Physical therapy for women with urinary incontinence
Date Issued
2011
Date
2011
Author(s)
Hung, Hsiu-Chuan
Abstract
Pelvic floor muscle training (PFMT) was recommended as one of the first-line conservative managements for women with urinary incontinence (UI), especially for stress UI (SUI) and mixed UI (MUI). Exercise adherence was supposed to be an important factor of its treatment effectiveness. It is hypothesized that intensive resistance training could change morphology of pelvic floor muscles (PFM), and then stabilize the bladder neck by improving its stiffness against increased intra-abdominal pressure. However, it is unknown whether a regular strengthening of PFM would change the bladder neck position and stiffness. And there was no direct evidence demonstrated if exercise adherence is a significant predictor on symptom reduction for symptomatic women after PFM strengthening. Retraining coordinated function of diaphragmatic, deep abdominal and PFM was a new approach to treat SUI. To date, there was only one single-blinded randomized controlled trial demonstrated the treatment effect of this new approach for symptomatic women. Whether this approach has equivalent effectiveness as intensive PFMT is still unknown.
Hence, the purposes of this series of studies were: Study I: to investigate the effect of PFM strengthening on bladder neck mobility for women with UI; Study II: to compare the treatment effects of retraining coordinated function of diaphragmatic, deep abdominal and PFM with intensive PFMT for women with UI; and Study III: to explore the predictors of treatment effectiveness for women with UI receiving PFM strengthening.
Results of the study I showed that the ability of the PFM to elevate the bladder neck voluntarily was improved, but the stiffness of the bladder neck during cough and Valsalva was not improved after the 4-month PFM strengthening. The findings suggested that the use of volitional PFM contractions during cough or Valsalva maneuver should be taught in addition to PFM strengthening program for clinical implications. Results of the study II showed that the effect of treating UI by retraining coordinated function of diaphragmatic, deep abdominal and PFM was comparable with intensive PFM strengthening. This new approach may be an alternative approach for symptomatic women who are not suitable to receive PFM strengthening. However, it could not improve the strength of PFM and should be applied carefully for women with poor PFM strength. Its treatment effects may come from other aspects of PFM function beyond PFM strength, such as muscle endurance, velocity of contraction, or coordination with other muscles around. The results of multiple regression analysis in study III revealed that exercise adherence was not a significant predictor of symptom reduction for women who received PFM strengthening program. The severity of symptom and improvement score of PFM strength had more impacts on the effectiveness than exercise adherence. Women who had more significant symptom of leakage and who had more improvement of PFM strength showed more improvement of symptom after PFM strengthening.
In summary, an intensive PFM strengthening program may not be sufficient to enhance the stiffness of bladder neck against intra-abdominal pressure. The new approach for women with UI, retraining coordinated function of diaphragmtic, deep abdominal and PFM, had comparable treatment effect with PFMT. Although women who has more severe symptoms and who get more improvement of PFM strength would get more symptom reduction, PFM strength may not be the only indicator to ensure the treatment effectiveness for women with UI. For clinical implications, women who have poor PFM strength should strengthen her PFM by intensive PFM strengthening program firstly. Instead, women who already have good PFM strength could retrain the coordinated function of diaphragmatic, deep abdominal, and PFM to relieve the symptom of UI.
Subjects
incontinence
physical therapy
pelvic floor muscles
Type
thesis
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