Examining the Evidence
Pelvic floor exercises really do work
Do pelvic floor muscle exercise regimens improve persistent postnatal stress urinary incontinence, compared to no treatment?
More than 70% of parous women in 2 treatment groups were continent on pad testing, versus 0% in the control group: Pelvic floor muscle rehabilitation, 14 of 20 continent (70%); pelvic floor plus abdominal rehabilitation, 17 of 23 (74%).
This well-designed study had important strengths: blinded outcome assessment, randomized design, and a proper control group.
A total of 64 women were randomized to a group that underwent fairly intensive instruction and assistance in pelvic floor muscle exercise (n = 21), a group following a similar physical therapy program plus abdominal training (n = 23), or a control group that received massage but no pelvic floor muscle exercise (n = 20). All subjects had 8 weekly therapy sessions under the supervision of a physiotherapist. The primary endpoint was a 20-minute pad test.
Everybody had a coach
Several weaknesses are notable. First, the setting was highly optimized: Every woman had a personal physiotherapy coach to oversee the rehabilitation program.
The small sample size and the fact that outcomes were reported only 1 week after treatment ended are problematic, as are the strict exclusion criteria, which make results difficult to generalize. Further, some outcomes were reported as “cure” when urine leakage persisted. Why not divide out those who were “dry” versus “improved”?
It is unclear why the authors used “postnatal” in the title, since women were several years remote from delivery. The power calculation is also unclear, as the authors failed to document the effect size they used to derive their needed sample size.
What about the long term?
Short-term results are encouraging, but the more pertinent issue is whether outcomes will persist. Still, with more than 200,000 surgeries performed each year in the United States for female stress incontinence—with their many well-recognized complications—it is encouraging to see such excellent science applied to evaluating nonsurgical care.
Whenever possible, attempt nonsurgical treatment of persistent stress urinary incontinence. It is less invasive and less expensive than surgery, and stands a good chance of easing a patient’s symptoms.