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Pelvic floor muscle training in treatment of female stress urinary incontinence, pelvic organ prolapse and sexual dysfunction

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Abstract

Objectives

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.

Methods

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.

Results

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.

Conclusions

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.

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References

  1. Olsen AL, Smith VJ, Bergstrom JO, Colling JC, Clark AL (1997) Epidemiology of surgically managed pelvic organ prolapse and urinary incontinence. Obstet Gynecol 89:501–506

    Article  PubMed  CAS  Google Scholar 

  2. Bump RC, Norton PA (1998) Epidemiology and natural history of pelvic floor dysfunction. Obstet Gynecol Clinics North Am 25:723–746

    Article  CAS  Google Scholar 

  3. Wall L, DeLancey JO (1991) The politics of prolapse: a revisionist approach to disorders of the pelvic floor in women. Perspect Biol Med 34:486–496

    PubMed  CAS  Google Scholar 

  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.e5

    Google Scholar 

  5. Ashton-Miller J, DeLancey JO (2007) Functional anatomy of the female pelvic floor. Ann NY Acad Sci 1101:266–296

    Article  PubMed  Google Scholar 

  6. Kegel AH (1948) Progressive resistance exercise in the functional restoration of the perineal muscles. Am J Obstet Gynecol 56:238–249

    PubMed  CAS  Google Scholar 

  7. Kegel AH (1952) Stress incontinence and genital relaxation. Ciba Clinical Symp 2:35–51

    Google 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 1–8

  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 113–119

  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 171–187

  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 1025–1108

  12. Dumoulin C, Hay-Smith J (2010) Pelvic floor muscle training versus no treatment for urinary incontinence in women. Cochrane Database Syst Rev 20:CD005654

    Google 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:CD001407

  14. Herbison GP, Dean N (2002) Weigthed vaginal cones for urinary incontinence. Cochrane Database Syst Rev Issue 1:CD002114

  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, London

  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–iv

    Google 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:CD005654

    Google Scholar 

  18. Bø K (2002) Is there still a place for physiotherapy in the treatment of female incontinence? EAU Update Ser 1:145–152

    Article  Google Scholar 

  19. Felicissimo MF, Carneiro MM, Saleme CS, Pinto RZ, da Fonseca AMRM, da Siva-Filho AL (2010) Intensive supervised versus unsupervised pelvic floor muscle training for the treatment of stress urinary incontinence: a randomized comparative study. Int Urogynecol J 21:835–840

    Article  PubMed  Google Scholar 

  20. Glavind K, Nøhr SB, Walter S (1996) Biofeedback and physiotherapy versus physiotherapy alone in the treatment of genuine stress urinary incontinence. Int Urogynecol J Pelvic Floor Dysfunct 7:339–343

    Article  PubMed  CAS  Google Scholar 

  21. Bø K, Kvarstein B, Nygaard I (2005) Lower urinary tract symptoms and pelvic floor muscle exercise adherence after 15 years. Obstet Gynecol 105:999–1005

    Article  PubMed  Google Scholar 

  22. Hagen S, Stark D, Cattermole D (2004) A United Kingdom-wide survey of physiotherapy practice in the treatment of pelvic organ prolapse. Physiotherapy 90:19–26

    Article  Google Scholar 

  23. Hagen S, Stark D, Maher C, Adams E (2006) Conservative management of pelvic organ prolapse in women. Cochrane Database Syst Rev 4:CD003882

    Google 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.e7

    Google Scholar 

  25. Hagen S, Stark D, Glazener C et al (2009) A randomized controlled trial of pelvic floor muscle training for stages I and II pelvic organ prolapse. Int Urogynecol J Pelvic Floor Dysfunct 20:45–51

    PubMed  Google Scholar 

  26. Ghroubi S, Kharrat O, Chaari M (2008) Effect of conservative treatment in the management of low-degree urogenital prolapse. Ann Readapt Med Phys 51:96–102

    Article  PubMed  CAS  Google 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 86:509–515

    Google 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 21:236–237

    Google 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 266–287

  30. Wilson PD, Herbison GP (1998) A randomized controlled trial of pelvic floor muscle exercises to treat postnatal urinary incontinence. Int Urogynecol J 9:257–264

    Article  CAS  Google 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 26:667

    Google Scholar 

  32. Citak N, Cam C, Arslan H et al (2010) Postpartum sexual function of women and the effects of early pelvic floor muscle exercises. Acta Obstet Gynecol 89:817–822

    Article  Google Scholar 

  33. Bø K, Talseth T, Vinsnes A (2000) Randomized controlled trial on the effect of pelvic floor muscle training on quality of life and sexual problems in genuine stress incontinent women. Acta Obstet Gynecol Scand 79:598–603

    Article  PubMed  Google Scholar 

  34. Bø K (2004) Pelvic floor muscle training is effective in treatment of stress urinary incontinence, but how does it work? Int Urogynecol J Pelvic Floor Dysfunct 15:76–84

    Article  PubMed  Google Scholar 

  35. Brækken IH, Majida M, Ellstrom-Engh M, Bø K (2010) Morphological changes after pelvic floor muscle training measured by 3-dimensional ultrasound: a randomized controlled trial. Obstet Gynecol 115:317–324

    Article  PubMed  Google Scholar 

  36. Sapsford R (2001) The pelvic floor: a clinical model for function and rehabilitation. Physiotherapy 87:620–630

    Article  Google Scholar 

  37. Bø K, Mørkved S, Frawley H, Sherburn M (2009) Evidence for benefit of transversus abdominis training alone or in combination with pelvic floor muscle training to treat female urinary incontinence: a systematic review. Neurourol Urodyn 28:368–373

    Article  PubMed  Google Scholar 

  38. Dumoulin C, Lemieux M, Bourbonnais D et al (2004) Physiotherapy for persistent postnatal stress urinary incontinence: a randomized controlled trial. Obstet Gynecol 104:504–510

    Article  PubMed  Google Scholar 

  39. Carriere B (2001) Fitness for the pelvic floor. Georg Thieme verlag 2002

  40. Haskell WL, Lee IM, Pate RR (2007) Physical activity and public health: updated recommendations for adults from the American College of Sports Medicine and the American Heart Association. Med Sci Sports Exerc 39:1423–1434

    Article  PubMed  Google Scholar 

  41. DeLancey JO (1993) Anatomy and biomechanics of genital prolapse. Clin Obstet Gynecol 36:897–909

    Article  PubMed  CAS  Google 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 119–132

  43. Baytur YB, Deveci A, Uyar Y et al (2005) Mode of delivery and pelvic floor strength and sexual function after childbirth. Int J Gynecol Obstet 88:276–280

    Article  CAS  Google Scholar 

  44. Schimpf MO, Harvie HS, Omotosho TB et al (2010) Does vaginal size impact sexual activity and function? Int Urogynecol J 21:447–552

    Article  PubMed  Google Scholar 

  45. Lowenstein L, Gruenwald I, Gartman I, Vardi Y (2010) Can stronger pelvic muscle floor improve sexual function? Int Urogynecol J 21:553–556

    Article  PubMed  Google Scholar 

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The author declares that she has no conflict of interest.

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Correspondence to Kari Bø.

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Bø, K. Pelvic floor muscle training in treatment of female stress urinary incontinence, pelvic organ prolapse and sexual dysfunction. World J Urol 30, 437–443 (2012). https://doi.org/10.1007/s00345-011-0779-8

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