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Pelvic floor muscle training for female stress urinary incontinence: a randomised control trial comparing home and outpatient training

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Abstract

Introduction and hypothesis

In the literature, it is suggested that supervised pelvic floor muscle training (PFMT) might be the first option treatment for female stress urinary incontinence (SUI). However, inadequate accessibility to health care and scarce individual resources may prevent adherence to the treatment. Our study is aimed at comparing the efficacy of performing PFMT in an outpatient clinic and at home in Brazilian incontinent women, and to verify if home PFMT may be an alternative to those not able to attend the outpatient sessions.

Methods

A total of 69 women with predominant SUI were randomised into two groups: outpatient PFMT and home PFMT. The primary outcome was the cure of SUI defined as <2 g of leakage in a 20-min pad test. Secondary outcomes were: pelvic floor muscle function; urinary symptoms; quality of life; patient satisfaction; and adherence to home exercise sets. The assessments were conducted at baseline and after 3 months of treatment. Statistical analyses consisted of Student’s t, Mann–Whitney U, Chi-squared, and Wilcoxon tests, with a 5% cut-off for significance.

Results

A superior objective cure of SUI was observed in the outpatient clinic (62%) compared with the home (28%) PFMT groups (OR: 4.0 [95% CI: 1.4–11.0]; p = 0.011). Secondarily, there was no difference between groups regarding the following: satisfaction with the treatment; quality of life; function of the PFMs; and number of episodes of urine leakage per week. The home adherence to the exercises was superior in the outpatient PFMT group only during the first-month training.

Conclusions

Outpatient PFMT was associated with a higher objective cure of SUI than home PFMT. However, subjective findings show equal benefit of home PFMT providing evidence that this may be an alternative treatment to our population.

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Abbreviations

CERT:

Consensus on Exercise Reporting Template

CONSORT:

Consolidated Standards of Reporting Trials

I-QoL:

Incontinence Quality-of-Life Questionnaire

ITT:

Intention-to-treat

OD:

Odds ratio

PFM:

Pelvic floor muscle

PFMT:

Pelvic floor muscle training

RCT:

Randomised controlled trial

SUI:

Stress urinary incontinence

UI:

Urinary incontinence

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Authors and Affiliations

  1. Department of Gynaecology, Universidade Federal de São Paulo, Rua Napoleão de Barros, 608 – Vila Clementino, São Paulo, SP, CEP 04024-002, Brazil

    Fátima Faní Fitz, Márcia Maria Gimenez, Letícia de Azevedo Ferreira, Mayanni Magda Perreira Matias, Maria Augusta Tezelli Bortolini & Rodrigo Aquino Castro

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  1. Fátima Faní Fitz
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  2. Márcia Maria Gimenez
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  3. Letícia de Azevedo Ferreira
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  5. Maria Augusta Tezelli Bortolini
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  6. Rodrigo Aquino Castro
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Correspondence to Fátima Faní Fitz.

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The study was approved by the Review Board Committee of this institution, paper no. 0589/2017.

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Fitz, F.F., Gimenez, M.M., de Azevedo Ferreira, L. et al. Pelvic floor muscle training for female stress urinary incontinence: a randomised control trial comparing home and outpatient training. Int Urogynecol J 31, 989–998 (2020). https://doi.org/10.1007/s00192-019-04081-x

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