Effect Of Pelvic Floor Muscle Training Research Articles

Never Too Late to Train: The Effects of Pelvic Floor Muscle Training on the Shape of the Levator Hiatus in Incontinent Older Women.

Pelvic floor muscle (PFM) training is the first-line treatment for women of all ages with urinary incontinence (UI), but evidence supporting its effects on the functional anatomy of the pelvic floor is scarce in older women. We aimed to evaluate the long-term (one-year) effects of PFM training on the shape of the levator hiatus (LH) in older women with UI and its association with PFM force, incontinence severity, and potential effect modifiers (age, UI severity, BMI, and UI type). This is a secondary analysis of the GROUP study, a non-inferiority RCT assessing the effects of a structured and progressive 12-week PFM training program to treat UI in older women. Data were available from 264/308 participants at the one-year follow-up. PFM training resulted in reduced LH size toward a more “circular” shape, which was consistently associated with greater PFM force and reduced UI severity. Further, no significant interactions were found between LH shape changes and any of the potential effect modifiers, suggesting that women will potentially benefit from PFM training, regardless of age, UI severity, BMI, and UI type (stress or mixed), with changes that can be observed in the functional anatomy of the pelvic floor and sustained in the long-term.

Effects of Pelvic-Floor Muscle Training in Patients with Pelvic Organ Prolapse Approached with Surgery vs. Conservative Treatment: A Systematic Review.

The aim of this systematic review was to explore the effectiveness of pelvic-floor muscle training (PFMT) in the treatment of women with pelvic organ prolapse (POP) who had undergone either surgery or only conservative treatment, based on a selection of randomized clinical trials (RCT). The search was carried out in PubMed, Cochrane, Scopus, CINAHL, and PEDro databases between April 2021 and October 2021 using the following MeSH terms or keywords: “pelvic organ prolapse”, “POP”, “pelvic floor muscle training”, “pelvic floor muscle exercise”, “kegel exercise”, and “surgery”. The methodological quality of the studies was assessed using the PEDro scale. Eighteen RCTs were included in this review. The findings showed improvements in symptoms associated with POP, in pelvic-floor function, and in quality of life in women who performed a PFMT protocol. However, PFMT did not produce significant changes in sexual function, and the results of the change in POP stage were inconclusive. When viewing PFMT as a complementary treatment to surgery, no significant improvements were observed in any of the analyzed variables. In conclusion, a PFMT program is an effective way to improve the pelvic, urinary, and intestinal symptoms associated with POP; function of the pelvic floor; and quality of life. PFMT as an adjunct to surgery does not seem to provide a greater benefit than surgical treatment alone. RCTs of higher methodological quality, with a larger sample size and a longer follow-up, are needed to confirm the results.

Effects of nonsurgical, minimally or noninvasive therapies for urinary incontinence due to neurogenic bladder: a systematic review and meta-analysis.

Objective:To determine the effects of nonsurgical, minimally or noninvasive therapies on urge urinary incontinence (UUI) symptoms and quality of life (QoL) in individuals with neurogenic bladder (NGB).Data Sources:Cochrane library, EMBASE, MEDLINE, PEDro, Scopus, and Web of Science databases were searched from inception to September 2021.Review Methods:Randomized controlled trials that compared therapies such as intravaginal electrical stimulation (IVES), transcutaneous electrical nerve stimulation (TENS), neuromuscular electrical stimulation (NMES), transcutaneous tibial nerve stimulation (TTNS), pelvic floor muscle training (PFMT), and behavioural therapy (BT) to control were included. Study screening, data extraction, and study quality assessments were performed by two independent authors.Results:Fourteen trials with 804 participants were included in the study after screening of 4281 potentially relevant articles. Meta-analyses revealed a significant effect of electrical stimulation on UUI due to multiple sclerosis (standardized mean difference (SMD): −0.614; 95% confidence interval (CI): −1.023, −0.206; p = 0.003) and stroke (SMD: −2.639; 95% CI: −3.804, −1.474; p = 0.000). The pooled analyses of TTNS (weighted mean difference (WMD): −12.406; 95% CI: −16.015, −8.797; p = 0.000) and BT (WMD: −9.117; 95% CI: −14.746, −3.487; p = 0.002) revealed significant effects of these interventions on QoL in people with Parkinson’s disease. However, meta-analyses revealed nonsignificant effects for PFMT (WMD: −0.751; 95% CI: −2.426, 0.924; p = 0.380) and BT (WMD: −0.597; 95% CI: −1.278, 0.083; p = 0.085) on UUI due to Parkinson’s disease.Conclusions:Our meta-analyses found electrical stimulation to be beneficial for improving the symptoms of UUI among people with multiple sclerosis and those with stroke. Our review also revealed that TTNS and BT might improve QoL for people with NGB due to Parkinson’s disease, although the effects of PFMT and BT on UUI warrant further investigation.

Pelvic-Floor Dysfunction Prevention in Prepartum and Postpartum Periods.

Every woman needs to know about the importance of the function of pelvic-floor muscles and pelvic organ prolapse prevention, especially pregnant women because parity and labor are the factors which have the biggest influence on having pelvic organ prolapse in the future. In this article, we searched for methods of training and rehabilitation in prepartum and postpartum periods and their effectiveness. The search for publications in English was made in two databases during the period from August 2020 to October 2020 in Cochrane Library and PubMed. 77 articles were left in total after selection—9 systematic reviews and 68 clinical trials. Existing full-text papers were reviewed after this selection. Unfinished randomized clinical trials, those which were designed as strategies for national health systems, and those which were not pelvic-floor muscle-training-specified were excluded after this step. Most trials were high to moderate overall risk of bias. Many of reviews had low quality of evidence. Despite clinical heterogeneity among the clinical trials, pelvic-floor muscle training shows promising results. Most of the studies demonstrate the positive effect of pelvic-floor muscle training in prepartum and postpartum periods on pelvic-floor dysfunction prevention, in particular in urinary incontinence symptoms. However more high-quality, standardized, long-follow-up-period studies are needed.

The Effect of Pelvic Floor Muscle Training on Pelvic Floor Dysfunction in Pregnant and Postpartum Women

<strong>Background:</strong> Pelvic floor dysfunction (PFD) seriously affects the patients’ quality of life, and its incidence is closely related to pregnancy and delivery. Pelvic floor muscle training (PFMT) is a conservative treatment of PFD. For decades, different researchers have conducted PFMT research on different female groups. However, the efficacy of PFMT for pregnant and postpartum women is controversial. Therefore, this article aimed to systematic review the efficacy of PFMT for them. This article reviewed the relationship between the occurrence and development of PFD during pregnancy and delivery, and the effect of PFMT on PFD in pregnant and postpartum women. <strong>Method:</strong> We used the keywords of “pelvic floor dysfunction” and “pelvic floor muscles training”, and focused on the study of PFMT during pregnancy and postpartum. Finally, 54 related studies were selected, including randomized controlled trials, quasi experimental trials, observational studies, longitudinal cohort studies, cross-sectional studies, and systematic reviews. <strong>Result:</strong> During pregnancy, PFMT can prevent the occurrence of PFD in late pregnancy and early postpartum, and in the early postpartum period, PFMT can improve the symptoms of PFD. PFMT has a protective effect on the pelvic floor without obvious negative effects. However, PFMT has not been popularized in pregnant and postpartum women. And its beneficial effects cannot be maintained for a long time if women cannot insist on it for a long time. <strong>Conclusion:</strong> The popularization and standard guidance of PFMT during the pregnancy and postpartum period should be strengthened vigorously in hospital. The development of a personalized PFMT program according to the individual situation of pregnant and postpartum women can improve the pelvic floor symptoms and their quality of life of women.

Exercise and Quality of Life in Women with Menopausal Symptoms: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.

Menopausal symptoms are associated with deterioration in physical, mental, and sexual health, lowering women’s quality of life (QoL). Our study objective is to examine the effect of exercise on QoL in women with menopausal symptoms. After initially identifying 1306 studies published on PubMed, Web of Science, Scopus, and Cochrane Library before June 2020, two researchers independently selected nine randomized controlled trials (RCTs) in which any type of exercise was compared with no active treatment. We assessed the risk of bias in the included studies using the Cochrane risk-of-bias 2.0 tool for RCTs and computed the converged standardized mean difference with a 95% confidence interval. We found evidences for the positive effects of exercise on physical and psychological QoL scores in women with menopausal symptoms. However, there was no evidence for the effects of exercise on general, social, and menopause-specific QoL scores. The most common interventions for women with menopausal and urinary symptoms were yoga and pelvic floor muscle training (PFMT), respectively. In our meta-analyses, while yoga significantly improved physical QoL, its effects on general, psychological, sexual, and vasomotor symptoms QoL scores as well as the effect of PFMT on general QoL were not significant. Our findings suggest that well-designed studies are needed to confirm the effect of exercise on QoL in women with menopausal symptoms.

Pelvic floor muscle training programme in pregnant Nepalese women-a feasibility study.

Pelvic floor muscle training (PFMT) is internationally recommended for prevention and treatment of urinary incontinence (UI) and pelvic organ prolapse (POP). However, there is lack of knowledge about PFMT among pregnant Nepalese women. The objectives of this study were to develop a PFMT programme and to assess the feasibility of the programme. A feasibility study was conducted to address aspects of the PFMT programme provided to pregnant women attending antenatal check-ups at Kathmandu University Dhulikhel Hospital. The women were recruited consecutively from June 2017 to April 2018. The PFMT programme consisted of attending a minimum of four supervised PFMT follow-up visits after inclusion to the programme and performing PFMT daily at home. Feasibility was assessed in terms of the recruitment capability, sample characteristics, data collection procedures, outcome measures, and acceptability (attendance to PFMT visits, PFMT adherence, participant experiences) of the programme. Data were collected using self-reported questionnaires. Educational material (video, leaflet, and exercise diary) was developed in Nepali. Among 253 women included, 144 (57%) attended four or more supervised PFMT visits. No significant differences were found in the symptoms of UI (0.89) and POP (0.44) between those attending and those not attending four PFMT visits. Half of the women adhered to 50-100% of PFMT daily at home. The supervised PFMT and the educational material motivated the women to daily PFMT. The PFMT programme was acceptable, at least to those living in the district of the study site. The results and experiences from the current study may guide implementation and future studies on the effectiveness of PFMT in Nepal.

Effectiveness of physiotherapy interventions for improving erectile function and climacturia in men after prostatectomy: a systematic review and meta-analysis of randomized controlled trials

Objective: To determine the effectiveness of physiotherapy interventions for postprostatectomy erectile dysfunction and climacturia. Data sources: Multiple databases were searched from database inception to February 2019. Review methods: Randomized controlled trials comparing physiotherapy interventions to control were included. Results: The search yielded 127 potentially relevant articles; seven met the inclusion criteria and were included in the review. Meta-analysis of two studies revealed a statistically significant effect of pelvic floor muscle training (PFMT) plus biofeedback compared to the no treatment control group for erectile function at the12-month follow-up period (risk ratio (RR) = 3.65, 95% confidence interval (CI) = 1.02–13.05; P = 0.05). Data from one small study (n = 31) identified a greater number of men reporting improved climacturia in the PFMT plus electrical stimulation group compared to the no treatment control group, and the overall effect was significant (RR = 15.60, 95% CI = 0.95–254.91; P = 0.05). Meta-analyses of two studies found no statistically significant differences between groups receiving PFMT and no treatment control for erectile function or climacturia at long-term follow-up. Conclusions: PFMT augmented with biofeedback improves erectile function after prostatectomy. Data from a single study found PFMT combined with electrical stimulation to be beneficial for postprostatectomy climacturia. However, electrical stimulation is recommended for terminally ill people only. The effect of PFMT alone on postprostatectomy erectile dysfunction and climacturia remains inconclusive. However, this is likely to be affected by the participant adherence and physiotherapy supervision. High-quality trials providing intensive supervision and due consideration of adherence factors are recommended.

Effectiveness of Pelvic Floor Muscle Training Alone and in Combination With Biofeedback, Electrical Stimulation, or Both Compared to Control for Urinary Incontinence in Men Following Prostatectomy: Systematic Review and Meta-Analysis.

The efficacy of pelvic floor muscle training (PFMT) alone and in combination with biofeedback (BFB), electrical stimulation (ES), or both for urinary incontinence in men following prostatectomy is inconclusive. The purpose of this study was to determine whether PFMT works well alone or in combination with BFB, ES, or both in comparison with a control. The databases Ovid Medline, EMBASE, CENTRAL, Scopus, and Web of Science, and the specialized register of the Citroen Incontinence Review Group were searched from study inception to August 2017. Abstract proceedings from urological meetings, including the European Association of Urology and the American Urological Association, were also searched. Randomized controlled trials that compared PFMT alone and PFMT with ES, BFB, or both and no treatment, placebo, or sham were included in the review. Two independent reviewers completed data extraction and quality appraisal. The Grading of Recommendations, Assessment, Development, and Evaluation tool was used for quality appraisal. Meta-analysis was done with software used for preparing and maintaining Cochrane reviews. Methodological flaws in the included studies limited internal validity. PFMT alone, PFMT plus BFB and ES, and PFMT plus ES were more effective than the control for urinary incontinence following prostatectomy. The effect of PFMT plus BFB on postprostatectomy incontinence remains uncertain.

Clinical effect of electrical stimulation and exercise on the rehabilitation of the pelvic floor

Objective To investigate the effect of biofeedback electrical stimulation and pelvic floor muscle training on the rehabilitation of pelvic floor muscle after delivery by vaginal delivery. Methods From January 2014 to June 2015, 90 cases who received pelvic floor rehabilitation treatment after vaginal delivery in Department of Gynecology and Obstetrics of our hospital were selected as the research subjects.According to whether the patients received pelvic floor rehabilitation training, they were divided into the treatment group and control group, 90 cases in each group.The treatment group received biofeedback electrical stimulation, pelvic floor muscle training methods of rehabilitation at 6 weeks postpartum.The control group did not take any measures of rehabilitation. Results 4 months postpartum, the bladder neck mobility, urethral rotation angle of the treatment group were significantly lower than those of the control group (t=6.052, 4.400, all P<0.05). the vaginal muscles voltage measured values of the treatment group was significantly higher than that of the control group (t=9.524, P<0.05).4 months postpartum, in the treatment group, vaginal muscle Ⅰ grade in 24.44%, grade Ⅱ in 55.56% and grade Ⅲ in 17.78%, grade Ⅳ in 2.22%; in the control group, the vaginal muscle strength grade Ⅰin 44.44%, grade Ⅱ in 55.56%; The vaginal muscle distribution in the treatment group was significantly better than the control group (Z=-2.865, P<0.05). Conclusion After vaginal delivery, maternal postpartum receiving biofeedback electrical stimulation, pelvic floor muscle exercise can significantly promote the recovery of pelvic floor muscle function. Key words: Vagina delivery; Biofeedback; Electrical stimulation; Pelvic floor muscle exercise; Rehabilitation

Influence of voluntary pelvic floor muscle contraction and pelvic floor muscle training on urethral closure pressures: a systematic literature review

Stress urinary incontinence (SUI) is managed with pelvic floor muscle training (PFMT), but the mechanism of treatment action is unclear. Resting maximal urethral closure pressure (MUCP) is lower in women with SUI, but it is unknown whether PFMT can alter resting MUCP. This systematic review evaluated whether voluntary pelvic floor muscle (PFM) contraction increases MUCP above its resting value (augmented MUCP) and the effect of PFMT on resting and augmented MUCP. Experimental and effect studies were identified using PubMed and PEDro. The PEDro scale was used to assess internal validity of interventional studies. We identified 21 studies investigating the influence of voluntary PFM contraction in women. Comparison was hindered by varying demographics, antecedent history, reporting of confirmed correct PFM contraction, and urethral pressure profilometry (UPP) techniques. Mean incremental increase in MUCP during PFM contraction in healthy women was 8-47.3cm H2O; in women with urinary incontinence (UI), it was 6-24cm H2O. Nine trials reporting MUCP as an outcome of PFMT were found. Wide variation in PFMT regimes affected the findings. Two studies found significant improvement in MUCP of 5-18cmH20. Seven studies assessed augmentation of MUCP with PFM contraction; mean increase was -0.1 to 25cmH20. There is no definitive evidence that PFMT increases resting MUCP as its mechanism of action in managing SUI. The degree to which a voluntary PFM contraction augments MUCP varies widely. There was evidence to suggest PFMT increases augmented MUCP. Drawing firm conclusions was hampered by study methodologies.

Effects of puerperium pelvic floor muscle training on pelvic floor muscle strength

Objective To analyze the effects of puerperium pelvic floor muscle training on pelvic floor muscle strength and its clinical significance. Methods One hundred postpartum women were included, with full-term singleton pregnancies and with complete follow-up records from Obstetrics Department of Peking University First Hospital between March 1, 2013 and October 31, 2013. Women with vaginal birth and cesarean birth commenced pelvic floor muscle training twice a day from 24 and 72 h after delivery, respectively. According to the different training frequencies, the subjects were divided into three groups: never-training group, occasional-training group (<6 times per week) and regular-training group (≥6 times per week). All patients received pelvic floor muscle strength measurement 6-8 weeks after parturition. And the strength of type Ⅰ and type Ⅱ pelvic floor muscle fiber was divided into 0, Ⅰ, Ⅱ, Ⅲ, Ⅳ and Ⅴgrade. The abnormal strength of type Ⅰ and type Ⅱ pelvic floor muscle fiber standed for the grades lower than Ⅲ. We compared the general conditions, delivery modes and abnormal ratio of type Ⅰ and type Ⅱ pelvic floor muscle fiber among the three groups, analyzed the relativity between the level of pelvic floor muscle fiber strength and pelvic floor muscle training frequency, and analyzed the influential factors of pelvic floor muscle fiber strength. Statistical analyses were performed by one-way ANOVA, rank-sum test, Pearson χ2 test, Kruskal-Wallis nonparametric test, Nemenyi test, Spearman rank correlation analysis and multivariate Logistic regression analysis. Results There was no statistical difference in age, gestation at delivery, parity, body mass index before delivery, neonatal birth weight and delivery mode among the never-training group (21 cases), occasional-training group (30 cases) and regular-training group (49 cases) (all P >0.05). There was no statistical difference in labor time of first, second and total stage and episiotomy rate among the vaginal birth cases of the three groups. The abnormal ratio of typeⅠmuscle fiber strength among the three groups was 100% (21/21), 77% (23/30) and 6% (3/49), respectively, while that of typeⅡmuscle fiber strength was 100% (21/21), 53% (16/30) and 20% (10/49), respectively. And there were significant statistical differences among the three groups (F=119.16 and 77.84, both P<0.01). Spearman rank correlation analysis indicated that the level of typeⅠand typeⅡmuscle fiber strength had a significant positive correlation with pelvic floor muscle training frequency (r=0.88 and 0.79, both P<0.01). Multivariate Logistic regression analysis showed that pelvic floor muscle training was an influential factor for pelvic floor muscle strength level (95%CI: 0.000-0.193, P<0.01). Conclusions Puerperium pelvic floor muscle training can help enhance the tension force of pelvic floor muscle, might benefiting the postpartum recovery of pelvic floor muscle function. Key words: Postpartum period; Pelvic floor; Exercise therapy; Muscle strength

Postpartum pelvic floor muscle training and pelvic organ prolapse—a randomized trial of primiparous women

Pelvic organ prolapse (POP) is a common and distressing condition. The aim of the present study was to evaluate the effect ofpelvic floor muscle training (PFMT) on prevention and treatment ofsymptoms and signs of POP in primiparous postpartum women. This was a parallel group assessor blind randomized controlled trial. One hundred seventy-five primiparous postpartum women, mean age 29.8 years (standard deviation 4.1), stratified on major levator ani defects or no defect diagnosed by 3-/4-dimensional ultrasound, participated in a 4-month PFMT starting at 6-8 weeks' postpartum or control. All participants had thorough individual instruction and assessment of ability to perform correct pelvic floor muscle contractions. The PFMT group followed a supervised, weekly group training program and performed 3 sets of 8-12 daily maximal contractions at home. Main outcome was POP stage II or greater assessed by POP quantification and bladder neck position assessed by 3-/4- dimensional transperineal ultrasonography. Secondary outcome was symptoms of vaginal bulge using International Consultation on Incontinence Vaginal Symptoms questionnaire. Ninety-six percent of the intervention group adhered to ≥80% of both group and home training sessions. At postintervention, there was no significant risk difference in POP (rational ratio, 1.62; 95% confidence interval, 0.55-4.75), bladder neck position or symptoms of vaginal bulging. No effect was found of postpartum PFMT on POP in primiparous women. More randomized controlled trials are needed before strong conclusions can be drawn on the effect of PFMT on POP in the particular population.

Does Regular Exercise Including Pelvic Floor Muscle Training Prevent Urinary and Anal Incontinence During Pregnancy? A Randomised Controlled Trial

Please cite this paper as: Stafne S, Salvesen K, Romundstad P, Torjusen I, Morkved S. Does regular exercise including pelvic floor muscle training prevent urinary and anal incontinence during pregnancy? A randomised controlled trial. BJOG 2012; DOI: 10.1111/j.1471-0528.2012.03426.x. Objective To assess whether pregnant women following a general exercise course, including pelvic floor muscle training (PFMT), were less likely to report urinary and anal incontinence in late pregnancy than a group of women receiving standard care. Design A two-armed, two-centred randomised controlled trial. Setting Trondheim University Hospital (St. Olavs Hospital) and Stavanger University Hospital, in Norway. Population A total of 855 women were included in this trial. Methods The intervention was a 12-week exercise programme, including PFMT, conducted between 20 and 36 weeks of gestation. One weekly group session was led by physiotherapists, and home exercises were encouraged at least twice a week. Controls received regular antenatal care. Main outcome measures Self-reported urinary and anal incontinence after the intervention period (at 32-36 weeks of gestation). Results Fewer women in the intervention group reported any weekly urinary incontinence (11 versus 19%, P = 0.004). Fewer women in the intervention group reported faecal incontinence (3 versus 5%), but this difference was not statistically significant (P = 0.18). Conclusions The present trial indicates that pregnant women should exercise, and in particular do PFMT, to prevent and treat urinary incontinence in late pregnancy. Thorough instruction is important, and specific pelvic floor muscle exercises should be included in exercise classes for pregnant women. The preventive effect of PFMT on anal incontinence should be explored in future trials. (Less)

Pelvic floor muscle training for prevention and treatment of urinary and faecal incontinence in antenatal and postnatal women

About a third of women have urinary incontinence and up to a 10th have faecal incontinence after childbirth. Pelvic floor muscle training is commonly recommended during pregnancy and after birth both for prevention and the treatment of incontinence. To determine the effect of pelvic floor muscle training compared to usual antenatal and postnatal care on incontinence. We searched the Cochrane Incontinence Group Specialised Register, which includes searches of CENTRAL, MEDLINE, MEDLINE in Process and handsearching (searched 7 February 2012) and the references of relevant articles. Randomised or quasi-randomised trials in pregnant or postnatal women. One arm of the trial needed to include pelvic floor muscle training (PFMT). Another arm was either no PFMT or usual antenatal or postnatal care. Trials were independently assessed for eligibility and methodological quality. Data were extracted then cross checked. Disagreements were resolved by discussion. Data were processed as described in the Cochrane Handbook for Systematic Reviews of Interventions. Three different populations of women were considered separately, women dry at randomisation (prevention); women wet at randomisation (treatment); and a mixed population of women who might be one or the other (prevention or treatment). Trials were further divided into those which started during pregnancy (antenatal); and those started after delivery (postnatal). Twenty-two trials involving 8485 women (4231 PFMT, 4254 controls) met the inclusion criteria and contributed to the analysis.Pregnant women without prior urinary incontinence (prevention) who were randomised to intensive antenatal PFMT were less likely than women randomised to no PFMT or usual antenatal care to report urinary incontinence up to six months after delivery (about 30% less; risk ratio (RR) 0.71, 95% CI 0.54 to 0.95, combined result of 5 trials).Postnatal women with persistent urinary incontinence (treatment) three months after delivery and who received PFMT were less likely than women who did not receive treatment or received usual postnatal care to report urinary incontinence 12 months after delivery (about 40% less; RR 0.60, 95% CI 0.35 to 1.03, combined result of 3 trials). It seemed that the more intensive the programme the greater the treatment effect.The results of seven studies showed a statistically significant result favouring PFMT in a mixed population (women with and without incontinence symptoms) in late pregnancy (RR 0.74, 95% CI 0.58 to 0.94, random-effects model). Based on the trial data to date, the extent to which mixed prevention and treatment approaches to PFMT in the postnatal period are effective is less clear (that is, offering advice on PFMT to all pregnant or postpartum women whether they have incontinence symptoms or not). It is possible that mixed prevention and treatment approaches might be effective when the intervention is intensive enough.There was little evidence about long-term effects for either urinary or faecal incontinence. There is some evidence that for women having their first baby, PFMT can prevent urinary incontinence up to six months after delivery. There is support for the widespread recommendation that PFMT is an appropriate treatment for women with persistent postpartum urinary incontinence. It is possible that the effects of PFMT might be greater with targeted rather than mixed prevention and treatment approaches and in certain groups of women (for example primiparous women; women who had bladder neck hypermobility in early pregnancy, a large baby, or a forceps delivery). These and other uncertainties, particularly long-term effectiveness, require further testing.

The Role of Pelvic Floor Muscle Training in Urinary Incontinence

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.

Pelvic Floor Muscle Training is Effective in Treatment of Female Stress Urinary Incontinence, but how Does it Work?

To date several randomized controlled trials (RCT) have shown that pelvic floor muscle (PFM) training is effective in the treatment of female stress (SUI) and mixed urinary incontinence and, therefore, it is recommended as a first-line therapy. While the effectiveness of treatment is established, there are different theoretical rationales for why PFM training is effective. The aims of this article are to discuss the theories behind why PFM training is effective in treating SUI and to discuss each theory in the framework of new knowledge of functional anatomy and examples of results from RCTs. There are three proposed theories to explain the effectiveness of PFM training for SUI: 1) women learn to consciously pre-contract the PFMs before and during increases in abdominal pressure (such as coughing, physical activity) to prevent leakage; 2) strength training builds up long-lasting muscle volume and thus provides structural support; and 3) abdominal muscle training indirectly strengthens the PFM. The first can be placed in a behavioral construct, while the two latter both have the aim of changing neuromuscular function and morphology, thus making the PFM contraction automatic. To date there are RCTs and basic anatomy studies to support the first two concepts only.