Urinary Incontinence Supervised Exercise Much More Effective Than Unsupervised

The condition affects physical, social, psychological, and even financial domains, levying a significant effect on quality of life.2 While treatments can include pharmacotherapy, lifestyle modification, or surgery, level-1 evidence (recommendation A) puts pelvic-floor muscle training as the first-line treatment.3

Research suggests that pelvic-floor muscle training (PFMT) is as effective as surgery for roughly half of women with stress urinary incontinence.3 However, not all training programs are created equal. Various approaches, such as vaginal cone, biofeedback, electrical muscle stimulation, radiofrequency, and electroacupuncture, have all been found effective but to varying degrees.

The research comparing these interventions to each has not been done to the extent needed. Yet, one theme has emerged from the research: “The less supervision and interaction in the program, the worse the outcomes.” One of the latest additions to that body of work is the research of Daxa G. Mishra and colleagues.4 Their randomised, controlled trial consisted of three groups: control, supervised exercise, and unsupervised exercise. The groups consisted of women, averaging 45 years of age, with mild to moderate incontinence of any of the three types (mixed, stress, and urge). All groups received standardised, supervised training in PFMT and were prescribed home exercise programs.

Spread over three months, the supervision group additionally attended 11 physiotherapy appointments, wherein the patients performed the exercises, receiving supervision and coaching. At six-month follow-up, only patients in the supervision group had completed the number of exercise sessions considered needed for effectiveness. The supervised group accomplished a 76% improvement on the revised incontinence scale.

The unsupervised exercise group saw a 27% improvement compared to a 10% improvement in the control group, which did not exercise. PMFT is consistently shown to be an effective treatment for urinary incontinence, but scheduling supervised sessions in pelvic-floor muscle training appears instrumental in achieving optimal outcomes.

References

1. Minassian VA, Drutz HP, Al-Badr A. Urinary incontinence as a worldwide problem. International Journal of Gynecology & Obstetrics. 2003 Sep 1;82(3):327-38.

2. Trantafylidis SC. Impact of urinary incontinence on quality of life. Pelviperineology. 2009;28(28):51-3.

3. National Institute for Health and Care Excellence. NICE guideline. Urinary incontinence and pelvic organ prolapse in women: management [NG123] Published date: April 2019 Last updated: June 2019.

4. Mishra DG, Vaishnav SB, Phatak AG. Comparison of effectiveness of home-based verses supervised pelvic floor muscle exercise in women with urinary incontinence. Journal of Mid-life Health. 2022 Jan;13 (1):74.