter K. Adult Conservative Management. In: Abrams P, Cardozo L, Wagg A, Wein A, editors. Incontinence. 6th Intern. Tokyo: ICUD ICS; 2016. p. 1446–537.
  • Nunes E, Sampaio L, Biasotto-Gonzalez, DA, Nagano R dos R, Lucarelli P, Politti F. Biofeedback for pelvic floor muscle training in women with stress urinary incontinence: A systematic review with meta-analysis. Physiotherapy 2019;105(1):10–23. https://doi.org/10.1016/j.physio.2018.07.012
  • Matsi AE, Billis E, Lampropoulou S, Xergia SA, Tsekoura M, Fousekis K. The Effectiveness of pelvic floor muscle exercise with biofeedback in women with urinary ıncontinence: A systematic review. Appl Sci. 2023;13(23):1-22. https://doi.org/10.3390/app132312743
  • Özlü A, Yıldız N, Öztekin Ö. Comparison of the efficacy of perineal and intravaginal biofeedback assisted pelvic floor muscle exercises in women with urodynamic stress urinary incontinence. Neurourol Urodyn. 2017; 36(8):2132-2141. https://doi.org/10.1002/nau.23257
  • Cheng S, Lin D, Hu T, Cao L, Liao H, Mou X, Zhang Q,Liu J, Wu T. Association of urinary incontinence and depression or anxiety: A meta-analysis. J Int Med Res. 2020;48(6):1–12. https://doi.org/10.1177/0300060520931348
  • Yazdany T, Bhatia N, Reina A. Association of depression and anxiety in underserved women with and without urinary incontinence. Female Pelvic Med Reconstr Surg. 2014;20(6):349–353. https://doi.org/10.1097/SPV.0000000000000071
  • Khan Z, Whittal C, Mansol S, Osborne L, Reed P, Emery S. Effect of depression and anxiety on the success of pelvic floor muscle training for pelvic floor dysfunction. J Obstet Gynaecol (Lahore). 2013;33 (7):710–714. https://doi.org/10.3109/01443615.2013.813913
  • Weber-Rajek M, Straczynska A, Strojek K, Piekorz Z, Pilarska B, Podhorecka M, Sobieralska-Michalak K, Goch A, Radziminska A. Assessment of the effectiveness of pelvic floor muscle training (pfmt) and extracorporeal magnetic innervation (exmı) in treatment of stress urinary incontinence in women: A randomized controlled trial. Biomed Res Int. 2020:1-7. https://doi.org/10.1155/2020/1019872
  • Brubaker L, Chiang S, Zyczynski H, Norton P, Kalinoski D, Stoddard A, Kusek JW, Steers W. The impact of stress incontinence surgery on female sexual function. Am J Obs Gynecol. 2009; 200(5): 562.e1–562.e7. https://doi.org/10.1016/j.ajog.2008.11.017
  • Liebergall-Wischnitzer M, Paltiel O, Celnikier D, Lavy Y, Manor O, Woloski Wruble A. Sexual function and quality of life of women with stress urinary ıncontinence: A randomized controlled trial comparing the paula method (circular muscle exercises) to pelvic floor muscle training (PFMT) exercises. Int Soc Sex Med. 2012; 9(6):1613–1623. https://doi.org/10.1111/j.1743-6109.2012.02721.x
  • Bliss D, Mimura T, Berghmans B, Bharucha A, Chiarioni G, Emmanuel A. Assessment and conservative management of faecal incontinence and quality of life in adults. In: Abrams P, Cardozo L, Wagg A, Wein A, editors. 6th International Consultation on Incontinence. 6th Intern. Tokyo: ICUD ICS; 2016. p. 2034–2047.
Year 2025, Volume: 15 Issue: 1, 95 - 102, 28.03.2025
https://doi.org/10.33808/clinexphealthsci.1462829

Abstract

References

  • Haylen B, de Ridder D, Freeman R, Swift S, Berghmans B, Lee J. An International Urogynecological Association (IUGA)/International Continence Society (ICS) joint report on the terminology for female pelvic floor dysfunction. Neurourol Urodyn. 2010;29(1):4–20. https://doi.org/10.1002/nau.20798
  • Patel UJ, Godecker AL, Giles DL, Brown HW. Updated prevalence of urinary ıncontinence in women: 2015–2018 National Population-Based Survey Data. Female Pelvic Medicine & Reconstructive Surgery 2022; 28(4):181-187. https://doi.org/10.1097/SPV.0000000000001127
  • Anand A, Khan SM, Khan AA. Stress urinary incontinence in females. Diagnosis and treatment modalities – past, present and the future. Journal of Clinical Urology 2023; 16(6): 622-630. https://doi.org/10.1177/20514158211044583
  • Cacciari LP, Dumoulin C, Hay-Smith EJ. Pelvic floor muscle training versus no treatment, or inactive control treatments, for urinary incontinence in women: A cochrane systematic review abridged republication. Braz J Phys Ther. 2019; 23(2):93-107. https://doi.org/10.1016/j.bjpt.2019.01.002
  • Kegel AH. Progressive resistance exercise in the functional restoration of the perineal muscles. Am J Obstet Gynecol. 1948; 56(2): 238-248. https://doi.org/10.1016/0002-9378(48)90266-x
  • Bump RC, Hurt WG, Fantl JA, Wyman JF. Assessment of Kegel pelvic muscle exercise performance after brief verbal instruction. Am J Obstet Gynecol. 1991; 165(2): 322-327. https://doi.org/10.1016/0002-9378(91)90085-6
  • Bo K, Larsen S, Oseid S. Knowledge about and ability to correct pelvic floor muscle exercises in women with urinary stress incontinence. Neurourol Urodyn. 1988;7:261–262.
  • Herderschee R, Hay-Smith E, Herbison G. Feedback or biofeedback to augment pelvic floor muscle training for urinary incontinence in women. Cochrane Database Syst Rev 2011 6:(7):CD009252. https://doi.org/10.1002/14651858.CD009252.
  • Diaz DC, Robinson D, Bosch R, Costantini E, Cotterill N, Espuna-Pons M. Initial assesment of urinary incontinence in adult male and female patients. In: Abrams P, Cardozo L, Wagg A, Wein A, editors. International Consultation on Incontinence. 6th Ed. Tokyo: ICUD ICS; 2017. p. 500–35.
  • Vij M, Srikrishna S, Robinson D, Cardozo L. Quality assurance in quality of life assessment measuring the validity of the King’sHealth Questionnaire. Int Urogynecol J. 2014;25(8):1133- 1135. https://doi.org/10.1007/s00192-014-2370-5
  • Kaya S, Akbayrak T, Çelenay T, Dolgun A, Ekici G, Beksaç S. Reliability and validity of the Turkish King’s Health Questionnaire in women with urinary incontinence. Int Urogynecol J. 2015;26 (12):1853–1859. https://doi.org/10.1007/s00192-015-2786-6
  • Uebersax J, Wyman J, Shumaker S, McClish D, Fantl J& the CP for WRG. Short forms to assess life quality and symptom distress for urinary incontinence in women: The incontinence impact questionnaire and the urogenital distress inventory. Neurourol Urodyn. 1995;14(2):131-139. https://doi.org/10.1002/nau.1930140206.
  • Cam C, Sakalli M, Ay P, Cam M, Karateke A. Validation of the Short Forms of the Incontinence Impact Questionnaire (IIQ-7) and the Urogenital Distress Inventory (UDI-6) in a Turkish Population. Neurourol Urodyn. 2007; 26 (1):129–133. https://doi.org/10.1002/nau.20292
  • Patrick D, Martin M, Bushnell D. Quality of life of women with urinary incontinence: Further development of the incontinence quality of life instrument (I-QOL. Urology 1999;53 (1):71–76. https://doi.org/10.1016/s0090-4295(98)00454-3
  • Eyigor S, Karapolat H, Akkoç Y, Yeşil H, Ekmekci O. Quality of life in patients with multiple sclerosis and urinary disorders: Reliability and validity of Turkish-language version of Incontinence Quality of Life Scale. J Rehabil Res Dev. 2010; 47(1):67–71. https://doi.org/10.1682/jrrd.2009.08.0132
  • Beck AT, Steer RA, Brown GK. 1996. Beck Depression Inventory-Second Edition Manual. San Antonio, TX: The Psychological Corporation.
  • Kapci EG , Uslu R, Turkcapar H, Karaoglan A. Beck Depression Inventory II: Evaluation of the psychometric properties and cut-off points in a Turkish adult population. Depress Anxiety 2008;25(10):E104-110. https://doi.org/10.1002/da.20371
  • Dumoulin C, Adewuyi T, Bradley C, Burgio K, Hagen S, Hunter K. Adult Conservative Management. In: Abrams P, Cardozo L, Wagg A, Wein A, editors. Incontinence. 6th Intern. Tokyo: ICUD ICS; 2016. p. 1446–537.
  • Nunes E, Sampaio L, Biasotto-Gonzalez, DA, Nagano R dos R, Lucarelli P, Politti F. Biofeedback for pelvic floor muscle training in women with stress urinary incontinence: A systematic review with meta-analysis. Physiotherapy 2019;105(1):10–23. https://doi.org/10.1016/j.physio.2018.07.012
  • Matsi AE, Billis E, Lampropoulou S, Xergia SA, Tsekoura M, Fousekis K. The Effectiveness of pelvic floor muscle exercise with biofeedback in women with urinary ıncontinence: A systematic review. Appl Sci. 2023;13(23):1-22. https://doi.org/10.3390/app132312743
  • Özlü A, Yıldız N, Öztekin Ö. Comparison of the efficacy of perineal and intravaginal biofeedback assisted pelvic floor muscle exercises in women with urodynamic stress urinary incontinence. Neurourol Urodyn. 2017; 36(8):2132-2141. https://doi.org/10.1002/nau.23257
  • Cheng S, Lin D, Hu T, Cao L, Liao H, Mou X, Zhang Q,Liu J, Wu T. Association of urinary incontinence and depression or anxiety: A meta-analysis. J Int Med Res. 2020;48(6):1–12. https://doi.org/10.1177/0300060520931348
  • Yazdany T, Bhatia N, Reina A. Association of depression and anxiety in underserved women with and without urinary incontinence. Female Pelvic Med Reconstr Surg. 2014;20(6):349–353. https://doi.org/10.1097/SPV.0000000000000071
  • Khan Z, Whittal C, Mansol S, Osborne L, Reed P, Emery S. Effect of depression and anxiety on the success of pelvic floor muscle training for pelvic floor dysfunction. J Obstet Gynaecol (Lahore). 2013;33 (7):710–714. https://doi.org/10.3109/01443615.2013.813913
  • Weber-Rajek M, Straczynska A, Strojek K, Piekorz Z, Pilarska B, Podhorecka M, Sobieralska-Michalak K, Goch A, Radziminska A. Assessment of the effectiveness of pelvic floor muscle training (pfmt) and extracorporeal magnetic innervation (exmı) in treatment of stress urinary incontinence in women: A randomized controlled trial. Biomed Res Int. 2020:1-7. https://doi.org/10.1155/2020/1019872
  • Brubaker L, Chiang S, Zyczynski H, Norton P, Kalinoski D, Stoddard A, Kusek JW, Steers W. The impact of stress incontinence surgery on female sexual function. Am J Obs Gynecol. 2009; 200(5): 562.e1–562.e7. https://doi.org/10.1016/j.ajog.2008.11.017
  • Liebergall-Wischnitzer M, Paltiel O, Celnikier D, Lavy Y, Manor O, Woloski Wruble A. Sexual function and quality of life of women with stress urinary ıncontinence: A randomized controlled trial comparing the paula method (circular muscle exercises) to pelvic floor muscle training (PFMT) exercises. Int Soc Sex Med. 2012; 9(6):1613–1623. https://doi.org/10.1111/j.1743-6109.2012.02721.x
  • Bliss D, Mimura T, Berghmans B, Bharucha A, Chiarioni G, Emmanuel A. Assessment and conservative management of faecal incontinence and quality of life in adults. In: Abrams P, Cardozo L, Wagg A, Wein A, editors. 6th International Consultation on Incontinence. 6th Intern. Tokyo: ICUD ICS; 2016. p. 2034–2047.
There are 28 citations in total.

Details

Primary Language English
Subjects Urology
Journal Section Articles
Authors

Yeşim Akkoç 0000-0003-0480-499X

Aylin Kılıçkap 0000-0001-8807-1513

Özgür Yeniel 0000-0002-5604-047X

Early Pub Date March 23, 2025
Publication Date March 28, 2025
Submission Date April 1, 2024
Acceptance Date February 2, 2025
Published in Issue Year 2025 Volume: 15 Issue: 1

Cite

APA Akkoç, Y., Kılıçkap, A., & Yeniel, Ö. (2025). Individualized Pelvic Floor Muscle Training with Single Session Versus Long Term Biofeedback for Treating Stress Urinary Incontinence: A Prospective Randomized Trial. Clinical and Experimental Health Sciences, 15(1), 95-102. https://doi.org/10.33808/clinexphealthsci.1462829
AMA Akkoç Y, Kılıçkap A, Yeniel Ö. Individualized Pelvic Floor Muscle Training with Single Session Versus Long Term Biofeedback for Treating Stress Urinary Incontinence: A Prospective Randomized Trial. Clinical and Experimental Health Sciences. March 2025;15(1):95-102. doi:10.33808/clinexphealthsci.1462829
Chicago Akkoç, Yeşim, Aylin Kılıçkap, and Özgür Yeniel. “Individualized Pelvic Floor Muscle Training With Single Session Versus Long Term Biofeedback for Treating Stress Urinary Incontinence: A Prospective Randomized Trial”. Clinical and Experimental Health Sciences 15, no. 1 (March 2025): 95-102. https://doi.org/10.33808/clinexphealthsci.1462829.
EndNote Akkoç Y, Kılıçkap A, Yeniel Ö (March 1, 2025) Individualized Pelvic Floor Muscle Training with Single Session Versus Long Term Biofeedback for Treating Stress Urinary Incontinence: A Prospective Randomized Trial. Clinical and Experimental Health Sciences 15 1 95–102.
IEEE Y. Akkoç, A. Kılıçkap, and Ö. Yeniel, “Individualized Pelvic Floor Muscle Training with Single Session Versus Long Term Biofeedback for Treating Stress Urinary Incontinence: A Prospective Randomized Trial”, Clinical and Experimental Health Sciences, vol. 15, no. 1, pp. 95–102, 2025, doi: 10.33808/clinexphealthsci.1462829.
ISNAD Akkoç, Yeşim et al. “Individualized Pelvic Floor Muscle Training With Single Session Versus Long Term Biofeedback for Treating Stress Urinary Incontinence: A Prospective Randomized Trial”. Clinical and Experimental Health Sciences 15/1 (March 2025), 95-102. https://doi.org/10.33808/clinexphealthsci.1462829.
JAMA Akkoç Y, Kılıçkap A, Yeniel Ö. Individualized Pelvic Floor Muscle Training with Single Session Versus Long Term Biofeedback for Treating Stress Urinary Incontinence: A Prospective Randomized Trial. Clinical and Experimental Health Sciences. 2025;15:95–102.
MLA Akkoç, Yeşim et al. “Individualized Pelvic Floor Muscle Training With Single Session Versus Long Term Biofeedback for Treating Stress Urinary Incontinence: A Prospective Randomized Trial”. Clinical and Experimental Health Sciences, vol. 15, no. 1, 2025, pp. 95-102, doi:10.33808/clinexphealthsci.1462829.
Vancouver Akkoç Y, Kılıçkap A, Yeniel Ö. Individualized Pelvic Floor Muscle Training with Single Session Versus Long Term Biofeedback for Treating Stress Urinary Incontinence: A Prospective Randomized Trial. Clinical and Experimental Health Sciences. 2025;15(1):95-102.

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