Expert Commentary

Pelvic floor exercises really do work

Author and Disclosure Information

 

Study Question

Do pelvic floor muscle exercise regimens improve persistent postnatal stress urinary incontinence, compared to no treatment?

Results

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%).

Expert Commentary

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.

Bottom Line

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.

Recommended Reading

VBAC: When is it safe?
MDedge ObGyn
Pap test every year? Not for every woman
MDedge ObGyn
Putting new guidelines into practice is easier said than done
MDedge ObGyn
EasyROAD—high road or path of least resistance?
MDedge ObGyn
Weekly fluconazole reduces recurrent candidiasis
MDedge ObGyn
Previous SGA or preterm infant increases stillbirth risk
MDedge ObGyn
John Edwards was right to multiply liability
MDedge ObGyn
John Edwards’ case seemed right on target
MDedge ObGyn
Nurses question FHR tracing
MDedge ObGyn
Choosing the best technique for vaginal vault prolapse
MDedge ObGyn