Skip to main content
Log in

Pelvic floor exercises for female stress urinary incontinence

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

Abstract

Urinary continence is maintained by passive and active forces at the bladder neck and along the urethra. Pelvic floor exercises can improve these forces, provided there is sufficient muscular awareness, nerve supply and intact muscles. Instructions in the exercises must include a test for correct muscle use. Biofeedback methods seem superior. Patients must attend intensive repeated instruction for 2–3 months and perform daily exercises at home. All patients can benefit from pelvic floor exercises, but to save money and time various scoring systems, including grade of incontinence, menopausal state and pelvic muscle strength can be applied. Patients with mild incontinence and a strong pelvic floor prior to exercises have the best prognosis. Long-term follow-up after exercises shows a cure rate of 50% for stress incontinence, but this depends on the continuation rate of exercise performance. A sustained effect demands continuous or repeated exercises and attempts to protect the pelvic floor.

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

Access this article

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

Instant access to the full article PDF.

Similar content being viewed by others

References

  1. Kegel A. Progressive resistance exercise in the functional restoration of the perineal muscles. Am J Obstet Gynecol 1948;56:238–248

    Google Scholar 

  2. Kujansuu E. The effect of pelvic floor exercises on urethral function in female stress urinary incontinence: a urodynamic study. Ann Chir Gynaecol 1983;72:28–32

    Google Scholar 

  3. Enhorning G. Simultaneous recording of the intravesical and intraurethral pressures. Acta Obstet Gynecol Scand 1961;276 (Suppl): 1–68

    Google Scholar 

  4. Hilton P, Stanton SL. Urethral pressure measurement by microtransducers: the result in symptom-free women and in those with genuine stress incontinence. Br J Obstet Gynaecol 1983;90:919–933

    Google Scholar 

  5. Constantinou CE, Govan DE. Spatial distribution and timing of transmitted and reflexly generated urethral pressure in healthy women. J Urol 1982;127:964–969

    Google Scholar 

  6. Delancey JOL. Structural aspects of the extrinsic continence mechanism. Obstet Gynecol 1988;72:296–301

    Google Scholar 

  7. Rud T, Andersson KE, Asmussen M, Hunting A, Ulmsten U. Factors maintaining the intraurethral pressure in women. Invest Urol 1980;17:343–347

    Google Scholar 

  8. Wilson PD, Barker G, Barnard RJ, Siddle NC. Steroid hormone receptors in the female lower urinary tract. Urol Int 1984;39:5–8

    Google Scholar 

  9. Ingelmann-Sundberg A, Rosen J, Gustafson SA, Carlstrom K. Cystol estrogen receptors in the urogenital tissues in stress incontinent women. Acta Obstet Gynecol Scand 1981;60:585–586

    Google Scholar 

  10. Haadem K, Ling L, Ferno M, Graffner H. Estrogen receptors in the external anal sphincter. Am J Obstet Gynecol 1991;164:609–610

    Google Scholar 

  11. Walter S, Wolf H, Barlebo H, Jensen HK. Urinary incontinence in postmenopausal women treated with estrogens: a double-blind clinical trial. Urol Int 1978;33:135–143

    Google Scholar 

  12. Benvenuti F, Caputo GM, Bandinelli S, Mayer F, Biagini C, Sommavilla A. Reeducative treatment of female genuine stress incontinence. Am J Phys Med 1987;66:155–168

    Google Scholar 

  13. Mouritsen L, Rasmussen A. Bladder neck mobility evaluated by vaginal ultrasonography. Br J Urol 1992

  14. Snooks SJ, Setchell M, Swash M, Henry MM. Injury to innervation of pelvic floor sphincter musculature in childbirth. Lancet 1984;8:546–550

    Google Scholar 

  15. Swash M, Snooks SJ, Henry MM. Unifying concept of pelvic floor disorders and incontinence. J Roy Soc Med 1985;78:908–911

    Google Scholar 

  16. Richardson AC, Edmonds PB, Williams NL. Treatment of urinary incontinence due to paravaginal fascial defect. Obstet Gynecol 1981;57:357–362

    Google Scholar 

  17. Bo K, Larsen S, Oseid S, Kvarstein B, Hagen R, Jorgensen J. Knowledge about and ability to correct pelvic floor muscle exercise in women with urinary stress incontinence. Neurourol Urodyn 1988;7:261–262

    Google Scholar 

  18. Bump R, Hurt WG, Fantl JA, Wyman JF. Assessment of Kegel pelvic muscle exercise performance after brief verbal instruction. Am J Obstet Gynecol 1991;165:322–328

    Google Scholar 

  19. Brink CA, Sampselle CM, Wells TJ, Diokno AC, Gillis GL. A digital test for pelvic muscle strength in older women with urinary incontinence. Nursing Res 1989;38:196–199

    Google Scholar 

  20. Peattie AB, Plevnik S, Stanton SL. Vaginal cones: a conservative method of treating genuine stress incontinence. Br J Obstet Gynaecol 1988;95:1049–1053

    Google Scholar 

  21. Mouritsen L, Frimodt-Moller C, Moller M. Longterm effect of pelvic floor exercises in female urinary incontinence. Br J Urol 1991;68:32–37

    Google Scholar 

  22. Lose G, Colstrup H. Urethral pressure and power generation during coughing and voluntary contraction of the pelvic floor in healthy females. Br J Urol 1991;67:573–579

    Google Scholar 

  23. Norgaard JP, Nissen T, Djurhuus JC. A device for treatment of detrusor hyperreflexia by biofeedback. Urol Res 1985;13:241–242

    Google Scholar 

  24. Abet VL, Richter J, Hegensscheid F et al. Urodynamische und rontgenologische befunde vor und nach komplexer physiotherapie der weiblichen harninkontinenz. Zentralbl Gynaekol 1986;108:1431–1435

    Google Scholar 

  25. Klarskov P, Behring D, Bishoff N et al. Pelvic floor exercises versus surgery for female stress incontinence. Urol Int 1986;41:129–132

    Google Scholar 

  26. Olah KS, Bridges N, Denning J, Farrer DJ. The conservative management of patients with symptoms of stress incontinence: a randomized prospective study comparing weighted vaginal cones and interferential therapy. Am J Obstet Gynecol 1990;162:87–92

    Google Scholar 

  27. Stoddart GD. Research project into the effect of pelvic floor exercises on genuine stress incontinence. Physiotherapy 1983;69:148–149

    Google Scholar 

  28. Susset JG, Galea G, Read L. Biofeedback therapy for female incontinence due to low urethral resistance. J Urol 1990;143:298–300

    Google Scholar 

  29. Bo K, Hagen RH, Kvastein B, Jorgensen J, Larsen S. Pelvic muscle exercise for the treatment of female stress urinary incontinence III: effects of two different degrees of pelvic floor muscle exercises. Neurourol Urodyn 1990;9:489–502

    Google Scholar 

  30. Burns PA, Pranikoff K, Reis JS, Levy KJ. Effectiveness of biofeedback therapy for stress incontinent females. Neurourol Urodyn 1988;7:280–282

    Google Scholar 

  31. Wilson PD, Al Samarrai T, Deakin M, Kolbe E, Brown ADG. An objective assessment of physiotherapy for female genuine stress incontinence. Br J Obstet Gynaecol 1987;94:575–582

    Google Scholar 

  32. Mohr JA, Rogers J, Brown T, Starkweather G. Stress urinary incontinence: a simple and practical approach to diagnosis and treatment. J Am Geriatr Soc 1983;31:476–478

    Google Scholar 

  33. Jolleys JV. Diagnosis and management of female urinary incontinence in general practice. J Roy Coll Gen Pract 1989;July:277–279

    Google Scholar 

  34. Castleden C, Duffin HM, Mitchel EP. The effect of physiotherapy on stress incontinence. Age Ageing 1984;13:235–237

    Google Scholar 

  35. Ferguson KL, McKey PL, Bishop KR, Kloen P, Verheul JB, Dougherty MC. Stress urinary incontinence: effect of pelvic muscle exercise. Obstet Gynecol 1990;75:671–675

    Google Scholar 

  36. Burgio KL, Robinson JC, Engel BT. The role of biofeedback in Kegel exercise training for stress urinary incontinence. Am J Obstet Gynecol 1986;154:58–64

    Google Scholar 

  37. Wilson PD, Borland M. Vaginal cones for the treatment of genuine stress incontinence. Aust NZ Obstet Gynecol 1990;30:157–160

    Google Scholar 

  38. Peattie AB, Plevnik S. Cones versus physiotherapy as conservative management of genuine stress incontinence. Neurourol Urodyn 1988;7:265–266

    Google Scholar 

  39. Eriksen B. Electrostimulation of the pelvic floor in female urinary incontinence. Thesis, University of Trondheim, Norway, 1989

    Google Scholar 

  40. Moore T, Schofield PF. Treatment of stress incontinence by maximum perineal electrical stimulation. Br Med J 1967;3:150–151

    Google Scholar 

  41. McGuire WA. Electrophysiotherapy and exercises for stress incontinence and urinary frequency. Physiotherapy 1975;61:305–307

    Google Scholar 

  42. Hofbauer VJ, Preisinger F, Nurnberg N. Der stellenwert der physikotherapie bei der weiblichen genuinen stress inkontinenz. Z Urol Nephrol 1990;83:249–254

    Google Scholar 

  43. Hahn I, Sommar S, Fall M. A comparative study of pelvic floor training and electrical stimulation for the treatment of genuine female stress urinary incontinence. Neurourol Urodyn 1991;10:545–554

    Google Scholar 

  44. Henella SM, Kirwan P, Castleden CM, Hutshins CJ, Breeson AJ. The effect of pelvic floor muscle exercises on genuine urinary stress incontinence in two hospitals. Br J Obstet Gynaecol 1988;95:602–606

    Google Scholar 

  45. Wells T, Brink CA, Diokno AC, Wolfe R, Gillis GL. Pelvic muscle exercises for stress urinary incontinence in elderly women. JAGS 1991;39:785–791

    Google Scholar 

  46. Henderson JS, Taylor KH. Age as a variable in an exercise program for the treatment of simple urinary stress incontinence. JOGNN 1987;6:266–272

    Google Scholar 

  47. Bonde B. The pelvic floor. Danish Physiotherapists 1992;10:4–8

    Google Scholar 

  48. Fisher W. Physiotherapeutic aspects of urine incontinence. Acta Obstet Gynecol Scand 1983;62:579–583

    Google Scholar 

  49. Sandri SD, Bioggioggero L, Fanciullacci F, Zanollo A. Are there limitations to pelvic floor rehabilitation in female stress urinary incontinence? Neurourol Urodyn 1988;7:258–259

    Google Scholar 

  50. Tapp AJS, Cardozo L, Hills B, Barnick C. Who benefits from physiotherapy? Neurourol Urodyn 1988;7:259–261

    Google Scholar 

  51. Bo K, Larsen S, Kvarstein B, Hagen RH. Classification and characterization of responders to pelvic floor muscle exercise for female stress urinary incontinence. Neurourol Urodyn 1990;9:395–397

    Google Scholar 

  52. Jones EG. Non operative treatment of stress incontinence. Clin Obstet Gynecol 1963;6:220–235

    Google Scholar 

  53. Burton JR, Pearce KL, Burgio KL, Engel BT, Whitehead WR. Behavioral training for urinary incontinence in elderly ambulatory patients. JAGS 1988;36:693–698

    Google Scholar 

  54. Klarskov P, Nielsen KK, Kromann-Andersen B, Maegaard E. Longterm results of pelvic floor training and surgery for stress urinary incontinence. Int Urogynecol J 1991;2:132–135

    Google Scholar 

  55. Nielsen CA, Sigsgaard I, Olsen M, Tolstrup M, Danneskjold-Samsoe, Bock JE. Trainability of the pelvic floor. A prospective study during pregnancy and after delivery. Act Obstet Gynecol Scand 1988;67:437–440

    Google Scholar 

  56. Dougherty MC, Bishop KR, Abrams RM, Batich CD, Gimotty PA. The effect of exercises on the circumvaginal muscles in postpartum women. J Nurse Midwifery 1989;34:8–14

    Google Scholar 

  57. Norgaard JP, Djurhuus JC. Treatment of detrusor-sphincter dyssynergia by biofeedback. Urol Int 1982;37:236–239

    Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Rights and permissions

Reprints and permissions

About this article

Cite this article

Mouritsen, L. Pelvic floor exercises for female stress urinary incontinence. Int Urogynecol J 5, 44–51 (1994). https://doi.org/10.1007/BF00451716

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF00451716

Keywords

Navigation