Pelvic Floor Muscle Training Research Articles

Conservative treatments for women with stress urinary incontinence: a systematic review and network meta-analysis

ObjectiveThis study aimed to compare the effectiveness of various conservative treatment strategies for women with stress urinary incontinence.MethodsA comprehensive search of PubMed, Web of Science, Embase, and the Cochrane Library was conducted from their inception through March 2024, without restrictions on language or location. Randomized controlled trials (RCTs) comparing the efficacy of conservative treatments for stress urinary incontinence, using short-term pad test or the International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form (ICIQ-UI SF) score as outcome measures, were included. We conducted a network meta-analysis using a random-effects model to compare the effectiveness of different conservative treatment strategies, employing prediction interval plots and league tables, and ranked them according to the surface under the cumulative ranking curve (SUCRA). The quality of the included studies was assessed following the Cochrane Handbook for Systematic Reviews of Interventions.ResultsA total of 31 RCTs involving 1,900 patients across 8 intervention categories were included in the analysis. SUCRA rankings indicated that electrical stimulation (SUCRA = 95.9%) was the most effective therapy for improving ICIQ-UI SF scores, followed by biofeedback electrical stimulation (SUCRA = 84.9%), radiofrequency (SUCRA = 77.5%), biofeedback (SUCRA = 57.8%), magnetic stimulation (SUCRA = 45.3%), pelvic floor muscle training (SUCRA = 38.4%), Er: YAG laser (SUCRA = 37.4%), and CO2 laser (SUCRA = 7.4%). In terms of reducing urine leakage, the treatments were ranked in descending order as follows: Er: YAG laser (SUCRA = 97.5%), biofeedback electrical stimulation (SUCRA = 83.4%), biofeedback (SUCRA = 67.0%), radiofrequency (SUCRA = 59.5%), electrical stimulation (SUCRA = 48.4%), pelvic floor muscle training (SUCRA = 43.0%), magnetic stimulation (SUCRA = 27.8%), and CO2 laser (SUCRA = 21.4%). Based on the clustered rankings of the two metrics, biofeedback electrical stimulation was identified as the most effective therapy for improving stress urinary incontinence.ConclusionBased on the combined analysis of two indicators, we found that biofeedback electrical stimulation may be the optimal therapy for the conservative management of stress urinary incontinence.Systematic review registrationhttps://www.crd.york.ac.uk/prospero/, identifier CRD42024569845.

Effect of Bladder Training and Pelvic Floor Muscle Exercises on Urge Control among Patients with Overactive Bladder Syndrome.

Effect of Bladder Training and Pelvic Floor Muscle Exercises on Urge Control among Patients with Overactive Bladder Syndrome.

A physical therapy program to treat late-effect vaginal stenosis in gynecological cancer survivors: An interventional study.

To evaluate the effect of a physical therapy program on vaginal length and diameter, pelvic floor strength, and quality of life among gynecological cancer survivors suffering from late-effect vaginal stenosis. Thirty-four women who were previously diagnosed with gynecological cancer and experiencing vaginal stenosis, at least 12months post-oncological treatment, were enrolled. The intervention program consisted of ten weeks of individualized weekly sessions, each lasting 50min, involving perineal massage, progressive vaginal dilation, and pelvic floor exercises. Pre- and post-treatment evaluations included assessments of pelvic floor muscle strength through digital palpation, measurements of vaginal length and diameter using a silicone vaginal dilator, and classification of stenosis according to the Common Terminology Criteria for Adverse Events (CTCAE v5.0). Health-related quality of life was assessed using the FACT-G and FACT-Cx questionnaires. Twenty-one women completed the physical therapy program. There was a significant increase in vaginal length (p < 0.001), vaginal diameter (p < 0.001) and improvement in pelvic floor muscle strength (p < 0.001), with a large effect size (r = 0.81), a medium effect size (r = -0.77) and a medium effect size (r = -0.78), respectively. This resulted in resolution of vaginal stenosis in 14 participants (66.7%) following intervention. Mean scores for FACT-Cx and FACIT-G, encompassing total scores and physical, social, and functional well-being domains, increased significantly after the treatment. The proposed physical therapy program demonstrated positive effects on vaginal stenosis, pelvic floor muscle strength and health-related quality of life in gynecological cancer survivors.

Do We Need to Re-Focus on Functional Female Urethral Disorders in Lower Urinary Tract Dysfunction? ICI-RS 2024.

Insights into the role of the urethra in maintaining continence and in normal voiding have been provided with advances in imaging techniques. Also, functional urethral testing is used to understand which treatments are optimal for women with functional bladder outlet obstruction (BOO), but which testing is better for which treatment? This review aims to describe our current understanding of female urethral function and dysfunction and to provide future research directions for treating functional female urethral disorders. This is a consensus report of the proceedings of a research proposal discussed at the annual International Consultation on Incontinence-Research Society (ICI-RS), 6th-8th June 2024 (Bristol, UK): "Do we need to re-focus on functional female urethral disorders in lower urinary tract dysfunction? ICI-RS 2024". Regarding female urethral nomenclature, it was agreed that the same terminology should be used in the orientation of the female urethra as in the male. Also, functional MRI and computer modeling could aid further understanding of urethral function in women with voiding dysfunction and OAB symptoms. As for functional urethral assessment, options include video-urodynamics with leak point pressure (LPP) testing, urethral pressure profilometry (UPP), and striated urethral sphincter electromyography (EMG). Future testing may include the use of modalities (borrowed from cardiologic assessment of vascular structures such as resistive measures obtained with ultrasound) for the purpose of assessing urethral closure. UPP testing has limitations in measurement and reproducibility in assessing urethral pressure. Urethral sphincter EMG is difficult to perform and reproduce. LPP also has limitations related to testing and to patient effort, in addition to being influenced by factors such as bladder volume and compliance. When performing urethral surgery, it is imperative to dissect in tissue planes that preserve urethral function. Regarding therapeutic modalities for the treatment of functional female urethral dysfunction, conservative management includes pelvic floor muscle training with or without biofeedback, electrical stimulation, and extracorporeal magnetic stimulation. Furthermore, there was a robust discussion on the use of cognitive-behavioral therapy to address psychological comorbidities, thereby improving female LUTD. The evidence supporting long-term pharmacologic treatment of female urethral LUTD remains scarce. As for invasive management options, the evidence supporting the use of botulinum toxin in female LUTD is limited. Finally, the very existence of BNO and the validity of its diagnosis was discussed. Furthermore, bladder neck incision as a treatment of BNO was debated, and the indications for this procedure include a therapeutic decision balancing benefit to complications. Improving the treatment of female functional storage and voiding disorders depends on optimal urethral function assessment. Functional MRI to better understand urethral function, expanding the use of UPP testing, LPP testing, and emerging modalities while maintaining urethral function during female urethral surgery, and addressing psychological comorbidities whilst pursuing both conservative and invasive options (for refractory symptoms) are all important considerations in treating functional female urethral disorders.

EFICÁCIA DO TREINAMENTO DA MUSCULATURA DO ASSOALHO PÉLVICO ASSOCIADO A OUTROS RECURSOS FISIOTERAPÊUTICOS PARA TRATAMENTO DE MULHERES COM INCONTINÊNCIA URINÁRIA DE ESFORÇO: REVISÃO DE LITERATURA

Background: Urinary Incontinence (UI) consists of any involuntary voiding loss, being frequent in the female population. The most common types of UI are: stress urinary incontinence (SUI), urge urinary incontinence (UUI), and mixed urinary incontinence (IUM). This condition negatively affects patients, impairing psychological well-being and quality of life. Physiotherapy plays an assertive role in the rehabilitation of patients suffering from Urinary Incontinence, with pelvic floor muscle training (PFMT) being one of the most used resources to help prevent and treat this condition. Pourpose: To understand the efficacy of PFMT associated with other physical therapy resources in the treatment of women with SUI. Methods: This is a literature review study, whose databases were PEDro, Pubmed and Capes Journals. The inclusion criteria were articles from randomized clinical trials or experimental studies on the role of PFMT associated with other physical therapy resources in the treatment of women with SUI. Results: This review included seven articles that verified the efficacy of PFMT associated with other physiotherapeutic resources, of which PFMT in conjunction with biofeedback, electroacupuncture and resistance training obtained beneficial results with some caveats, while PFMT associated with reflective involuntary training did not obtain significant results. Conclusion: Pelvic floor muscle training remains the best protocol for reducing symptoms of stress urinary incontinence.

Electrical Muscle Stimulation for the Conservative Management of Female Pelvic Floor Muscle Dysfunction: A Scoping Review

Background: Electrical muscle stimulation (EMS) is a conservative management tool for the treatment of pelvic floor dysfunctions (PFDs). The aim of this review was to scope, summarize and critically evaluate available research investigating the impact of various modes of EMS on PFDs in females. Methods: Joanna Briggs Institute methodology for scoping reviews was used with The Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews. Three databases were searched. Articles published in English that included female participants living with pelvic floor muscle dysfunction where EMS was used as a conservation care intervention were included in the review. Included studies were analyzed following Arksey and O’Malley’s framework. The Cochrane Risk of Bias Tool for randomized trials was used to assess risk of bias for the randomized controlled trials (RCTs), and Hawker and Payne’s quality appraisal criteria was used to appraise the data from the other included papers systematically. Results: A total of 37 studies, including 20 RCTs were included. A favorable impact, across various outcomes, was found across trials which investigated different types of EMS with varying protocols. The heterogenous nature of intervention protocols limited the ability to apply any statistical or meta-analyses. EMS demonstrates a positive effect for improving outcomes related to PFDs in adult women. Included studies support the use of EMS for stress, urgency and mixed urinary incontinence. All versions of EMS studied were found to provide significant improvements, which included them being used as a sole intervention or as an adjunct intervention. High intensity forms of EMS were consistently found to require shorter intervention times. Conclusions: EMS demonstrates improvement across outcomes for PFDs among adult women. In particular, the results of this review suggest that EMS may be particularly useful in women living with stress urinary incontinence (SUI) or who those are unable to perform voluntary muscle contractions when pelvic floor muscle training is attempted. Further research related to more novel versions of high intensity EMS approaches is needed.

Prenatal Exercise Decreases Urinary Incontinence in Late Pregnancy and Three Months Postpartum: A Randomized Controlled Trial

ABSTRACT Purpose This study aimed to evaluate the impact of a supervised exercise program, including Pelvic Floor Muscle Training (PFMT), throughout pregnancy on Urinary Incontinence (UI). Methods A randomized clinical trial (NCT04563065) was conducted. Initially, 600 pregnant women were screened for eligibility, with data from 356 participants eventually analyzed. Of these, 172 were allocated to the Exercise Group (EG) and 184 to the Control Group (CG). Participants in the EG engaged in a supervised moderate exercise program three days per week, each session lasting 60 minutes, from 8-10 weeks to 38-40 weeks of gestation, achieving an adherence rate of 73.5%. Results A lower prevalence of UI in the EG compared to the CG was observed during late pregnancy (χ2 = 20.04; p = 0.001) and at three months postpartum (χ2 = 12.52; p = 0.03), as well as in birth weight (F = 4.16; p = 0.04). No significant differences were found between the groups in other maternal and newborn outcomes. Conclusions Supervised exercise during pregnancy, which included PFMT, effectively reduced the incidence of urinary incontinence in late pregnancy and at three months postpartum.

FORTALECENDO O CONTROLE PÉLVICO PARA UMA VIDA SEM LIMITAÇÕES: UMA REVISÃO DE LITERATURA SOBRE A EFICÁCIA DA FISIOTERAPIA COM EXERCÍCIO DE KEGEL NO TRATAMENTO DA INCONTINÊNCIA URINÁRIA

The pelvic floor muscles support organs such as the bladder and uterus, and can weaken due to pregnancy and aging, which results in problems such as urinary incontinence or prolapse. The latter affects millions of women, being associated with factors such as age and number of births. Evaluation, especially through ultrasound, is crucial. Treatments include Kegel exercises, behavioral therapy, and mechanical devices. Innovative strategies, such as the gamification of Kegel exercises, have shown promise for improving adherence and treatment outcomes. The importance of pelvic floor muscles and their dysfunctions, such as urinary incontinence, was addressed, highlighting the need for effective and innovative approaches to improve patients' quality of life. An analysis of the efficacy of Kegel exercise on urinary incontinence in women was conducted, reviewing studies, synthesizing results, and offering recommendations for future research. A systematic review of the literature, conducted between February and May 2024, was adopted to analyze studies on Kegel exercise in urinary incontinence in women, searching for articles in databases such as VHL, PubMed, ScienceDirect, and JSTOR, with strict inclusion criteria. Studies on treatments for pelvic floor dysfunctions, such as prolapse and urinary incontinence, have revealed several approaches. Some have shown effectiveness in personalized training of the muscles, while others have compared methods such as electrical stimulation and active training. In addition, innovative techniques such as position detection during Kegel exercises and mechanotherapy were explored. The efficacy of simple interventions, such as Kegel exercises combined with behavioral therapy, was highlighted. These studies highlighted the complexity of pelvic floor dysfunctions and the importance of multifaceted and individualized approaches to treatment, highlighting the challenges faced and the need for more effective interventions to improve patients' health and quality of life. Authors have emphasized the importance of pelvic muscles and treatments such as training and behavioral therapy, while innovative strategies such as gamification have shown promise for promoting better physical, emotional, and social well-being and outcomes.

Cutting-Edge Approaches in Urinary Incontinence Treatment: A Comprehensive Review

Introduction: Urinary incontinence is a prevalent health issue that profoundly impacts the quality of life for patients worldwide. Traditional treatments, including pharmacotherapy and surgical procedures, often fall short, leaving many individuals struggling with bladder control issues that restrict physical and social activities and cause significant psychological distress. Recent advancements in therapeutic methods—encompassing behavioral therapies, cutting-edge medical technologies, innovative pharmacotherapy, and advanced surgical techniques—offer promising alternatives. By exploring the effectiveness and advantages of these novel approaches, we can enhance treatment accessibility and elevate the quality of care for those affected by urinary incontinence, ultimately improving their daily functioning and overall well-being. Abbreviated description of the state of knowledge:Current research on innovative treatments for urinary incontinence indicates significant advancements in enhancing patients' quality of life. These cutting-edge methods encompass behavioral therapies like pelvic floor muscle training, state-of-the-art medical technologies such as nerve stimulation, new pharmacological treatments with high efficacy and minimal side effects, and advanced surgical interventions, including artificial sphincter implants and urinary tract modifications. Conclusions: Urinary incontinence is a prevalent health issue that significantly deteriorates the quality of life, particularly affecting half of women and one-third of men over the age of 80. As our society ages and the number of individuals affected by this condition rises, understanding and advancing treatment methods become increasingly crucial. Ongoing research aims to discover new and improved therapeutic approaches with minimal side effects, offering hope for enhanced patient outcomes and better management of urinary incontinence in the future.

Do Women with Urinary Incontinence and Pelvic Organ Prolapse Receive Optimal First-Line Treatment?

There is scant knowledge on previous pelvic floor muscle training (PFMT) in women with urinary incontinence (UI) and pelvic organ prolapse (POP) referred to hospitals. We hypothesized that women with predominately UI and POP had not received optimal primary care conservative management. This was a descriptive, cross-sectional survey among women attending a gynecological outpatient's clinic. The questionnaire included questions about demographics, PFMT dosage, whether ability to contract had been assessed and whether the patients had used precontraction before increase in intra-abdominal pressure ("the knack"). One hundred two women, mean age 52.5 (SD 13.4) years, responded; 37.3% had never been treated previously. There was no statistically significant difference in age, BMI, level of education, parity, time since last birth, SUI, or POP between the women who had been treated conservatively or not before the hospital visit. Thirty-three percent had trained with a physiotherapist and > 35% reported that their ability to contract had not been assessed or were unsure whether it had been assessed; 37% were not able to stop their urine stream; 52% reported that they performed "the knack," with 15.7% reporting it to be effective. Reasons for not having trained the PFM before visiting the hospital included not being motivated, not knowing how to do PFMT, not being told/advised to do PFMT and not believing PFMT would help. The results of this study indicated that there is a need for improvement within first-line health care service for women with predominately UI and POP.

EFFECTIVENESS OF HYPOPRESSIVE EXERCISES ON POSTNATAL MOTHERS WITH URINARY INCONTINENCE-A PILOT STUDY.

Background: Pelvic Floor Muscle Dysfunctions can lead to Urinary Incontinence, a condition which often affects women both during pregnancy and after childbirth. As a result of this, certain exercises are recommended during and after pregnancy to prevent and treat this incontinence. Hypopressive Exercise is one of these methods used to prevent Urinary Incontinence. Objective: The purpose of the study is to find the Effectiveness of Hypopressive Exercises on Postnatal Mothers with Urinary Incontinence. Methods: 30 Mothers (between the age group of 25 – 35 years) clinically pre diagnosed with urinary incontinence with PERFECT score were included in the study. with informed consent, the protocol was explained to the subjects. Mothers were given Hypopressive Exercises for 3 sessions per week for 4 weeks. This session lasted between 30 to 40 minutes. The outcome measure of the Exercises was measured using UI – QUID and PERFECT test. Results were tabulated using statistical analysis. Result: The analysis shows that the mothers who underwent Hypopressive exercises have significant reduction in urinary incontinence (p-value) P&lt;0.0001. Conclusion: This study concluded that the mothers underwent Hypopressive exercises have significant reduction in Urinary Incontinence and increase in Pelvic Floor Muscle Strength Implications: The Hypopressive Exercises strengthens the Deep Core Muscles which increases body awareness by training the Pelvic Floor Muscles in women and reduces Urinary Incontinence. These Exercises not only pay attention to maintaining proper body posture and Pelvic Floor Muscles activation. But also had a positive impact on the Quality of Life and reduction of incidents of urine leakage among mothers.

Physical therapy approach and non-invasive modalities in treatment of vaginal laxity: a literature review.

Pelvic floor physical therapy (PFPT) and noninvasive modalities can be more safe and available treatments for vaginal laxity (VL) with less risk of postsurgical complications. The purpose of this review is to define the concepts of PFPT and noninvasive modalities, examine the evidence supporting those modalities as a treatment for VL, and evaluate their effectiveness. Between 2002 and 2023, clinical studies including women diagnosed with VL were examined in the Web of Science, Cochrane Library, Scopus, and PubMed databases. Exclusion criteria included studies with no outcomes or inadequate data, procedures, suggestions, editorials, book chapters, letters to editors, reviews, meta-analyses, animal research, and articles in languages other than English. Only seventeen studies have been identified. Four studies have demonstrated the impact of PFPT (low- and medium-energy radiofrequency (RF), ultrasound, low-energy laser treatment, par sacral stimulation, the knack method, and pelvic floor exercises), and thirteen studies have discussed the impact of noninvasive modalities (RF, combined multipolar RF with pulsed electromagnetic, combined RF and pulsed electromagnetic field, high-intensity focused ultrasound, CO2 laser, combining multipolar RF and hybrid fractional laser, microfocused ultrasound, and the VIVEVE surface-cooled RF) on vaginal laxity. This review indicates many knowledge areas that must be attempted in order to understand the influence of nonstrengthening physical therapy and noninvasive methods on vaginal laxity. In addition to the mechanisms behind their impacts. In addition, we strongly recommend that more clinical trials of high methodological and interventional quality are required to investigate the efficacy of various physical therapy approaches, including electrical stimulation, biofeedback exertion, acupressure, manual therapy, neuromodulation, core exercise therapy, hydrotherapy, well-designed ultrasound therapy protocols, and vaginal weight training.

Pressure-Mediated Biofeedback With Pelvic Floor Muscle Training for Urinary Incontinence

Supervised pelvic floor muscle training (PFMT) has been recommended as the first-line treatment for women with stress urinary incontinence (SUI), but more evidence on whether adjunctive methods would provide additional benefits is needed. To compare the efficacy of PFMT with or without a home-based pressure-mediated biofeedback (BF) device. This multicenter assessor-blinded randomized clinical trial was conducted in the obstetric clinics of 5 participating tertiary hospitals in China. Participants included eligible women with new-onset postpartum SUI who were enrolled from March 28, 2022, to October 13, 2023. All participants received 3 months of supervised PFMT and were randomized to either the intervention (PFMT with a home-based pressure-mediated BF device) or the control group (home-based PFMT). The primary outcome was the severity of urinary incontinence evaluated by the International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form after 3 months of supervised PFMT. The secondary outcomes included the cure and improvement rates, PFM strength, quality of life, self-efficacy, and adherence. A total of 452 participants (median age, 34 [IQR, 31-36] years; median body mass index [calculated as the weight in kilograms divided by the height in square meters], 23.71 [IQR, 21.37-25.97]; median time since delivery, 50 [IQR, 43-61] days) were included in the analysis, with 223 in the intervention group and 229 in the control group. Compared with the control group, the intervention group achieved a significantly greater reduction in incontinence severity (median, 3.00 [IQR, 1.00-6.00] vs 2.00 [IQR, 0-4.00] points; z = -3.05; P = .002), significantly increased cure rate (45 of 223 [20.2%] vs 20 of 229 [8.7%]; z = 12.02; P = .001) and improvement (132 of 223 [59.2%] vs 102 of 229 [44.5%]; z = 9.71; P = .002), significantly greater pelvic floor muscle strength (median, 26.00 [IQR, 17.00-38.00] vs 21.00 [IQR, 13.50-33.50] cm H2O; z = -2.28; P = .02), and a significantly greater correlation between subjective and objective adherence (r = 0.825 vs r = 0.627). In this randomized clinical trial, the efficacy of pressure-mediated BF combined with PFMT was superior to that of PFMT alone. These findings support the use of pressure-mediated BF devices for improving treatment outcomes for patients with SUI. ClinicalTrials.gov Identifier: NCT05115864.

Combined effects of high-intensity focused electromagnetic therapy and pelvic floor exercises on pelvic floor muscles and sexual function in postmenopausal women.

This study aimed to explore the impact of high-intensity focused electromagnetic therapy (HIFEMT) on the pelvic floor muscles (PFM), sexual function, and quality of life (QoL) among postmenopausal women. Fifty postmenopausal women with PFM weakness and sexual dysfunction were randomly allocated into two equal groups. The HIFEMT group participated in the PFM training program in addition to HIFEMT, whereas the control group performed PFM training only. For 12 weeks, HIFEMT was scheduled twice a week, while PFM training was performed daily. At baseline and after 12 weeks, PFM strength and endurance were assessed using a perineometer, sexual function was examined using the female sexual function index (FSFI), and QoL was assessed through the menopause-specific quality of life questionnaire (MENQOL). The HIFEMT and control groups showed significant increases in PFM strength and endurance and FSFI scores, and significant declines in MENQOL compared with baseline measures (P<0.05). Compared to the control group, the HIFEMT group showed substantial improvements in all measured variables after 12 weeks (P<0.05). Addition of HIFEMT to PFM training improved the PFM strength, endurance, sexual function, and QoL in postmenopausal women with PFM weakness and sexual dysfunction.

Knowledge of pelvic floor muscles in community-dwelling women aged over 60: its relationship with urinary incontinence.

To investigate the awareness of the pelvic floor muscles (PFMs) and PFM exercises (PFME) knowledge, training and experience in community-dwelling women aged 60 and over and its relationship with urinary incontinence (UI). This is a questionnaire based study which was carried out in 9 Physical Medicine and Rehabilitation Centers, including a total of 500 women aged 60 and over and living in the community. The questionnaire included questions about awareness of PFMs, UI complaints and PFME knowledge, training and experience. Knowledge and awareness of PFMs and PFME knowledge, training and experience were compared in subgroups with or without urinary incontinence. The mean age of the women included in the study was 67.8 ± 6.1 (60-88). Knowledge and awareness of PFMs and PFME knowledge, training and experience were low in the study population. Knowledge and awareness of PFMs were significantly low in the subgroup with urinary incontinence (p < 0.05). Kegel exercise training and experience were significantly low in the subgroup without urinary incontinence (p = 0.01, p < 0.01). Knowledge and awareness of PFMs and PFME knowledge, training and experience are low in community-dwelling women aged 60 and over and training programs should be organized to teach the function of the PFMs and to perform PFME correctly in this population.

Effect of a Nurse-Led Remote Guided Pelvic Floor Exercise Program on Stress Urinary Incontinence, Pelvic Floor Function and Sexual Function in Patients after Total Hysterectomy: A Retrospective Study.

Hysterectomy is associated with stress urinary incontinence (SUI), pelvic floor muscle weakness and sexual dysfunction. Pelvic floor exercises have emerged as a potential intervention for addressing these challenges, with remote guided programs offering personalised care. This retrospective study aimed to assess the effect of a nurse-led remote guided pelvic floor exercise program on in patients after total hysterectomy. A retrospective analysis was conducted on 81 patients who underwent pelvic floor exercises after total hysterectomy. The patients were divided into regular pelvic floor exercise group (n = 40) and nurse-led remote guided pelvic floor exercise group (n = 41). The severity of SUI in patients was assessed using the International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form (ICIQ-UI SF). The strength and endurance of pelvic floor muscles were assessed using a pressure sensor before and after treatment, and sexual function was evaluated using the Female Sexual Function Index (FSFI) questionnaire. The baseline characteristics showed no significant differences between the two groups. The nurse-led remote guided pelvic floor exercise group had a significantly greater reduction in urinary incontinence severity (65.00% vs. 85.37%, χ2 = 4.516, p = 0.034) and a lower post-treatment SUI frequency (1.76 ± 0.75 vs. 2.15 ± 0.95, t = 2.059, p = 0.043). Additionally, this group showed better improvements in muscle strength and endurance (25.61 ± 5.69 vs. 23.19 ± 5.02, t = 2.036, p = 0.045) and FSFI score (29.67 ± 4.05 vs. 27.91 ± 3.83, t = 2.011, p = 0.048). The study demonstrates that a nurse-led remote guided pelvic floor exercise program is associated with significant improvements in SUI, pelvic floor muscle function and sexual well-being in patients after total hysterectomy.

The impact of urinary and bowel incontinence: psychological and physical effects and interventions

This clinical review explores the multifaceted impact of urinary and bowel incontinence on the physical and psychological wellbeing of individuals, particularly older adults. The psychological effects, which often include anxiety, depression and social isolation, are addressed through interventions such as cognitive behavioural therapy and peer support groups, which are crucial for alleviating the emotional burden. The review also examines conservative management strategies, such as pelvic floor muscle training, bladder retraining and dietary changes, as well as discussing pharmacological treatments and surgical options for more severe cases. A key emphasis is placed on the importance of a multidisciplinary approach and incorporating the expertise of continence nurses, physiotherapists, occupational therapists and psychologists to comprehensively address patient needs.

Long-term effects of pelvic floor training in male chronic pelvic pain, correlation between subjective and objective outcomes: a study protocol for a randomised controlled trial

IntroductionChronic primary pelvic pain syndrome (CPPPS) is a condition characterised by pain in the pelvic area together with lower urinary tract symptoms. Pathophysiology remains largely unclear. Common treatment modalities show...

The comparative effectiveness of pelvic floor muscle training and hypopressive breathing techniques for pelvic organ prolapse: A systematic review and pooled analysis of randomized controlled trials

BackgroundPelvic floor (PF) disorder affects 25 ​% of females, often progressing to Pelvic Organ Prolapse (POP). PF muscle training (PFMT) and hypopressive breathing (HB) are conservative techniques used to repair pelvic muscles. This study analyzes the comparative efficacy of PFMT and HB for POP. MethodsA systematic review was conducted and seven records were included in the pooled analysis, which compared PF outcomes between HB and PFMT. ResultsPFMT (d ​= ​2.14 and d ​= ​1.07) demonstrated a larger effect size compared to HB (d ​= ​1.24 and d ​= ​0.78) for sEMG contractility and the Modified Oxford Scale, respectively. The Pelvic Floor Disability Index (PFDI-20) found a lower effect size of PFMT (d ​= ​0.558) compared to HB (d ​= ​0.961). ConclusionsPFMT was found to improve PF strength (Oxford) more than HB, while HB had a greater effect on quality of life (PFDI-20). Results were insignificant for contractility.

Midwifery-led antenatal pelvic floor muscle exercise intervention to reduce postnatal urinary incontinence: APPEAL research programme including a feasibility and pilot cluster RCT

Midwifery-led antenatal pelvic floor muscle exercise intervention to reduce postnatal urinary incontinence: APPEAL research programme including a feasibility and pilot cluster RCT