Pelvic floor muscle exercise for the treatment of stress urinary incontinence: An exercise physiology perspective

Abstract

The aim of this article is to give an overview of the exercise science related to pelvic floor muscle (PFM) strength training, and to assess the effect of PFM exercises to treat stress urinary incontinence (SUI). Sixteen articles addressing the effect of PFM exercise alone on SUI were compiled by computerized search or found in other review articles. Studies with no statement that correct PFM contraction had been performed were excluded. Kegel's suggestion was to perform 3–500 PFM contractions per day. However, suggestions for effective strength training from the exercise science is 8–12 contractions in three series 3–4 times a week for 15–20 weeks or more. Frequency of training varies between 10 repetitions every waking hour to half an hour 3 days a week. Holding periods vary between 2 and 3 s and 30–40 s. Exercise periods vary between 3 weeks and 6 months. Only a few research groups have used methods to measure PFM strength that were reproducible and valid. Statistically significant strength increase has been found after PFM exercise lasting from 3 to 6 months. In all studies the exercises were conducted with thorough individual instruction, vaginal palpation, feedback and close follow-up. Self-reported cure and success rates vary between 17% and 84%. Statistically significant improvement has been demonstrated on self-grading instruments, urethral closure pressure during cough, resting urethral pressure, functional urethral profile length, leakage episodes and pad tests with standardized bladder volume. The results of the long-term studies are promising. It is therefore concluded that PFM exercises are effective in treating SUI. They are cost-effective and should be the first choice of treatment. To be effective, PFM exercise has to be thoroughly taught and performed with weekly or monthly follow-up.