EMG-biofeedback assisted pelvic floor muscle training is an effective therapy of stress urinary or mixed incontinence: a 7-year experience with 390 patients

Abstract

The aim of the study was to determine the short- and long-term efficacy of an intensive and EMG-biofeedback-assisted pelvic floor muscle training (PFMT) program as a therapy of female stress or mixed urinary incontinence. All women with stress or mixed urinary incontinence treated in the pelvic floor reeducation program at our clinic between September 1996 and March 2003 were included. EMG-biofeedback assisted PFMT was performed by specially trained therapists (one registered nurse and one midwife). Electric stimulation preceded PFMT if the pelvic floor muscle contractions were considered too weak for active training (Oxford < 2). Examinations included among others: conventional urodynamic studies prior to therapy, a stress provocation test (cough test), and determination of maximal pelvic floor muscle strength (Oxford-grading and electric EMG-potential). A retrospective chart review was performed. A questionnaire was administered for long-term follow-up. Four hundred and thirty four women attended our PFR-program in this 7-year period. All 390 women with stress (80%) or mixed (20%) urinary incontinence were evaluated. Mean age: 52 years. Mean duration of incontinence: 6.7 years. Two hundred and sixty three women completed the training (group 1, average number of training sessions: 8.7), 127 patients ended therapy prematurely (group 2, average number of training sessions: 4.1). Short-term results at the end of the PFR-program are available for group 1. There was a statistically significant improvement of the stress provocation test (cough test). The data before the therapy was 141x SUI degrees III (60%); 50x SUI degrees II (21%), 24x SUI degrees I (10%), 20x SUI degrees 0 (9%) as opposed to after the therapy 9x SUI degrees III (5%), 34x SUI degrees II (19%), 48x SUI degrees I (26%), 91x SUI degrees 0 (50%). There was a significant increase in the Oxford-score by 1.2 points (2.9-4.1; P<0.001). Self-reported improvement of incontinence symptoms was 95%. The electric EMG-potentials almost doubled (11.3-20.5 muV; P<0.001). Long-term results (questionnaire) for all patients: the average follow-up time was 2.8 years (range: 3 months to 7 years). Three hundred and twelve (80%) of the questionnaires returned. Seventy-one percent of them self-reported a persisting improvement of their incontinence symptoms. Thirteen percent of all women underwent incontinence surgery following the completion of conservative therapy (9.2% group 1, 25% group 1; P<0.001). An intensive and EMG-biofeedback assisted PFMT is very effective. Often, avoidance of surgery is possible.