Electromyographic characteristics of pelvic floor muscles in women with stress urinary incontinence following sEMG-assisted biofeedback training and Pilates exercises.

Daria Chmielewska,Magdalena Stania,Agnieszka Smykla,Krystyna Kwaśna,Dominika Hudziak,Patrycja Dolibog,Edward Błaszczak,Katarzyna Kucab–Klich,Ioannis G Fatouros

doi:10.1371/journal.pone.0225647

Abstract

The aim of this study was to compare the effect of pelvic floor muscle training with surface electromyographic (sEMG) biofeedback (BF group) and Pilates exercises (P group) on the bioelectrical activity of pelvic floor muscles in women with stress urinary incontinence. The other aim aim was to compare changes in voiding diaries and scores on quality of life questionnaire against baseline values and between the groups. Women in the BF group (n = 18) participated in pelvic floor muscle training with sEMG biofeedback; the P group (n = 13) participated in basic level Pilates workouts. Both protocols were continued for eight weeks. Voiding diary, quality of life and electromyographic characteristics of the pelvic floor muscles were assessed at the three-time points: at baseline, after eight weeks’ training, and at month six post-training. The sEMG activity of the pelvic floor muscles was tested during five trials in two positions. There was no marked improvement in bioelectrical activity of the pelvic floor muscles during contraction following training with sEMG biofeedback or Pilates exercises. Following eight weeks of sEMG biofeedback training, a decrease was noted in resting bioelectrical activity of pelvic floor muscles and during relaxation after sustained contraction but only in supine-lying. No such effect was observed in the Pilates group. In the BF group, the number of incontinence episodes after end of treatment (timpepoints: 1vs. 2) and at six month follow-up (timpepoints: 1vs. 3) decreased by 68.5% and 89.3%, respectively. The respective values in the P group were 78.6%, and 86.4%. The intergroup differences did not reach the level of statistical significance. As regards the quality of life, the questionnaire demonstrated that Pilates exercises had significantly better effects compared to biofeedback training both at the end of the eight-week exercise program and (p = 0.003) and at six month follow-up (p = 0.0009). The International Consultation on Incontinence Questionnaire—Short Form (ICIQ- SF) showed comparable efficacy of Pilates exercises and training with sEMG biofeedback. Intragroup improvements in micturition frequency, incontinence (leakage) episodes, and nocturia frequency were comparable. Alleviation of urinary incontinence symptoms was comparable in both groups, whereas the improvement in the quality of life was more notable in the Pilates group. The obtained results failed to demonstrate the superiority of any of the two methods regarding the bioelectrical activity of pelvic floor muscles in patients with stress urinary incontinence.

Highlights

The most common types of female urinary incontinence are stress urinary incontinence, defined according to ICS, as involuntary leakage from the urethra, synchronous with exertion/ effort, sneezing or coughing
Following preliminary recruitment at the specialist clinic, the candidates contacted one of the researchers on the phone to declare whether they were willing to participate in the study. They decided on the type of pelvic floor muscle (PFM) training they wanted to join
The BF and P groups did not differ with respect to age, mean BMI, number of pregnancies (Table 1), mean number of urinary leakage episodes, mean micturition frequency, King’s Health Questionnaire (KHQ) scores, severity of symptoms as assessed with the ICIQ-UI SF questionnaire and Surface electromyography (sEMG) activity of pelvic floor muscles

Summary

Introduction

The most common types of female urinary incontinence are stress urinary incontinence, defined according to ICS, as involuntary leakage from the urethra, synchronous with exertion/ effort, sneezing or coughing. The recommended non-surgical and non-pharmacological treatment methods of urinary incontinence include pelvic floor muscle training (PFMT) and biofeedback [1]. Surface electromyography (sEMG) is considered an acceptable tool for real-time evaluation of pelvic floor muscle (PFM) contractions [2, 3] and for the assessment of PFM function [4] by identification of the PFM motor unit action potential [5]. Incontinent subjects of Capson et al exhibited significantly higher resting PFM activity in the standing compared to supine position. Resting PFM activity was higher in the standing hypolordotic posture as compared to the normal and hyperlordotic postures [9]. Incontinent women had lower PFM activities, especially in the standing position, related to age and vaginal deliveries [10]

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