Pelvic floor muscle training in treatment of female stress urinary incontinence, pelvic organ prolapse and sexual dysfunction
- 3.2k Downloads
The objectives of the present review was to present and discuss evidence for pelvic floor muscle (PFM) training on female stress urinary incontinence (SUI), pelvic organ prolapse (POP) and sexual dysfunction.
This manuscript is based on conclusions and data presented in systematic reviews on PFM training for SUI, POP and sexual dysfunction. Cochrane reviews, the 4th International Consultation on Incontinence, the NICE guidelines and the Health Technology Assessment were used as data sources. In addition, a new search on Pubmed was done from 2008 to 2011. Only data from randomized controlled trials (RCTs) published in English language is presented and discussed.
There is Level 1, Grade A evidence that PFM training is effective in treatment of SUI. Short-term cure rates assessed as <2 g of leakage on pad testing vary between 35 and 80%. To date there are 5 RCTs showing significant effect of PFM training on either POP stage, symptoms or PFM morphology. Supervised and more intensive training is more effective than unsupervised training. There are no adverse effects. There is a lack of RCTs addressing the effect of PFM training on sexual dysfunction.
PFM training should be first line treatment for SUI and POP, but the training needs proper instruction and close follow-up to be effective. More high quality RCTs are warranted on PFM training to treat sexual dysfunction.
KeywordsPelvic floor muscle training Pelvic organ prolapse Strength Sexual dysfunction Stress urinary incontinence
Conflict of interest
The author declares that she has no conflict of interest.
- 4.DeLancey JO, Low LK, Miller JM, Patel DA, Tumbarello JA (2008) Graphic integration of causal factors of pelvic floor disorders: an integrated life span model. Am J Obstet Gynecol 199:610.e1–610.e5Google Scholar
- 7.Kegel AH (1952) Stress incontinence and genital relaxation. Ciba Clinical Symp 2:35–51Google Scholar
- 8.Bø K (2007) Overview of physical therapy for pelvic floor dysfunction. In: Bø K, Berghmans B, Mørkved S, van Kampen M (eds) Evidence based physical therapy for the pelvic floor: bridging science and clinical practice. Elsevier, Churchill Livingstone, pp 1–8Google Scholar
- 9.Bø K, Mørkved S (2007) Motor learning. In: Bø K, Berghmans B, Mørkved S, van Kampen M (eds) Evidence based physical therapy for the pelvic floor: bridging science and clinical practice. Elsevier, Churchill Livingstone, pp 113–119Google Scholar
- 10.Bø K Pelvic floor muscle training for stress urinary incontinence. In: Bø K, Berghmans B, Mørkved S, van Kampen M (eds) Evidence based physical therapy for the pelvic floor: bridging science and clinical practice. Elsevier, Churchill Livingstone, pp 171–187Google Scholar
- 11.Hay Smith J, Berghmans B, Burgio K, et al (2009) Adult conservative management: Committee 12. In: Abrams P, Cardozo L, Khoury S, Wein A (eds) Incontinence: 4th international consultation on incontinence, 4th edn. Health Publication Ltd, pp 1025–1108Google Scholar
- 12.Dumoulin C, Hay-Smith J (2010) Pelvic floor muscle training versus no treatment for urinary incontinence in women. Cochrane Database Syst Rev 20:CD005654Google Scholar
- 13.Hay-Smith EJ, Bø K, Berghmans LC et al (2001) Pelvic floor muscle training fur urinary incontinence in women. Cochrane Database Syst Rev Issue 1:CD001407Google Scholar
- 14.Herbison GP, Dean N (2002) Weigthed vaginal cones for urinary incontinence. Cochrane Database Syst Rev Issue 1:CD002114Google Scholar
- 15.Welsh A (2006) Urinary incontinence—the management of urinary incontinence in women. National Collaborating Centre for Women’s and Children’s Health. The National Institute for Health and Clinical Excellence (NICE). RCOG Press. Royal College of Obstetricians and Gynaecologists, LondonGoogle Scholar
- 16.Imamura M, Abrams P, Bain C et al (2010) Systematic review and economic modelling of the effectiveness of non-surgical treatments for women with stress urinary incontinence. Health Technol Assess 14:1–118, iii–ivGoogle Scholar
- 17.Hay-Smith EJC, Dumoulin C (2006) Pelvic floor muscle training versus no treatment, or inactive control treatments, for urinary incontinence in women. Cochrane Database Syst Rev 25:CD005654Google Scholar
- 23.Hagen S, Stark D, Maher C, Adams E (2006) Conservative management of pelvic organ prolapse in women. Cochrane Database Syst Rev 4:CD003882Google Scholar
- 24.Brækken IH, Majida M, Ellstrom-Engh M, Bø K (2010) Can pelvic floor muscle training reverse pelvic organ prolapse and reduce prolapse symptoms? An assessor-blinded, randomized controlled trial. Am J Obstet Gynecol 203:170.e1–170.e7Google Scholar
- 27.Piya-Anant M, Therasakvichya S, Leelaphatanadit C, Techatrisak K (2003) Integrated health research program for the Thai elderly: prevalence of genital prolapse and effectiveness of pelvic floor exercise to prevent worsening of genital prolapse in elderly women. J Med Assos Thail 86:509–515Google Scholar
- 28.Stupp L, Resende APM, Bernardes BT et al (2010) Pelvic floor muscle training for treatment of pelvic organ prolapse: randomized controlled trial. Int Urogynecol J 21:236–237Google Scholar
- 29.Graziottin A (2007) Female sexual dysfunction. In: Bø K, Berghmans B, Mørkved S, van Kampen M (eds) Evidence based physical therapy for the pelvic floor: bridging science and clinical practice. Elsevier, Churchill Livingstone, pp 266–287Google Scholar
- 31.Mørkved S, Rømmen K, Schei B, Salvesen KÅ, Bø K (2007) No difference in urinary incontinence between training and control group six years after cessation of a randomized controlled trial, but improved sexual satisfaction in the training group. Neurourol Urodyn 26:667Google Scholar
- 39.Carriere B (2001) Fitness for the pelvic floor. Georg Thieme verlag 2002Google Scholar
- 42.Bø K, Aschehoug A (2007) Pelvic floor and exercise science: strength training, In: Bø K, Berghmans B, Mørkved S, van Kampen M (eds) Evidence based physical therapy for the pelvic floor: bridging science and clinical practice. Elsevier, Churchill Livingstone, pp 119–132Google Scholar