The effect of pelvic floor muscle training and intravaginal electrical stimulation on urinary incontinence in women with incomplete spinal cord injury: an investigator-blinded parallel randomized clinical trial

  • Marlene Elmelund
  • Fin Biering-Sørensen
  • Ulla Due
  • Niels Klarskov
Original Article
First Online:
Received:
Accepted:
  • 70 Downloads

Abstract

Introduction and hypothesis

Urinary incontinence is a prevalent problem in women with spinal cord injury. The aim of this study was to examine the effect of pelvic floor muscle training (PFMT) alone and combined with intravaginal electrical stimulation (IVES) on urinary incontinence in women with incomplete spinal cord injury.

Methods

In this investigator-blinded randomized clinical trial, we recruited women aged 18–75 with incomplete spinal cord injury and urinary incontinence from a single spinal cord injury clinic in Denmark. Women were randomly assigned to either PFMT or PFMT combined with IVES daily at home for 12 weeks. All women were trained by a physiotherapist using vaginal palpation and electromyography biofeedback. Outcome measures were recorded at baseline (week 0), post-intervention (week 12) and follow-up (week 24) and included change in the total score on the International Consultation on Incontinence Questionnaire urinary incontinence short form (ICIQ-UI-SF) and daily episodes of urinary incontinence.

Results

From 27 April 2015−9 September 2016, we randomly assigned 36 women (17 in the PFMT group and 19 in the PFMT+IVES group); 27 completed the interventions (13 in the PFMT group and 14 in the PFMT+IVES group). The results showed no difference between the groups on ICIQ-UI-SF or episodes of urinary incontinence at 12 and 24 weeks. Only the PFMT group had a significant change from baseline on ICIQ-UI-SF [−2.4 (95% CI -4.3−−0.5), p = 0.018] and daily episodes of urinary incontinence [−0.4 (95% CI -0.8−−0.1), p = 0.026] at 12 weeks.

Conclusions

PFMT+IVES is not superior to PFMT alone in reducing urinary incontinence in women with incomplete spinal cord injury.

Keywords

Urinary incontinence Spinal cord injury Pelvic floor muscle training Electrical stimulation Neurogenic bladder 
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Notes

Acknowledgements

The authors thank Berit Sejersen Larsen from the Department of Obstetrics and Gynecology, Herlev and Gentofte Hospital, for her practical assistance during the project and Birthe Pedersen from the Clinic for Spinal Cord Injuries, Rigshospitalet, Tanja Skarum and Malene Skov Mailand from the Department of Occupational and Physical Therapy, Herlev and Gentofte Hospital, for their assistance with the physical therapy consultations.

Compliance with ethical standards

Financial disclaimer

M. Elmelund: Astellas Pharma. Paid travel expenses and honaria.

N. Klarskov: Astellas Pharma. Paid travel expenses and honaria, acceptance of payment for research.

U. Due: None.

F. Biering-Sørensen: None.

Conflicts of interest

None.

Supplementary material

192_2018_3630_MOESM1_ESM.docx (19 kb)
ESM 1 (DOCX 19 kb)
192_2018_3630_MOESM2_ESM.docx (19 kb)
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References

  1. 1.
    Ruffion A, Castro-Diaz D, Patel H, Khalaf K, Onyenwenyi A, Globe D, et al. Systematic review of the epidemiology of urinary incontinence and detrusor overactivity among patients with neurogenic overactive bladder. Neuroepidemiology. 2013;41(3–4):146–55.  https://doi.org/10.1159/000353274.CrossRefPubMedGoogle Scholar
  2. 2.
    Wyndaele JJ, Kovindha A, Madersbacher H, Radziszewski P, Ruffion A, Schurch B, et al. Neurologic urinary incontinence. Neurourol Urodyn. 2010;29(1):159–64.  https://doi.org/10.1002/nau.20852.CrossRefPubMedGoogle Scholar
  3. 3.
    Lombardi G, Del Popolo G, Macchiarella A, Mencarini M, Celso M. Sexual rehabilitation in women with spinal cord injury: a critical review of the literature. Spinal Cord. 2010;48(12):842–9.  https://doi.org/10.1038/sc.2010.36.CrossRefPubMedGoogle Scholar
  4. 4.
    Dumoulin C, Hay-Smith EJ, Mac Habee-Seguin G. Pelvic floor muscle training versus no treatment, or inactive control treatments, for urinary incontinence in women. Cochrane Database Syst Rev. 2014;5:CD005654.  https://doi.org/10.1002/14651858.CD005654.pub3.Google Scholar
  5. 5.
    Bo K, Berghmans LC. Nonpharmacologic treatments for overactive bladder-pelvic floor exercises. Urology. 2000;55(5A Suppl):7–11. discussion 14-16CrossRefPubMedGoogle Scholar
  6. 6.
    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(18):2293–9.CrossRefPubMedGoogle Scholar
  7. 7.
    Brubaker L. Electrical stimulation in overactive bladder. Urology. 2000;55(5A Suppl):17–23. discussion 31-12CrossRefPubMedGoogle Scholar
  8. 8.
    Bo K, Talseth T, Holme I. Single blind, randomised controlled trial of pelvic floor exercises, electrical stimulation, vaginal cones, and no treatment in management of genuine stress incontinence in women. BMJ. 1999;318(7182):487–93.CrossRefPubMedPubMedCentralGoogle Scholar
  9. 9.
    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(3):345–52.  https://doi.org/10.1001/jama.290.3.345.CrossRefPubMedGoogle Scholar
  10. 10.
    Schreiner L, Santos TG, Souza AB, Nygaard CC, Silva Filho IG. Electrical stimulation for urinary incontinence in women: a systematic review. Int Braz J Urol. 2013;39(4):454–64.  https://doi.org/10.1590/S1677-5538.IBJU.2013.04.02.CrossRefPubMedGoogle Scholar
  11. 11.
    Arruda RM, Castro RA, Sousa GC, Sartori MG, Baracat EC, Girao MJ. 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(8):1055–61.  https://doi.org/10.1007/s00192-008-0586-y.CrossRefPubMedGoogle Scholar
  12. 12.
    Ozdedeli S, Karapolat H, Akkoc Y. Comparison of intravaginal electrical stimulation and trospium hydrochloride in women with overactive bladder syndrome: a randomized controlled study. Clin Rehabil. 2010;24(4):342–51.  https://doi.org/10.1177/0269215509346092.CrossRefPubMedGoogle Scholar
  13. 13.
    Gross T, Schneider MP, Bachmann LM, Blok BF, Groen J, Hoen LA, et al. Transcutaneous electrical nerve stimulation for treating neurogenic lower urinary tract dysfunction: a systematic review. Eur Urol. 2016;69(6):1102–11.  https://doi.org/10.1016/j.eururo.2016.01.010.CrossRefPubMedGoogle Scholar
  14. 14.
    Guo ZF, Liu Y, Hu GH, Liu H, Xu YF. Transcutaneous electrical nerve stimulation in the treatment of patients with poststroke urinary incontinence. Clin Interv Aging. 2014;9:851–6.  https://doi.org/10.2147/CIA.S61084.CrossRefPubMedPubMedCentralGoogle Scholar
  15. 15.
    McClurg D, Ashe RG, Lowe-Strong AS. Neuromuscular electrical stimulation and the treatment of lower urinary tract dysfunction in multiple sclerosis—a double blind, placebo controlled, randomised clinical trial. Neurourol Urodyn. 2008;27(3):231–7.  https://doi.org/10.1002/nau.20486.CrossRefPubMedGoogle Scholar
  16. 16.
    Kirshblum SC, Burns SP, Biering-Sorensen F, Donovan W, Graves DE, Jha A, et al. International standards for neurological classification of spinal cord injury (revised 2011). J Spinal Cord Med. 2011;34(6):535–46.  https://doi.org/10.1179/204577211X13207446293695.CrossRefPubMedPubMedCentralGoogle Scholar
  17. 17.
    Messelink B, Benson T, Berghmans B, Bo K, Corcos J, Fowler C, et al. Standardization of terminology of pelvic floor muscle function and dysfunction: report from the pelvic floor clinical assessment group of the international continence society. Neurourol Urodyn. 2005;24(4):374–80.  https://doi.org/10.1002/nau.20144.CrossRefPubMedGoogle Scholar
  18. 18.
    Avery K, Donovan J, Peters TJ, Shaw C, Gotoh M, Abrams P. ICIQ: a brief and robust measure for evaluating the symptoms and impact of urinary incontinence. Neurourol Urodyn. 2004;23(4):322–30.  https://doi.org/10.1002/nau.20041.CrossRefPubMedGoogle Scholar
  19. 19.
    Hansen BB, Svare J, Viktrup L, Jorgensen T, Lose G. Urinary incontinence during pregnancy and 1 year after delivery in primiparous women compared with a control group of nulliparous women. Neurourol Urodyn. 2012;31(4):475–80.  https://doi.org/10.1002/nau.21221.CrossRefPubMedGoogle Scholar
  20. 20.
    Klarskov N, Lose G. Urethral pressure reflectometry; a novel technique for simultaneous recording of pressure and cross-sectional area in the female urethra. Neurourol Urodyn. 2007;26(2):254–61.  https://doi.org/10.1002/nau.20283.CrossRefPubMedGoogle Scholar
  21. 21.
    Klarskov N, Cerneus D, Sawyer W, Newgreen D, van Till O, Lose G. The effect of single oral doses of duloxetine, reboxetine, and midodrine on the urethral pressure in healthy female subjects, using urethral pressure reflectometry. Neurourol Urodyn. 2017;  https://doi.org/10.1002/nau.23282.
  22. 22.
    Sari Motlagh R, Hajebrahimi S, Sadeghi-Bazargani H, Joodi Tutunsaz J. Reliability and validation of the international consultation on incontinence questionnaire in over active bladder to Persian language. Low Urin Tract Symptoms. 2015;7(2):99–101.  https://doi.org/10.1111/luts.12059.CrossRefPubMedGoogle Scholar
  23. 23.
    Charlifue S, Post MW, Biering-Sorensen F, Catz A, Dijkers M, Geyh S, et al. International spinal cord injury quality of life basic data set. Spinal Cord. 2012;50(9):672–5.  https://doi.org/10.1038/sc.2012.27.CrossRefPubMedGoogle Scholar
  24. 24.
    Yalcin I, Bump RC. Validation of two global impression questionnaires for incontinence. Am J Obstet Gynecol. 2003;189(1):98–101.CrossRefPubMedGoogle Scholar
  25. 25.
    Sirls LT, Tennstedt S, Brubaker L, Kim HY, Nygaard I, Rahn DD, et al. The minimum important difference for the international consultation on incontinence questionnaire-urinary incontinence short form in women with stress urinary incontinence. Neurourol Urodyn. 2013;  https://doi.org/10.1002/nau.22533.
  26. 26.
    Nystrom E, Sjostrom M, Stenlund H, Samuelsson E. ICIQ symptom and quality of life instruments measure clinically relevant improvements in women with stress urinary incontinence. Neurourol Urodyn. 2015;34(8):747–51.  https://doi.org/10.1002/nau.22657.CrossRefPubMedGoogle Scholar

Copyright information

© The International Urogynecological Association 2018

Authors and Affiliations

  1. 1.Clinic for Spinal Cord Injuries, RigshospitaletUniversity of CopenhagenHornbækDenmark
  2. 2.Department of Obstetrics and Gynecology, Herlev and Gentofte HospitalUniversity of CopenhagenHerlevDenmark
  3. 3.Department of Occupational and Physical Therapy, Herlev and Gentofte HospitalUniversity of CopenhagenHerlevDenmark

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