Managing Incontinence with Pelvic Floor Muscle Exercises

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What the research says

Pelvic floor muscle exercises are considered a key component of continence promotion programs in Australia, New Zealand and around the world. With such an emphasis on this management approach and the increasing focus on evidence-based therapy, a number of recent reviews have assessed the data in an effort to determine the effectiveness of these exercises in preventing and treating incontinence.

Reviewing the data on pelvic floor muscle exercises

Strengthening exercises for pelvic floor muscles have generally been used to help manage stress incontinence, whereas the management of urge incontinence tends to include bladder training and adjuncts such as transcutaneous electrostimulation of the spinal micturition reflex centre.

Reflecting such practice, the bulk of research on pelvic floor muscle exercises is in women with stress incontinence. In fact, authors of a recent Cochrane review on conservative treatment of urge incontinence1 concluded that there are too few studies to evaluate the effects of pelvic floor muscle exercises for this type of incontinence. However, they say evidence suggests bladder training
is more effective than no treatment and better than drug therapy.

A systematic review on the effects of pelvic floor muscle training for women with stress, urge or mixed incontinence 2 found that many of the trials are small and use different outcome measures, making it difficult to draw firm conclusions. Despite this, the authors say the evidence showed that pelvic floor muscle training was better than no treatment or placebo treatments for women with stress or mixed incontinence and that ‘intensive’ training was better than ‘standard’ training. However, there was insufficient evidence to determine whether pelvic floor muscle exercises are better or worse than other treatments for stress incontinence.

Men and pelvic floor muscle exercises

Pelvic floor muscle training has also been shown to be effective for urinary incontinence in men. A recent study showed the benefits of the exercises in the treatment of post-micturition dribble in men with erectile dysfunction.3 Men who undertook the exercises had a significant reduction in post-micturition dribble at three months compared to those who merely received advice on lifestyle changes and two-thirds of the men in the intervention group became asymptomatic. The study authors note, “To obtain a benefit, pelvic floor muscle exercises should be properly taught, include a ‘squeeze out’ pelvic floor muscle contraction and practiced for up to 6 months.A maintenance program may then be implemented for life.”

Men who access physiotherapy for pelvic floor re-education after radical prostatectomy have also been shown to be significantly more likely to regain urinary control than men who don’t.4 The authors of these findings concluded, “Pelvic-floor re-education should be considered as a first-line option in curing incontinence after radical prostatectomy.”

DID YOU KNOW?

• One in three women who have had a baby experience urinary incontinence.
• The annual cost of urinary incontinence in community-dwelling women has been conservatively
estimated to be over $700 million.5
• Less than one in two women with incontinence seek help.5

Age group % of women with incontinence % of incontinent women who sought help
18 – 39 years 12.8% 22.9%
40 – 69 years 36.1% 45.5%
70+ years 35.0% 44.6%

References:

1. Berghmans L, et al. Conservative treatment of urge urinary incontinence in women: a systematic review of randomized clinical trials. BJU International 2000; 85: 254-263.

2. Hay-Smith E, et al. Pelvic floor muscle training for urinary incontinence in women. Cochrane Database Syst Rev. 2001; 1:CD001407.

3. Dorey G, et al. Pelvic floor exercises for treating post-micturition dribble in men with erectile dysfunction. Urol Nurs, 2004; 24:490-497.

4. Van Kampen Weerdt M, et al. Effects of pelvic-floor re-education on duration and degree of incontinence after radical prostatectomy. The Lancet 2000; 335: 98.

5. Doran C. et al. Economic costs of urinary incontinence in community-dwelling Australian women. MJA 2001; 174: 456-458

6. The Joanna Briggs Institute Adelaide, Pelvic Floor Muscle Exercise. Technical Report, 2005; 9 (2): ISSN 1329-1874. From Doran C. et al. Economic costs of urinary incontinence in community-dwelling Australian women. MJA 2001; 174: 456-458.

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