Involuntary reflexive pelvic floor muscle training in addition to standard training versus standard training alone for women with stress urinary incontinence: a randomized controlled trial

Helena Luginbuehl,Irene Koenig,Lorenz Radlinger,Annette Kuhn,Reto Buergin,Corinne Lehmann

doi:10.1007/s00192-021-04701-5

Abstract

Introduction and hypothesisAlthough involuntary reflexive pelvic floor muscle contractions seem crucial during stress urinary incontinence-provoking situations, hitherto existing guidelines feature voluntary pelvic floor muscle training only. Two pelvic floor muscle protocols were compared regarding their effect on stress urinary incontinence in women: one focusing on standard physiotherapy with voluntary pelvic floor muscle training, the other additionally including involuntary reflexive pelvic floor muscle training.MethodsThis study was designed as a triple-blind prospective randomized controlled trial with women suffering from stress urinary incontinence with two physiotherapy intervention groups (control group: standard physiotherapy, n = 48, experimental group: standard physiotherapy plus involuntary reflexive pelvic floor muscle training triggered by whole-body movements such as jumps n = 48). Both interventions lasted 16 weeks (9 personal physiotherapy consultations and 78 home training sessions). Group differences and development over time were analyzed concerning the primary outcome International Consultation on Incontinence Modular Questionnaire Urinary Incontinence short form (ICIQ-UIsf) by mixed effect regression models.ResultsThe ICIQ-UIsf score decreased significantly over time for both groups by about 3 points from about 10 to about 7 points with no group differences at any point in time.DiscussionThis trial did not find any additional benefit for stress urinary incontinence by adding involuntary reflexive pelvic floor muscle training to standard training. Both training protocols showed similar clinically relevant improvements; however, there was still moderate incontinence after interventions. Future studies should test and apply pelvic floor muscle function-oriented training methods for pelvic floor muscle hypertrophy, intramuscular coordination, and power, which are more in line with conventional skeletal muscle training, i.e., performed with higher intensities and workout.

Highlights

Introduction and hypothesis involuntary reflexive pelvic floor muscle contractions seem crucial during stress urinary incontinence-provoking situations, hitherto existing guidelines feature voluntary pelvic floor muscle training only
Baseline assessment of 45 (EXP) and 47 (CON) participants was completed, as 4 participants were lost after randomization (EXP: due to personal reasons n = 1, medical problems n = 2; control group (CON): not available n = 1)
Based on the intention-to-treat approach and the applied last observation carried forward method, missing data were replaced by the last valid data of the respective participant (EXP: 4 participants with 1, 3, 6, and 7 missing data; CON: 4 participants with 5, 5, 7, and 8 missing data)

Summary

Introduction

Introduction and hypothesis involuntary reflexive pelvic floor muscle contractions seem crucial during stress urinary incontinence-provoking situations, hitherto existing guidelines feature voluntary pelvic floor muscle training only. Fast involuntary reflexive PFM contractions were observed during coughing [6], running [7], trampolining [8] and jumping [8, 9] within the time interval of 30 ms before (pre-activation) to 150 ms after an impact. The latter characterizes slow (30–60 ms), mid (60–90 ms), and long latency (90–120 ms) reflex responses and long latency succeeding (120–150 ms) reflex responses [10]. Training procedures following the concepts of training science and sports medicine are generally evident, well known and widely implemented in rehabilitation and sports [14]; an optimal and wellstandardized training protocol that includes involuntary reflexive PFM contractions remains unknown

Methods

Results

Discussion

Conclusion