Skip to main content

Advertisement

Log in

Update on Behavioral and Physical Therapies for Incontinence and Overactive Bladder: The Role of Pelvic Floor Muscle Training

  • Lower Urinary Tract Symptoms and Voiding Dysfunction (G Badlani and H Goldman, Section Editors)
  • Published:
Current Urology Reports Aims and scope Submit manuscript

Abstract

Behavioral and physical therapies have been used for many years to treat incontinence and overactive bladder (OAB). This paper focuses on programs that include pelvic floor muscle training (PFMT) as a component in treatment for women or men. PFMT was long used almost exclusively for treatment of stress incontinence. When it became evident that voluntary pelvic floor muscle contraction can be used to control bladder function, PFMT was also integrated into the treatment of urge incontinence and OAB as part of a broader behavioral urge suppression strategy. PFMT has evolved over decades, both as a behavioral therapy and a physical therapy, combining principles from behavioral science, nursing, and muscle physiology into a widely recommended conservative treatment. The collective literature indicates that PFMT is effective for incontinence, as well as urgency, frequency, and nocturia. It can be combined with all other treatment modalities and holds potential for prevention of bladder symptoms.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References

  1. NIH Consensus Conference. Urinary incontinence in adults. JAMA. 1989;261:2685–96.

    Article  Google Scholar 

  2. Hartmann KE, McPheeters ML, Biller DH et al. Treatment of Overactive Bladder in Women. Evidence Report/Technology Assessment Number 187 (Prepared by the Vanderbilt Evidence-based Practice Center under Contract No. 290-2007-10065-I). Agency for Healthcare Research and Quality (AHRQ); 2009.

  3. Fantl JA, Newman DK, Colling J, et al. Urinary Incontinence in Adults: Acute and Chronic Management. Clinical Practice Guideline, No. 2 1996 Update; Rockville, MD: U.S. Department of Health and Human Services. Public Health Service, Agency for Health Care Policy and Research. AHCPR Publication No.96-0682.

  4. Gormley EA, Lightner DJ, Burgio KL, Chai TC, Clemens JQ, Culkin DJ, et al. Diagnosis and treatment of overactive bladder (non-neurogenic) in adults: AUA/SUFU guideline. J Urol. 2012;188:2455–63.

    Article  PubMed  Google Scholar 

  5. Hay Smith J, Berghmans B, Burgio K, Dumoulin C, Hagen S, Moore K, et al. Adult conservative management. In: Abrams P, Cardozo L, Khoury S, Wein A, editors. Incontinence, 4th international consultation on incontinence. Paris: Health Publications Ltd; 2009. p. 1101–227.

    Google Scholar 

  6. Kaya S, Akbayrak T, Beksac S. Comparison of different treatment protocols in the treatment of idiopathic detrusor overactivity: a randomized controlled trial. Clin Rehabil. 2011;25:327.

    Article  PubMed  Google Scholar 

  7. Arruda RM, Castro RA, Sousa GC, et al. Prospective randomized comparison of oxybutynin, functional electrostimulation, and pelvic floor training for treatment of detrusor overactivity in women. Int Urogynecol J Pelvic Floor Dysfunct. 2008;19:1055.

    Article  PubMed  Google Scholar 

  8. Colombo M, Zanetta G, Scalambrino S, et al. Oxybutynin and bladder training in the management of female urge urinary incontinence: a randomized study. Int Urogynecol J. 1995;6:63.

    Article  Google Scholar 

  9. Burgio KL, Goode PS, Johnson 2nd TM, Hammontree L, Ouslander JG, Markland AM, et al. Behavioral versus drug treatment for overactive bladder in men: the male overactive bladder treatment in veterans (MOTIVE) trial. J Am Geriatr Soc. 2011;59:2209–16.

    Article  PubMed  Google Scholar 

  10. Subak LL, Wing R, West DS, et al. Weight loss to treat urinary incontinence in overweight and obese women. NEJM. 2009;360:481.

    Article  PubMed  CAS  Google Scholar 

  11. Burgio KL, Locher JL, Goode PS, Hardin JM, McDowell BJ, Dombrowski M, et al. Behavioral versus drug treatment for urge incontinence in older women: a randomized clinical trial. JAMA. 1998;23:1995–2000.

    Article  Google Scholar 

  12. Goode PS, Burgio KL, Locher JL, et al. Urodynamic changes associated with behavioral and drug treatment of urge incontinence in older women. J Am Geriatr Soc. 2002;50:808.

    Article  PubMed  Google Scholar 

  13. Song C, Park JT, Heo KO, et al. Effects of bladder training and/or tolterodine in female patients with overactive bladder syndrome: a prospective, randomized study. J Korean Med Sci. 2006;21:1060.

    Article  PubMed  CAS  Google Scholar 

  14. Kafri R, Langer R, Dvir Z, et al. Rehabilitation vs drug therapy for urge urinary incontinence: short-term outcome. Int Urogynecol J Pelvic Floor Dysfunct. 2007;18:407.

    Article  PubMed  Google Scholar 

  15. Johnson TM, Burgio KL, Goode PS, et al. Effects of behavioral and drug therapy on nocturia in older incontinent women. J Am Geriatr Soc. 2005;53:846.

    Article  PubMed  Google Scholar 

  16. Johnson TM, Markland AD, Goode PS, Vaughan CP, Colli J, Ouslander JG, et al. Efficacy of adding behavioral treatment or antimuscarinic drug therapy to alpha-blocker therapy in men with nocturia. BJU Int. 2013;112(1):100–8.

    Article  PubMed  CAS  Google Scholar 

  17. Kegel AH. Progressive resistance exercise in the functional restoration of the perineal muscles. Am J Obstet Gynecol. 1948;56:238–48.

    PubMed  CAS  Google Scholar 

  18. Kegel AH. Stress incontinence of urine in women: physiologic treatment. J Int Coll Surg. 1956;25:487–99.

    PubMed  CAS  Google Scholar 

  19. Goode PS, Burgio KL, Locher JL, Roth DL, Umlauf MG, Richter HE, et al. Effect of behavioral training with or without pelvic floor electrical stimulation on stress incontinence in women: a randomized controlled trial. JAMA. 2003;290:345–52.

    Article  PubMed  Google Scholar 

  20. Bourcier AP, Juras JC, Jacquetin B. Urinary incontinence in physically active and sportswomen. In: Appell RA, Bourcier AP, La Torre F, editors. Pelvic floor dysfunction: investigations and conservative treatment. Rome: C.E.S.I.; 1999. p. 9–17.

    Google Scholar 

  21. Miller JM, Ashton-Miller JA, DeLancey JOL. A pelvic muscle precontraction can reduce cough-related urine loss in selected women with mild SUI. J Am Geriatr Soc. 1998;46:870.

    PubMed  CAS  Google Scholar 

  22. Hay-Smith EJC, Dumoulin C. Pelvic floor muscle training versus no treatment, or inactive control treatments, for urinary incontinence in women. Cochrane Database Syst Rev. 2010;1, CD005654.

    PubMed  Google Scholar 

  23. Shamliyan TA, Kane RL, Wyman J, Wilt TJ. Systematic review: randomized, controlled trials of nonsurgical treatments for urinary incontinence in women. Ann Intern Med. 2008;148(6):459–73.

    Article  PubMed  Google Scholar 

  24. Wells TJ, Brink CA, Diokno AD, Wolfe R, Gillis GL. Pelvic muscle exercise for stress urinary incontinence in elderly women. J Am Geriatr Soc. 1991;39:785–91.

    PubMed  CAS  Google Scholar 

  25. Berghmans LCM, Frederiks CMA, de Bie RA. Efficacy of biofeedback when included with pelvic floor muscle exercise treatment for genuine stress incontinence. Neurourol Urodyn. 1996;15:37–52.

    Article  PubMed  CAS  Google Scholar 

  26. Nygaard IE, Kreder KJ, Lepic MM, Fountain KA, Rhomberg AT. Efficacy of pelvic floor muscle exercises in women with stress, urge, and mixed urinary incontinence. Am J Obstet Gynecol. 1996;174:120–5.

    Article  PubMed  CAS  Google Scholar 

  27. Bo K, Talseth T. Single blind randomized controlled trial of pelvic floor exercises, electrical stimulation, vaginal cones, and no treatment in management of genuine stress incontinence in women. BMJ. 1999;318:487–93.

    Article  PubMed  CAS  Google Scholar 

  28. Wilson PD, Herbison GP. A randomized controlled trial of pelvic floor muscle exercises to treat postnatal urinary incontinence. Int Urogynecol J. 1998;9:257–64.

    Article  CAS  Google Scholar 

  29. Wilson PD, Herbison GP, Glazener CMA, Lang G, Gee H, MacArthur C. Postnatal incontinence: a multicenter, randomized controlled trial of conservative treatment. Neurourol Urodyn. 1997;16:349–50.

    Google Scholar 

  30. Glazener CM, Herbison GP, Wilson PD, MacArthey C, Lang GD, Gee H, et al. Conservative management of persistent postnatal urinary and faecal incontinence: a randomized controlled trial. BMJ. 2001;323:1–5.

    Article  Google Scholar 

  31. Burns PA, Pranikoff K, Nochajski TH, Hadley EC, Levy KJ, Ory MG. A comparison of effectiveness of biofeedback and pelvic muscle exercise treatment of stress incontinence in older community-dwelling women. J Gerontol. 1993;48:167–74.

    Article  Google Scholar 

  32. Morkved S, Bo K. Effect of postpartum pelvic floor muscle training in prevention and treatment of urinary incontinence: a one-year follow-up. Br J Obstet Gynaecol. 2000;107:1022–8.

    Article  CAS  Google Scholar 

  33. Glazener C, Boachie C, Buckley B, Cochran C, Dorey G, Grant A, et al. Conservative treatment for urinary incontinence in Men After Prostate Surgery (MAPS): two parallel randomised controlled trials. Health Technol Assess. 2011;15(24):1–296.

    PubMed  CAS  Google Scholar 

  34. Manassero F, Traversi C, Ales V, et al. Contribution of early intensive prolonged pelvic floor exercises on urinary continence recovery after bladder necksparing radical prostatectomy: results of a prospective controlled randomized trial. Neurourol Urodyn. 2007;26(7):985–9.

    Article  PubMed  Google Scholar 

  35. Van Kampen M, De Weerdt W, Van Poppel H, De Ridder D, Feys H, Baert L. Effect of pelvic-floor reeducation on duration and degree of incontinence after radical prostatectomy: a randomised controlled trial. Lancet. 2000;355(9198):98–102.

    Article  PubMed  Google Scholar 

  36. Ribeiro LH, Prota C, Gomes CM, de Bessa Jr J, Boldarine MP, Dall’Oglio MF, et al. Long-term effect of early postoperative pelvic floor biofeedback on continence in men undergoing radical prostatectomy: a prospective, randomized, controlled trial. J Urol. 2010;184(3):1034–9.

    Article  PubMed  Google Scholar 

  37. Burgio KL, Stutzman RE, Engel BT. Behavioral training for post-prostatectomy urinary incontinence. J Urol. 1989;141:303–6.

    PubMed  CAS  Google Scholar 

  38. Goode PS, Burgio KL, Johnson 2nd TJ, Clay OJ, Roth DL, Markland AD, et al. Behavioral therapy with or without biofeedback and pelvic floor electrical stimulation for persistent post-prostatectomy incontinence—a randomized controlled trial. JAMA. 2011;305:151–9.

    Article  PubMed  CAS  Google Scholar 

  39. Burgio KL, Whitehead WE, Engel BT. Urinary incontinence in the elderly: bladder-sphincter biofeedback and toileting skills training. Ann Intern Med. 1985;104:507–15.

    Article  Google Scholar 

  40. Burgio KL, Pearce KL, Lucco AJ. Staying dry: a practical guide to bladder control. Baltimore: Johns Hopkins University Press; 1989.

    Google Scholar 

  41. Burgio KL, Goode PS, Locher JL, Umlauf MG, Roth DL, Richter HE, et al. Behavioral training with and without biofeedback in the treatment of urge incontinence in older women: a randomized controlled trial. JAMA. 2002;288:2293–9.

    Article  PubMed  Google Scholar 

  42. Fantl JA, Wyman JF, McClish DK, et al. Efficacy of bladder training in older women with urinary incontinence. JAMA. 1991;265:609–13.

    Article  PubMed  CAS  Google Scholar 

  43. Floratos DL, Sonke GS, Rapidou CA, Alivizatos GJ, Deliveliotis C, Constantinides CA, et al. Biofeedback vs verbal feedback as learning tools for pelvic muscle exercises in the early management of urinary incontinence after radical prostatectomy. BJU Int. 2002;89(7):714–9.

    Article  PubMed  CAS  Google Scholar 

  44. Moore KN, Valiquette L, Chetner MP, Byrniak S, Herbison GP. Return to continence after radical retropubic prostatectomy: a randomized trial of verbal and written instructions versus therapist-directed pelvic floor muscle therapy. Urology. 2008;72(6):1280–6.

    Article  PubMed  Google Scholar 

  45. Opsomer RJ, Castille Y, Abi-Add AS, Van Cangh PJ. Urinary incontinence after radical prostatectomy: is professional pelvic floor training necessary? Neurourol Urodyn. 1994;13(4):382–4.

    Google Scholar 

  46. Herderschee R, Hay-Smith EJ, Herbison GP, Roovers JP, Heineman MJ. Feedback or biofeedback to augment pelvic floor muscle training for urinary incontinence in women. Cochrane Database Syst Rev. 2011;7, CD009252.

    PubMed  Google Scholar 

  47. Knight S, Laycock J, Naylor D. Evaluation of neuromuscular electrical stimulation in the treatment of genuine stress incontinence. Physiotherapy. 1998;84:61–71.

    Article  Google Scholar 

  48. Sand PK, Richardson DR, Staskin SE, Swift SE, Appell RA, Whitmore KE, et al. Pelvic floor stimulation in the treatment of genuine stress incontinence: a multicenter placebo-controlled trial. Am J Obstet Gynecol. 1995;173:72–9.

    Article  PubMed  CAS  Google Scholar 

  49. Yamanishi T, Yasuda K, Sakakibara R, Hattori T, Ito H, Marakami S. Pelvic floor electrical stimulation in the treatment of stress incontinence: an investigational study and a placebo controlled double-blind trial. J Urol. 1997;158:2127–31.

    Article  PubMed  CAS  Google Scholar 

  50. Burgio KL, Kraus SR, Menefee S, Borello-France D, Corton M, Johnson HW, et al. Behavior therapy to enable drug discontinuation in the treatment of urge incontinence: a randomized controlled trial. Ann Intern Med. 2008;149:161–9.

    Article  PubMed  Google Scholar 

  51. Mattiasson A, Blaakaer J, Hoye K, Wein AJ, Tolterodine Scandinavian Study Group. Simplified bladder training augments the effectiveness of tolterodine in patients with an overactive bladder. BJU Int. 2003;91:54–60.

    Article  PubMed  CAS  Google Scholar 

  52. Mattiasson A, Masala A, Morton R, et al. Efficacy of simplified bladder training in patients with overactive bladder receiving a solifenacin flexible-dose regimen: results from a randomized study. BJU Int. 2010;105(8):1126–35.

    Article  PubMed  CAS  Google Scholar 

  53. Burgio KL, Locher JL, Goode PS. Combined behavioral and drug therapy of urge incontinence in older women. J Am Geriatr Soc. 2000;48:370–4.

    PubMed  CAS  Google Scholar 

  54. Ghoniem GM, van Leeuwen JS, Elser DM, Freeman RM, Zhao YD, Yalcin I, et al. A randomized controlled trial of duloxetine alone, pelvic floor muscle training alone, combined treatment, and no active treatment in women with stress urinary incontinence. J Urol. 2005;173:1647–53.

    Article  PubMed  CAS  Google Scholar 

  55. Jarvis SK et al. Peri-operative physiotherapy improves outcomes for women undergoing incontinence and or prolapse surgery: results of a randomised controlled trial. Aust N Z J Obstet Gynaecol. 2005;45(4):300–3.

    Article  PubMed  Google Scholar 

  56. Frawley HC, Phillips BA, Bo K, Galea MP. Physiotherapy as an adjunct to prolapse surgery: an assessor-blinded randomized controlled trial. Neurourol Urodynam. 2010;29(5):719–25.

    Google Scholar 

  57. Barber MD, Brubaker L, Menefee S, Norton P, Borello-France D, et al. Operations and pelvic muscle training in the management of apical support loss (OPTIMAL) trial: design and methods. Contemp Clin Trials. 2009;30:178–89.

    Article  PubMed  Google Scholar 

  58. Diokno AC, Sampselle CM, Herzog AG, et al. Prevention of urinary incontinence by behavioral modification program: a randomized controlled trial among older women in the community. J Urol. 2004;171:1161–4.

    Article  Google Scholar 

  59. Morkved S, Bo K. The effect of postpartum pelvic floor muscle exercise in the prevention and treatment of urinary incontinence. Int Urogynecol J. 1997;8:217–22.

    Article  CAS  Google Scholar 

  60. Mørkved S, Bø K, Schei B, Salvesen KA. Pelvic floor muscle training during pregnancy to prevent urinary incontinence: a single-blind randomized controlled trial. Obstet Gynecol. 2003;101(2):313–9.

    Article  PubMed  Google Scholar 

  61. Ko PC, Liang CC, Chang SD, Lee JT, Chao AS, Cheng PJ. A randomized controlled trial of antenatal pelvic floor exercises to prevent and treat urinary incontinence. Int Urogynecol J Pelvic Floor Dysfunct. 2011;22(1):17–22.

    Article  CAS  Google Scholar 

  62. Mason L, Roe B, Wong H, Davies J, Bamber J. The role of antenatal pelvic floor muscle exercises in prevention of postpartum stress incontinence: a randomised controlled trial. J Clin Nurs. 2010;19:2777–86.

    Article  PubMed  Google Scholar 

  63. Hay-Smith J, Morkved S, Fairbrother KA, Herbison GP. Pelvic floor muscle training for prevention and treatment of urinary and faecal incontinence in antenatal and postnatal women. Cochrane Database Syst Rev. 2008;4, CD007471.

    PubMed  Google Scholar 

  64. Burgio KL, Goode PS, Urban DA, Umlauf MG, Locher JL, Bueschen A, et al. Preoperative biofeedback-assisted behavioral training to reduce post-prostatectomy incontinence: a randomized controlled trial. J Urol. 2006;175:196–201.

    Article  PubMed  Google Scholar 

  65. Mathewson-Chapman M. Pelvic muscle exercise/biofeedback for urinary incontinence after prostatectomy: an education program. J Cancer Educ. 1997;12:218–23.

    PubMed  CAS  Google Scholar 

  66. Sueppel C, Kreder K, See W. Improved continence outcomes with preoperative pelvic floor muscle strengthening exercises. Urol Nurs. 2001;21:201–10.

    PubMed  CAS  Google Scholar 

  67. Parekh AR, Feng MI, Kirages D, Bremner H, Kaswick J, Aboseif S. The role of pelvic floor exercises on post-prostatectomy incontinence. J Urol. 2003;170:130–3.

    Article  PubMed  CAS  Google Scholar 

  68. Centemero A, Rigatti L, Giraudo D, Lazzeri M, Lughezzani G, Zugna D, et al. Preoperative pelvic floor muscle exercise for early continence after radical prostatectomy: a randomised controlled study. Eur Urol. 2010;57(6):1039–43.

    Article  PubMed  Google Scholar 

  69. Overgård M, Angelsen A, Lydersen S, Morkved S. Does physiotherapist-guided pelvic floor muscle training reduce urinary incontinence after radical prostatectomy? A randomised controlled trial. Eur Urol. 2008;54(2):438–48.

    Article  PubMed  Google Scholar 

  70. Wille S, Sobottka A, Heidenreich A, Hofmann R. Pelvic floor exercises, electrical stimulation and biofeedback after radical prostatectomy: results of a prospective randomized trial. J Urol. 2003;170(2 Pt 1):490–3.

    Article  PubMed  CAS  Google Scholar 

  71. Filocamo MT, Li Marzi V, Del Popolo G, et al. Effectiveness of early pelvic floor rehabilitation treatment for post-prostatectomy incontinence. Eur Urol. 2005;48(5):734–8.

    Article  PubMed  Google Scholar 

  72. Subak LL, Quesenberry CP, Posner SF, Cattolica E, Soghikian K. The effect of behavioral therapy on urinary incontinence: a randomized controlled trial. Obstet Gynecol. 2002;100:72–8.

    Article  PubMed  Google Scholar 

  73. Sampselle CM, Wyman JF, Thomas KK, Newman DK, Gray M, Dougherty M, et al. Continence for women: a test of AWHONN’s evidence-based protocol in clinical practice. JOGNN. 2000;29:18–26.

    Article  PubMed  CAS  Google Scholar 

  74. Bo K, Haakstad LA. Is pelvic floor muscle training effective when taught in a general fitness class in pregnancy? A randomized controlled trial. Physiotherapy. 2011;97:190–5.

    Article  PubMed  Google Scholar 

  75. Pereira VS, Correia GN, Driusso P. Individual and group pelvic floor muscle training versus no treatment in female stress urinary incontinence: a randomized controlled pilot study. Eur J Obstet Gynecol Reprod Biol. 2011;159:465–71.

    Article  PubMed  Google Scholar 

Download references

Compliance with Ethics Guidelines

Conflict of Interest

Dr. Kathryn L. Burgio reported receiving consultancy, grants/grants pending, and travel/accommodations expenses covered or reimbursed by Pfizer.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Kathryn L. Burgio.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Burgio, K.L. Update on Behavioral and Physical Therapies for Incontinence and Overactive Bladder: The Role of Pelvic Floor Muscle Training. Curr Urol Rep 14, 457–464 (2013). https://doi.org/10.1007/s11934-013-0358-1

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11934-013-0358-1

Keywords

Navigation