Skip to main content

Advertisement

SpringerLink
Log in

Unsupervised behavioral and pelvic floor muscle training programs for storage lower urinary tract symptoms in women: a systematic review

  • Review Article
  • Published:
International Urogynecology Journal Aims and scope Submit manuscript

Abstract

Introduction and hypothesis

This study synthesized the effects of unsupervised behavioral and pelvic floor muscle training (B-PFMT) programs on outcomes relevant to women’s storage lower urinary tract symptoms (LUTS) and pelvic floor muscle strength (PFMS).

Methods

PubMed, CINAHL, Web of Science, and PsycINFO were searched since their inception to August 6, 2019. Randomized controlled trials (RCTs) and quasi-experimental articles that enrolled community women aged 18 years and older and reported storage LUTS outcomes including symptoms, severity, impact, self-reported symptom improvement, and PFMS were screened and extracted. Risk of bias was evaluated, and a narrative synthesis approach was used to synthesize evidence.

Results

Ten RCTs and three pretest-posttest articles were retrieved. Half of the RCTs had some concerns of bias; the remaining RCTs had high risk of bias. Three pretest-posttest articles had at least some risk of bias. Ten articles aimed to treat urinary incontinence (UI) primarily in middle-aged women, two aimed to prevent UI, and one aimed to improve PFMS in young continent women. Two months post-intervention, UI treatment effectiveness was observed, and cumulative effectiveness was evident in: (1) reduction in the number of incontinent episodes, (2) reduction in the International Consultation on Incontinence Questionnaire-Urinary Incontinence-Short Form and International Consultation on Incontinence Questionnaire-Lower Urinary Tract Symptoms Quality of Life scores, (3) increased patients’ global impression of improvement, and (4) improvement of PFMS.

Conclusions

Unsupervised B-PFMT programs improve outcomes relevant to UI and PFMS in midlife community women who have UI. Their effects on UI prevention and other storage LUTS remain unclear.

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

Access this article

Log in via an institution

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

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

Abbreviations

LUTS:

Lower urinary tract symptoms

UI:

Urinary incontinence

SUI:

Stress urinary incontinence

UUI:

Urgency urinary incontinence

MUI:

Mixed urinary incontinence

PFMT:

Pelvic floor muscle training

PFME:

Pelvic floor muscle exercise

RCT:

Randomized controlled trial

PFMS:

Pelvic floor muscle strength

MESA:

The standardized Medical Epidemiologic and Social Aspects of Aging questionnaire

IUSS:

Indevus Urgency Severity Scale

ICIQ-UI SF:

The International Consultation on Incontinence Questionnaire-Urinary Incontinence-Short Form

PGI-I:

The Patient Global Impression of Improvement

I-QOL:

Incontinence of Quality of Life

UDI-6:

Urogenital Distress Inventory-6

IIQ-7:

Incontinence Impact Questionnaire short form

ICIQ-LUTSqol:

International Consultation on Incontinence Questionnaire-Lower Urinary Tract Symptoms Quality of Life

EQ5D-VAS:

EuroQol 5D-Visual Analogue Scale

References

  1. Abrams P, Cardozo LD, Wagg A, Wein AJ (2017) International consultation on incontinence. 6th ed. Plymouth, UK: Health Publications Ltd.

  2. World Health Organization and Department of Reproductive Health and Research-ExpandNet (2010) Nine steps for developing a scaling-up strategy. https://www.who.int/reproductivehealth/publications/strategic_approach/9789241500319/en/.

  3. Newman DK, Wein AJ. Office-based behavioral therapy for management of incontinence and other pelvic disorders. Urol Clin. 2013;40(4):613–35. https://doi.org/10.1016/j.ucl.2013.07.010.

    Article  Google Scholar 

  4. Newman DK, Wein AJ (2008) Managing and treating urinary incontinence. 2nd ed. Health Professions Press.

  5. Lamin E, Parrillo LM, Newman DK, Smith AL. Pelvic floor muscle training: underutilization in the USA. Curr Urol Rep. 2016;17(2):10. https://doi.org/10.1007/s11934-015-0572-0.

  6. Newman DK, Borello-France D, Sung VW. Structured behavioral treatment research protocol for women with mixed urinary incontinence and overactive bladder symptoms. Neurourol Urodyn. 2018;37(1):14–26. https://doi.org/10.1002/nau.23244.

    Article  PubMed  Google Scholar 

  7. Newman DK, Burgio K (2016) Conservative management of urinary incontinence: behavioral and pelvic floor therapy and urethral and pelvic devices. Campbell-Walsh urology. 11th ed. Philadelphia, PA: Elsevier.

  8. 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(2):465–71. https://doi.org/10.1016/j.ejogrb.2011.09.003.

    Article  PubMed  Google Scholar 

  9. Palmer MH, Cockerell R, Griebling TL, Rantell A, van Houten P, Newman DK. Review of the 6th international consultation on incontinence: primary prevention of urinary incontinence. Neurourol Urodyn. 2020;39(1):66–72. https://doi.org/10.1002/nau.24222.

    Article  PubMed  Google Scholar 

  10. 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.

    Article  PubMed  PubMed Central  Google Scholar 

  11. Monteiro S, Riccetto C, Araújo A, Galo L, Brito N, Botelho S. Efficacy of pelvic floor muscle training in women with overactive bladder syndrome: a systematic review. Int Urogynecol J. 2018;29(11):1565–73. https://doi.org/10.1007/s00192-018-3602-x.

    Article  PubMed  Google Scholar 

  12. Bo K, Frawley HC, Haylen BT, Abramov Y, Almeida FG, Berghmans B et al. An International Urogynecological Association (IUGA)/International Continence Society (ICS) joint report on the terminology for the conservative and nonpharmacological management of female pelvic floor dysfunction. Int Urogynecol J. 2017;28(2):191–213. https://doi.org/10.1007/s00192-016-3123-4.

    Article  PubMed  Google Scholar 

  13. Jones A, Skinner MA. The current status of physical therapy in China. Chinese J Rehabil Med. 2013;28(6):493–501.

    Google Scholar 

  14. Ostaszkiewicz J, Peden-McAlpine C, Northwood M, Eustice S, Bliss DZ, Nishimura K (2018) Advanced Practice Continence Nursing. In Management of Fecal Incontinence for the Advanced Practice Nurse (pp. 15–47). Springer, Cham.

  15. Valenzuela T, Okubo Y, Woodbury A, Lord SR, Delbaere K. Adherence to technology-based exercise programs in older adults: a systematic review. J Geriatr Phys Ther. 2018;41(1):49–61. https://doi.org/10.1519/JPT.0000000000000095.

    Article  PubMed  Google Scholar 

  16. Field M (2019) Power and injustice: exploring the factors that limit Women's access to maternal health Care in rural Pennsylvania. Dissertation, Pennsylvania State University.

  17. Newman DK, Wein AJ. Office-based behavioral therapy for management of incontinence and other pelvic disorders. Urol Clin North Am. 2013;40(4):613–35. https://doi.org/10.1016/j.ucl.2013.07.010.

    Article  PubMed  Google Scholar 

  18. Asklund I, Samuelsson E, Hamberg K, Umefjord G, Sjöström M. User experience of an app-based treatment for stress urinary incontinence: qualitative interview study. J Med Internet Res. 2019;21(3):e11296. https://doi.org/10.2196/11296.

    Article  PubMed  PubMed Central  Google Scholar 

  19. Moher D, Liberati A, Tetzlaff J, Altman DG. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Ann Intern Med. 2009;151(4):264–9. https://doi.org/10.7326/0003-4819-151-4-200908180-00135.

    Article  Google Scholar 

  20. Sterne JA, Savović J, Page MJ, Elbers RG, Blencowe NS, Boutron I et al. RoB 2: a revised tool for assessing risk of bias in randomised trials. BMJ. 2019;366:l4898. https://doi.org/10.1136/bmj.l4898.

    Article  PubMed  Google Scholar 

  21. Fletcher J. What is heterogeneity and is it important? BMJ. 2007;334(7584):94–6. https://doi.org/10.1136/bmj.39057.406644.68.

    Article  PubMed  PubMed Central  Google Scholar 

  22. Popay J, Roberts H, Sowden A, Petticrew M, Arai L, Rodgers M, Britten N, Roen K, Duffy S (2006) Guidance on the conduct of narrative synthesis in systematic reviews. A product from the ESRC methods programme Version 1:b92.

  23. Diokno AC, Sampselle CM, Herzog AR, Raghunathan TE, Hines S, Messer KL et al. Prevention of urinary incontinence by behavioral modification program: a randomized, controlled trial among older women in the community. J Urol. 2004;171(3):1165–71. https://doi.org/10.1097/01.ju.0000111503.73803.c2.

    Article  PubMed  Google Scholar 

  24. Diokno AC, Newman DK, Low LK, Griebling TL, Maddens ME, Goode PS et al. Effect of group-administered behavioral treatment on urinary incontinence in older women: a randomized clinical trial. JAMA Intern Med. 2018;178(10):1333–41. https://doi.org/10.1001/jamainternmed.2018.3766.

    Article  PubMed  PubMed Central  Google Scholar 

  25. Diokno AC, Ocampo MS, Ibrahim IA, Karl CR, Lajiness MJ, Hall SA. Group session teaching of behavioral modification program (BMP) for urinary incontinence: a randomized controlled trial among incontinent women. Int Urol Nephrol. 2010;42(2):375–81. https://doi.org/10.1007/s11255-009-9626-x.

    Article  PubMed  Google Scholar 

  26. Sar D, Khorshid L. The effects of pelvic floor muscle training on stress and mixed urinary incontinence and quality of life. J Wound Ostomy Continence Nurs. 2009;36(4):429–35. https://doi.org/10.1097/WON.0b013e3181aaf539.

    Article  PubMed  Google Scholar 

  27. Sjöström M, Umefjord G, Stenlund H, Carlbring P, Andersson G, Samuelsson E. Internet-based treatment of stress urinary incontinence: a randomised controlled study with focus on pelvic floor muscle training. BJU Int. 2013;112(3):362–72. https://doi.org/10.1111/j.1464-410X.2012.11713.x.

    Article  PubMed  PubMed Central  Google Scholar 

  28. Sjöström M, Umefjord G, Stenlund H, Carlbring P, Andersson G, Samuelsson E. Internet-based treatment of stress urinary incontinence: 1- and 2-year results of a randomized controlled trial with a focus on pelvic floor muscle training. BJU Int. 2015;116(6):955–64. https://doi.org/10.1111/bju.13091.

    Article  PubMed  PubMed Central  Google Scholar 

  29. Asklund I, Nyström E, Sjöström M, Umefjord G, Stenlund H, Samuelsson E. Mobile app for treatment of stress urinary incontinence: a randomized controlled trial. Neurourol Urodyn. 2017;36(5):1369–76. https://doi.org/10.1002/nau.23116.

    Article  PubMed  Google Scholar 

  30. Hoffman V, Söderström L, Samuelsson E. Self-management of stress urinary incontinence via a mobile app: two-year follow-up of a randomized controlled trial. Acta Obstet Gynecol Scand. 2017;96(10):1180–7. https://doi.org/10.1111/aogs.13192.

    Article  PubMed  PubMed Central  Google Scholar 

  31. Sampselle CM, Newman DK, Miller JM, Kirk K, DiCamillo MA, Wagner TH, et al. A randomized controlled trial to compare 2 scalable interventions for lower urinary tract symptom prevention: Main outcomes of the TULIP study. J Urol. 2017;197(6):1480–6. https://doi.org/10.1016/j.juro.2016.12.099.

    Article  PubMed  Google Scholar 

  32. Pereira-Baldon VS, Avila MA, Dalarmi CB, de Oliveira AB, Driusso P. Effects of different regimens for pelvic floor muscle training in young continent women: randomized controlled clinical trial. J Electromyogr Kinesiol. 2019;44:31–5. https://doi.org/10.1016/j.jelekin.2018.11.008.

    Article  PubMed  Google Scholar 

  33. Hung HC, Chih SY, Lin HH, Tsauo JY. Exercise adherence to pelvic floor muscle strengthening is not a significant predictor of symptom reduction for women with urinary incontinence. Arch Phys Med Rehabil. 2012;93(10):1795–800. https://doi.org/10.1016/j.apmr.2012.03.010.

    Article  PubMed  Google Scholar 

  34. Fan HL, Chan SS, Law TS, Cheung RY, Chung TK. Pelvic floor muscle training improves quality of life of women with urinary incontinence: a prospective study. Aust N Z J Obstet Gynaecol. 2013;53(3):298–304. https://doi.org/10.1111/ajo.12075.

    Article  PubMed  Google Scholar 

  35. Cavkaytar S, Kokanali MK, Topcu HO, Aksakal OS, Doğanay M. Effect of home-based Kegel exercises on quality of life in women with stress and mixed urinary incontinence. J Obstet Gynaecol. 2015;35(4):407–10. https://doi.org/10.3109/01443615.2014.960831.

    Article  CAS  PubMed  Google Scholar 

  36. Slade SC, Dionne CE, Underwood M, Buchbinder R. Consensus on exercise reporting template (CERT): explanation and elaboration statement. Br J Sports Med. 2016;50(23):1428–37. https://doi.org/10.1136/bjsports-2016-096651.

    Article  PubMed  Google Scholar 

  37. Hoffmann TC, Glasziou PP, Boutron I, Milne R, Perera R, Moher D, et al. Better reporting of interventions: template for intervention description and replication (TIDieR) checklist and guide. BMJ. 2014;348:g1687. https://doi.org/10.1136/bmj.g1687.

    Article  PubMed  Google Scholar 

  38. Sussman RD, Syan R, Brucker BM. Guidelines of the guidelines: urinary incontinence in women. BJU Int. 2020;125(5):638–55. https://doi.org/10.1111/bju.14927.

    Article  PubMed  Google Scholar 

  39. DeVellis RF (2016) Scale development: theory and applications. 4th ed. Sage publications.

  40. Vidgen B, Yasseri T. P-values: misunderstood and misused. Front Phys. 2016;4(6). https://doi.org/10.3389/fphy.2016.00006.

Download references

Acknowledgements

We are grateful to Jamie Conklin, MLIS, for helping us retrieve articles from databases and to George Knafl, PhD, for providing methodological consultation for this study.

Author information

Authors and Affiliations

  1. School of Nursing, University of North Carolina at Chapel Hill, CB 7460, Chapel Hill, NC, USA

    Chen Wu & Mary H. Palmer

  2. Division of Urology, Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA

    Diane K. Newman

Authors
  1. Chen Wu
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Diane K. Newman
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Mary H. Palmer
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

C Wu, MH Palmer, and DK Newman: Protocol development.

C Wu, MH Palmer: Data management, data analysis, manuscript writing, manuscript editing.

DK Newman: Manuscript editing.

Corresponding author

Correspondence to Mary H. Palmer.

Ethics declarations

Conflict of interests

None.

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Electronic supplementary material

ESM 1

(DOCX 19 kb)

ESM 2

(DOCX 30 kb)

ESM 3

(DOCX 18 kb)

ESM 4

(DOCX 17 kb)

ESM 5

(DOCX 16 kb)

ESM 6

(DOCX 14 kb)

ESM 7

(DOCX 28 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Wu, C., Newman, D.K. & Palmer, M.H. Unsupervised behavioral and pelvic floor muscle training programs for storage lower urinary tract symptoms in women: a systematic review. Int Urogynecol J 31, 2485–2497 (2020). https://doi.org/10.1007/s00192-020-04498-9

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00192-020-04498-9

Keywords

Search

Navigation