POL Scientific / Bladder / Volume 11 / Issue 4 / DOI: 10.14440/bladder.2024.0032
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RESEARCH ARTICLE

Effectiveness and predictive factors of pelvic floor muscle training in female urinary incontinence: A retrospective cohort study

Marina Kalaitzi1 Efstathios Papaefstathiou1 Sotirios Gatsos1 Ilias Giannakodimos1* Ioannis Apostolidis1 Eleni Konstantinidou2 Konstantinos-Vaios Mytilekas1 Eleni Ioannidou1 Themistoklis Mikos3 Apostolos Apostolidis1
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1 2nd Department of Urology, School of Medicine, Aristotle University of Thessaloniki, Papageorgiou General Hospital, Thessaloniki, 56429 Greece
2 Department of Pelvic Floor Physiotherapy, Alexandrion Technological Educational Institute of Thessaloniki, Sindos, Thessaloniki, 57400 Greece
3 1st Department of Obstetrics and Gynecology, School of Medicine, Aristotle University of Thessaloniki, Papageorgiou General Hospital, Thessaloniki, 56429 Greece
Bladder 2024 , 11(4), e21200021; https://doi.org/10.14440/bladder.2024.0032
Submitted: 18 August 2024 | Revised: 2 October 2024 | Accepted: 8 November 2024 | Published: 12 December 2024
© 2024 by the Bladder published by POL Scientific. Licensee POL Scientific, USA. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution 4.0 International License ( https://creativecommons.org/licenses/by/4.0/ )
Abstract

Background: Factors predictive of the efficacy of pelvic floor muscle training (PFMT) in stress urinary incontinence (SUI) or mixed urinary incontinence (MUI) are poorly defined. Identifying these factors is crucial for guiding treatment decisions, determining training repetitions, and predicting PFMT outcomes. Objective: This study aimed to identify clinical factors predictive of PFMT outcomes in women with primary SUI. Methods: We retrospectively reviewed data from 188 consecutive women with either SUI (n = 90) or MUI (n = 98) with a primary stress component. All participants underwent a 3-month PFMT program. Predictive factors for 50% improvement and complete cure of incontinence were assessed through urogynecological history/examination, medical history, digital pelvic floor muscle (PFM) evaluation (n = 87), and 3-day bladder diaries. Logistic regression analyses were conducted for the overall group and separately for the SUI and MUI subpopulations. Results: At 3 months, 10% of SUI patients and 11.2% of MUI patients achieved complete SUI cure, while 35.7% of MUI patients were free from urge urinary incontinence (UUI). A complete cure of SUI was correlated with a negative or mildly positive results of stress test (p = 0.014). For MUI patients, complete UUI cure was linked to initial digital PFM evaluation results (p = 0.003) and negative (p = 0.005) or mildly positive findings of stress tests (p = 0.003). The absence of prior surgery and digital evaluation predicted a 50% improvement in MUI (p = 0.021 and p = 0.026, respectively). Endurance improvement was related independently with >50% improvement in MUI patients (odds ratio = 3.794, p = 0.019). Conclusion: Negative or mildly positive stress tests and digital PFM evaluation predict better outcomes with PFMT. Further prospective studies are needed to validate these findings.

Keywords
Mixed urinary incontinence
Pelvic floor muscle training
Predictive factors
Stress urinary incontinence
Urinary incontinence
Funding
This study was supported by unrestricted grants from Mavrogenis Hellas, ARITI S.A., Pierre-Fabre Medicament, Demo Pharmaceuticals, Solution Medical Systems, and Genepharm A.E.
References
  1. Kwon BE, Kim GY, Son YJ, Roh YS, You MA. Quality of life of women with urinary incontinence: A systematic literature review. Int Neurourol J. 2010;14(3):133-138. doi: 10.5213/inj.2010.14.3.133

 

  1. Thom D. Variation in estimates of urinary incontinence prevalence in the community: Effects of differences in definition, population characteristics, and study type. J Am Geriatr Soc. 1998;46(4):473-480. doi: 10.1111/j.1532-5415.1998.tb02469.x

 

  1. Milsom I, Gyhagen M. The prevalence of urinary incontinence. Climacteric. 2019;22(3):217-222. doi: 10.1080/13697137.2018.1543263

 

  1. Waetjen LE, Xing G, Johnson WO, Melnikow J, Gold EB, Study of Womenʼs Health Across the Nation (SWAN). Factors associated with reasons incontinent midlife women report for not seeking urinary incontinence treatment over 9 years across the menopausal transition. Menopause. 2018;25(1):29-37. doi: 10.1097/GME.0000000000000943

 

  1. Bo K, Frawley HC, Haylen BT, et al. An international urogynecological association (IUGA)/international continence society (ICS) joint report on the terminology for the conservative and nonpharmacological management of female pelvic floor dysfunction. Int Urogynecol J. 2017;28(2):191-213. doi: 10.1007/s00192-016-3123-4

 

  1. Dumoulin C, Cacciari LP, Hay-Smith EJC. Pelvic floor muscle training versus no treatment, or inactive control treatments, for urinary incontinence in women. Cochrane Database Syst Rev. 2018;10(10):CD005654. doi: 10.1002/14651858.CD005654.pub4

 

  1. Nie XF, Ouyang YQ, Wang L, Redding SR. A meta-analysis of pelvic floor muscle training for the treatment of urinary incontinence. Int J Gynaecol Obstet. 2017;138(3):250-255. doi: 10.1002/ijgo.12232

 

  1. Woodley SJ, Lawrenson P, Boyle R, et al. Pelvic floor muscle training for preventing and treating urinary and faecal incontinence in antenatal and postnatal women. Cochrane Database Syst Rev. 2020;5(5):CD007471. doi: 10.1002/14651858.CD007471.pub4

 

  1. Choi H, Palmer MH, Park J. Meta-analysis of pelvic floor muscle training: Randomized controlled trials in incontinent women. Nurs Res. 2007;56(4):226-234. doi: 10.1097/01.NNR.0000280610.93373.e1

 

  1. Nyström E, Asklund I, Sjöström M, Stenlund H, Samuelsson E. Treatment of stress urinary incontinence with a mobile app: Factors associated with success. Int Urogynecol J. 2018;29(9):1325-1333. doi: 10.1007/s00192-017-3514-1

 

  1. Lindh A, Sjöström M, Stenlund H, Samuelsson E. Non-face-to-face treatment of stress urinary incontinence: Predictors of success after 1 year. Int Urogynecol J. 2016; 27(12):1857-1865. doi: 10.1007/s00192-016-3050-4

 

  1. Alouini S, Memic S, Couillandre A. Pelvic floor muscle training for urinary incontinence with or without biofeedback or electrostimulation in women: A systematic review. Int J Environ Res Public Health. 2022;19(5):2789. doi: 10.3390/ijerph19052789

 

  1. Konstantinidou E, Apostolidis A, Kondelidis N, Tsimtsiou Z, Hatzichristou D, Ioannides E. Short-term efficacy of group pelvic floor training under intensive supervision versus unsupervised home training for female stress urinary incontinence: A randomized pilot study. Neurourol Urodyn. 2007;26(4):486-491. doi: 10.1002/nau.20380

 

  1. NICE (NG123)©. Urinary Incontinence and Pelvic Organ Prolapse in Women: Management. Available from: https://www. nice.org.uk/guidance/ng123/resources/urinary-incontinence-and-pelvic-organ-prolapse-in-women-management-pdf-66141657205189 [Last accessed on 2023 Feb 04]

 

  1. Bø K, Hagen RH, Kvarstein B, Jørgensen J, Larsen S, Burgio KL. Pelvic floor muscle exercise for the treatment of female stress urinary incontinence: III. Effects of two different degrees of pelvic floor muscle exercises. Neurourol Urodyn. 1990;9:489-502. doi: 10.1002/nau.1930090505

 

  1. Hagovska M, Svihra J, Urdzik P. Predictive value of pelvic floor muscle morphometry using 3D/4D ultrasound in relation to the success of pelvic floor muscle training in women with stress urinary incontinence. Int J Environ Res Public Health. 2022;19(22):14757. doi: 10.3390/ijerph192214757

 

  1. Bo K, Fernandes ACNL, Duarte TB, Brito LGO, Ferreira CHJ. Is pelvic floor muscle training effective for symptoms of overactive bladder in women? A systematic review. Physiotherapy. 2020;106:65-76. doi: 10.1016/j.physio.2019.08.011

 

  1. Arnouk A, De E, Rehfuss A, Cappadocia C, Dickson S, Lian F. Physical, complementary, and alternative medicine in the treatment of pelvic floor disorders. Curr Urol Rep. 2017;18(6):47. doi: 10.1007/s11934-017-0694-7

 

  1. Hendriks EJ, Kessels AG, De Vet HC, Bernards AT, De Bie RA. Prognostic indicators of poor short-term outcome of physiotherapy intervention in women with stress urinary incontinence. Neurourol Urodyn. 2010;29(3):336-343.doi: 10.1002/nau.20752

 

  1. Labrie J, Lagro-Janssen AL, Fischer K, Berghmans LC, Van der Vaart CH. Predicting who will undergo surgery after physiotherapy for female stress urinary incontinence. Int Urogynecol J. 2015;26(3):329-334. doi: 10.1007/s00192-014-2473-z

 

  1. Schaffer J, Nager CW, Xiang F, et al. Predictors of success and satisfaction of nonsurgical therapy for stress urinary incontinence. Obstet Gynecol. 2012;120(1):91-97. doi: 10.1097/AOG.0b013e31825a6de7

 

  1. Rocha F, Carvalho J, Jorge Natal R, Viana R. Evaluation of the pelvic floor muscles training in older women with urinary incontinence: A systematic review. Porto Biomed J. 2018;3(2):e9. doi: 10.1016/j.pbj.0000000000000009

 

  1. Laycock, JR, Jerwood D. Pelvic floor muscle assessment: The PERFECT scheme. Physiotherapy. 2001;87:631-642. doi: 10.1016/S0031-9406(05)61108-X

 

  1. Bernards AT, Berghmans BC, Slieker-Ten Hove MC, Staal JB, De Bie RA, Hendriks EJ. Dutch guidelines for physiotherapy in patients with stress urinary incontinence: An update. Int Urogynecol J. 2014;25(2):171-179. doi: 10.1007/s00192-013-2219-3

 

  1. Obloza A, Teo R, Marriott E, Parker G, Tincello D. Association of baseline severity of lower urinary tract symptoms with the success conservative therapy for urinary incontinence in women. Int Urogynecol J. 2019;30(5):705-710. doi: 10.1007/s00192-018-3778-0

 

  1. Brooks KCL, Varette K, Harvey MA, et al. A model identifying characteristics predictive of successful pelvic floor muscle training outcomes among women with stress urinary incontinence. Int Urogynecol J. 32(3):719-728. doi: 10.1007/s00192-020-04583-z

 

  1. Yoo EH, Kim YM, Kim D. Factors predicting the response to biofeedback-assisted pelvic floor muscle training for urinary incontinence. Int J Gynaecol Obstet. 2011;112(3):179-181. doi: 10.1016/j.ijgo.2010.09.016

 

  1. Hay-Smith J, Mørkved S, Fairbrother KA, Herbison GP. Pelvic floor muscle training for prevention and treatment of urinary and faecal incontinence in antenatal and postnatal women. Cochrane Database Syst Rev. 2008;(4):CD007471. doi: 10.1002/14651858.CD007471
Conflict of interest
The authors declare no conflict of interest.
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Bladder, Electronic ISSN: 2327-2120 Print ISSN: TBA, Published by POL Scientific