The role of pelvic floor muscle training in urinary incontinence

Abstract

Since Kegel first reported good outcomes for pelvic floor muscle training (PFMT) in women with urinary incontinence this therapy has become used for women with stress and mixed incontinence. PFMT is recommended as first line treatment by various groups and the NICE guidance on tension-free vaginal tape (TVT; www.nice.org.uk) suggests that this should only be used when conservative measures such as PFMT have been unsuccessful. Success rates of 56%–75% have been quoted but the quality of many studies is poor with only a few wellconducted randomised controlled trials. These have been assessed in a Cochrane review that shows that PFMT is better than no treatment or placebo treatments in stress incontinence, but the role in women with overactive bladder and urge incontinence is less clear. At present there is a lack of data to assess the long-term effectiveness of PFMT and it is claimed that many women do not wish to undergo several months of PFMT when minimally invasive surgical alternatives produce good medium-term results. However, in a recent study of preferences for treatment of stress incontinence, 65% of women attending three tertiary referral clinics chose pelvic muscle training rather than surgery (after being given information on all treatment options). This is consistent with the findings of an earlier study suggesting that most women would prefer to avoid surgery. It is essential therefore that PFMT is performed properly and that good results are achieved for these patients.