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
Yeşim Akkoç
,
Aylin Kılıçkap
,
Özgür Yeniel
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
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- 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
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- 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
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Year 2025,
Volume: 15 Issue: 1, 95 - 102, 28.03.2025
Yeşim Akkoç
,
Aylin Kılıçkap
,
Özgür Yeniel
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.