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García-Sánchez E, Rubio-Arias J, Ávila-Gandía V, Ramos-Campo D, López-Román J. Effectiveness of pelvic floor muscle training in treating urinary incontinence in women: A current review. Actas Urol Esp 2016; 40:271-8. [PMID: 26614435 DOI: 10.1016/j.acuro.2015.09.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2015] [Revised: 09/03/2015] [Accepted: 09/03/2015] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To analyse the content of various published studies related to physical exercise and its effects on urinary incontinence and to determine the effectiveness of pelvic floor training programmes. METHOD We conducted a search in the databases of PubMed, CINAHL, the Cochrane Plus Library, The Cochrane Library, WOS and SPORTDiscus and a manual search in the Google Scholar metasearcher using the search descriptors for documents published in the last 10 years in Spanish or English. The documents needed to have an abstract or complete text on the treatment of urinary incontinence in female athletes and in women in general. RESULTS We selected 3 full-text articles on treating urinary incontinence in female athletes and 6 full-text articles and 1 abstract on treating urinary incontinence in women in general. The 9 studies included in the review achieved positive results, i.e., there was improvement in the disease in all of the studies. CONCLUSIONS Physical exercise, specifically pelvic floor muscle training programmes, has positive effects on urinary incontinence. This type of training has been shown to be an effective programme for treating urinary incontinence, especially stress urinary incontinence.
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Te West NID, Parkin K, Hayes W, Costa DSJ, Kasparian NA, Moore KH. Does motivation predict outcome of pelvic floor muscle retraining? Neurourol Urodyn 2015; 36:316-321. [PMID: 26575361 DOI: 10.1002/nau.22917] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2015] [Accepted: 10/07/2015] [Indexed: 11/11/2022]
Abstract
AIMS Although pelvic floor muscle training (PFMT) is effective for stress urinary incontinence (SUI), patients need to be motivated to obtain cure. An instrument to assess motivation in such patients was published in 2009: the Incontinence Treatment Motivation Questionnaire (ITMQ). The ITMQ consists of five domains: (i) positive attitudes toward PFMT; (ii) reasons for not doing PFMT; (iii) difficulties living with incontinence; (iv) desire for treatment; and (v) incontinence severity influencing motivation. The aim of the present study was to examine the relationship between ITMQ scores and treatment success. METHODS After referral for PFMT, women with SUI completed the ITMQ. Pre- and post-treatment outcomes were the International Consultation on Incontinence Questionnaire (ICIQ) score and a 24-hr pad test. Correlations between ITMQ scores and baseline, as well as post-treatment change in ICIQ scores and pad test results were examined. Additionally, the demographics of non-participants, participants, and patients lost to follow-up were compared. RESULTS Of 85 recruits, 18 did not complete the ITMQ, 14 were lost to follow-up, thus 53 completed the PFMT programme and undertook either one or both outcomes. Pre-treatment, severity on ICIQ correlated with total ITMQ (ρ = 0.33, P = 0.01). Post-treatment change in pad test was inversely correlated with Domain 2 (ρ = -0.33, P = 0.03). CONCLUSIONS The pre-treatment severity of incontinence was significantly associated with motivation for treatment. Unfortunately, post-treatment change correlated with only one domain of the questionnaire. Further modification of the ITMQ is envisaged. Neurourol. Urodynam. 36:316-321, 2017. © 2015 Wiley Periodicals, Inc.
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Affiliation(s)
- Nevine I D Te West
- Department of Urogynaecology, St. George Hospital, School of Women's and Children's Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Katrina Parkin
- Department of Urogynaecology, St. George Hospital, School of Women's and Children's Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Wendy Hayes
- Department of Urogynaecology, St. George Hospital, School of Women's and Children's Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Daniel S J Costa
- Psycho-Oncology Co-Operative Research Group, School of Psychology, University of Sydney, Sydney, New South Wales, Australia
| | - Nadine A Kasparian
- Discipline of Paediatrics, School of Women's and Children's Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Kate H Moore
- Department of Urogynaecology, St. George Hospital, School of Women's and Children's Health, University of New South Wales, Sydney, New South Wales, Australia
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Golmakani N, Khadem N, Arabipoor A, Kerigh BF, Esmaily H. Behavioral Intervention Program versus Vaginal Cones on Stress Urinary Incontinence and Related Quality of Life: A Randomized Clinical Trial. Oman Med J 2014; 29:32-8. [PMID: 24498480 DOI: 10.5001/omj.2014.08] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2013] [Accepted: 11/12/2013] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE To compare the efficacy of behavioral intervention program and vaginal cones on stress urinary incontinence. METHODS In this randomized clinical trial, 60 women aged 25-65 years with stress urinary incontinence were randomly divided into two groups, those who participated in a behavioral intervention program (n=30) and those who used vaginal cones (n=30). The women in the behavioral intervention group were instructed on pelvic floor exercise and bladder control strategies. In the other group, pelvic floor exercises were performed using the vaginal cones. All participants were treated for 12 weeks and followed-up every 2 weeks. The subjective changes in severity of stress urinary incontinence were measured using a detection stress urinary incontinence severity questionnaire, leakage index, and a 3-day urinary diary. The objective changes were measured by pad test. For better evaluation of the effects, two questionnaires were used: Incontinence Quality of Life and King's Health Questionnaire. RESULTS Among the 51 women who completed the study, 25 subjects were in the vaginal cones group and 26 participated in the behavioral intervention program. The changes in leakage rate on pad test and leakage index in the behavioral intervention program group were significantly higher than in the vaginal cones group (p=0.001 and p=0.008, respectively), but the severity of stress urinary incontinence was not significantly different between the two groups (p=0.2). The changes in strength of the pelvic floor, Incontinence Quality of Life, and King's Health Questionnaire scores showed no significant differences between the two groups after 12 weeks of intervention. CONCLUSION Vaginal cones and behavioral intervention programs are both effective methods of treatment for mild to moderate stress urinary incontinence, but the behavioral intervention program is superior to vaginal cones in terms of cost-effectiveness and side effects.
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Affiliation(s)
- Nahid Golmakani
- Master of Science in Midwifery, Lecturer and Faculty Member of Department of Midwifery, School of Nursing & Midwifery, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Nayereh Khadem
- Professor of Obstetrics and Gynecology, Women's Health Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Arezoo Arabipoor
- Department of Endocrinology and Female Infertility at Reproductive Biomedicine Research Center, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran
| | - Behzad Feizzadeh Kerigh
- Department of Urology, Ghaem Hospital, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Habibollah Esmaily
- Associate Professor of Health Sciences Research Center, Department of Biostatistics and Epidemiology, School of Health, Mashhad University of Medical Sciences, Mashhad, Iran
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Kesiktas N, Karan A, Erkan H, Gungor F, Eskiyurt N, Yalcin O. Is There a Relationship between Vitamin B12 and Stress Urinary Incontinence? Low Urin Tract Symptoms 2012; 4:55-8. [PMID: 26676525 DOI: 10.1111/j.1757-5672.2011.00116.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Pelvic floor, which includes collagen, elastin, and smooth muscle, is very important in preventing urinary incontinence (UI). Studies suggest that vitamin B12 is involved in collagen synthesis. In the present study we aimed to determine the association of vitamin B12 deficiency with stress UI in a sample of Turkish women. METHODS Forty-two women with stress UI or mixed UI who met the inclusion criteria from a group of 541 women with stress UI or mixed UI, were included in the study. The study group was compared with a control group of 20 healthy women without UI who matched to the study group's demographic data and met the inclusion criteria. Demographic data as well as duration of symptoms and vitamin B12 levels were analyzed and compared. RESULTS The mean ages of the study and the control groups were 50.04 ± 4.6 and 49.02 ± 5.1 years, respectively. Vitamin B12 level was 300.95 ± 142.9 pg/mL in the study group, whereas in the control group it was 598.98 ± 120.3 pg/mL (P < 0.001). In the study group, 66.6% of the patients with stress UI had vitamin B12 levels less than 300 pg/mL. When the duration of symptoms and vitamin B12 levels were compared, women with vitamin B12 levels less than 200 pg/mL had symptoms for a longer duration (P < 0.01). CONCLUSION One of the main etiologic factors for stress UI is a defect in pelvic floor support. Vitamin B12 is lower in women with stress UI. Analysis of vitamin B12 levels should also be considered in the evaluation of women with stress UI.
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Affiliation(s)
- Nur Kesiktas
- Departments of Physical Medicine and RehabilitationDepartments of Obstetrics and Gynecology, Istanbul University, Istanbul, Turkey
| | - Ayse Karan
- Departments of Physical Medicine and RehabilitationDepartments of Obstetrics and Gynecology, Istanbul University, Istanbul, Turkey
| | - Habibe Erkan
- Departments of Physical Medicine and RehabilitationDepartments of Obstetrics and Gynecology, Istanbul University, Istanbul, Turkey
| | - Funda Gungor
- Departments of Physical Medicine and RehabilitationDepartments of Obstetrics and Gynecology, Istanbul University, Istanbul, Turkey
| | - Nurten Eskiyurt
- Departments of Physical Medicine and RehabilitationDepartments of Obstetrics and Gynecology, Istanbul University, Istanbul, Turkey
| | - Onay Yalcin
- Departments of Physical Medicine and RehabilitationDepartments of Obstetrics and Gynecology, Istanbul University, Istanbul, Turkey
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Herderschee R, Hay-Smith EJC, Herbison GP, Roovers JP, Heineman MJ. Feedback or biofeedback to augment pelvic floor muscle training for urinary incontinence in women. Cochrane Database Syst Rev 2011:CD009252. [PMID: 21735442 DOI: 10.1002/14651858.cd009252] [Citation(s) in RCA: 70] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
BACKGROUND Pelvic floor muscle training (PFMT) is an effective treatment for stress urinary incontinence in women. Whilst most of the PFMT trials have been done in women with stress urinary incontinence, there is also some trial evidence that PFMT is effective for urgency urinary incontinence and mixed urinary incontinence. Feedback or biofeedback are common adjuncts used along with PFMT to help teach a voluntary pelvic floor muscle contraction or to improve training performance. OBJECTIVES To determine whether feedback or biofeedback adds further benefit to PFMT for women with urinary incontinence.To compare the effectiveness of different forms of feedback or biofeedback. SEARCH STRATEGY We searched the Cochrane Incontinence Group Specialised Trials Register (searched 13 May 2010) and the reference lists of relevant articles. SELECTION CRITERIA Randomised or quasi-randomised trials in women with stress, urgency or mixed urinary incontinence (based on symptoms, signs or urodynamics). At least two arms of the trials included PFMT. In addition, at least one arm included verbal feedback or device-mediated biofeedback. DATA COLLECTION AND ANALYSIS Trials were independently assessed for eligibility and risk of bias. Data were extracted by two reviewers and cross-checked. Disagreements were resolved by discussion or the opinion of a third reviewer. Data analysis was conducted in accordance with the Cochrane Handbook for Systematic Reviews of Intervention (version 5.1.0). Analysis within subgroups was based on whether there was a difference in PFMT between the two arms that had been compared. MAIN RESULTS Twenty four trials involving 1583 women met the inclusion criteria; 17 trials contributed data to analysis for one of the primary outcomes. All trials contributed data to one or more of the secondary outcomes. Women who received biofeedback were significantly more likely to report that their urinary incontinence was cured or improved compared to those who received PFMT alone (risk ratio 0.75 , 95% confidence interval 0.66 to 0.86). However, it was common for women in the biofeedback arms to have more contact with the health professional than those in the non-biofeedback arms. Many trials were at moderate to high risk of bias, based on trial reports. There was much variety in the regimens proposed for adding feedback or biofeedback to PFMT alone, and it was often not clear what the actual intervention comprised or what the purpose of the intervention was. AUTHORS' CONCLUSIONS Feedback or biofeedback may provide benefit in addition to pelvic floor muscle training in women with urinary incontinence. However, further research is needed to differentiate whether it is the feedback or biofeedback that causes the beneficial effect or some other difference between the trial arms (such as more contact with health professionals).
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Affiliation(s)
- Roselien Herderschee
- Department of Obstetrics & Gynaecology Academic Medical Centre, University of Amsterdam, Kerkstraat 379b, Amsterdam, Netherlands, 1017 HW
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Sarma S, Hawthorne G, Thakkar K, Hayes W, Moore KH. The development of an Incontinence Treatment Motivation Questionnaire for patients undergoing pelvic floor physiotherapy in the treatment of stress incontinence. Int Urogynecol J 2009; 20:1085-93. [PMID: 19444364 DOI: 10.1007/s00192-009-0907-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2009] [Accepted: 04/24/2009] [Indexed: 11/24/2022]
Abstract
INTRODUCTION AND HYPOTHESIS The aim of this paper is to develop a motivation questionnaire regarding perseverance in pelvic floor muscle training (PFMT) supervised by physiotherapists for stress urinary incontinence. METHODS Sixteen semi-structured interviews were conducted in women with stress urinary incontinence that revealed 15 common themes; 117 items were constructed and reviewed by continence advisors. Surviving items (n = 73) were administered to 210 women. Data were analysed for item properties, factor analysis was used to examine the questionnaire structure and tests of convergence/divergence used to check for sensitivity. RESULTS The Incontinence Treatment Motivation Questionnaire (ITMQ) comprises 18-items in five scales, assessing attitudes towards treatment (72.62% of explained variance; alpha = 0.87), reasons for not doing PFMT (55.73%; alpha = 0.74), living with incontinence (62.70% variance; alpha = 0.70), desire for treatment (65.37% variance; alpha = 0.74) and the effect of incontinence severity on PFMT (51.62% variance, alpha = 0.68). Scales were generally sensitive to known group differences. CONCLUSIONS This study represents the first effort to develop a motivation scale for PFMT. This validated Motivation Questionnaire is an instrument to test the impact of motivation upon cure, in PFMT.
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Affiliation(s)
- Susmita Sarma
- Pelvic Floor Unit, St George Hospital, Kogarah, NSW, Australia 2217
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Schmidt AP, Sanches PRS, Silva DP, Ramos JGL, Nohama P. A new pelvic muscle trainer for the treatment of urinary incontinence. Int J Gynaecol Obstet 2009; 105:218-22. [PMID: 19232601 DOI: 10.1016/j.ijgo.2009.01.013] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2008] [Revised: 12/21/2008] [Accepted: 01/14/2009] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To describe a new device for home treatment of urinary incontinence (UI) by comparing 3 conservative techniques and monitoring compliance and performance. METHODS Thirty-two patients with UI were allocated to 1 of 3 intervention groups: pelvic floor muscle exercises (PFME; n=11) alone; PFME combined with biofeedback (n=10); or PFME combined with electrical stimulation (n=11). The outcomes assessed were: changes in quality of life score (QLS), urodynamic and perineometric parameters, episodes of urine loss, subjective assessment of improvement, and actual compliance and performance with treatment. RESULTS Increased pelvic muscle contraction strength (P<0.05), improvement in QLS (P<0.02), and fewer episodes of urine leakage were observed in all 3 groups (P<0.05). Compliance was similar among the groups (P=0.201). CONCLUSION All 3 techniques were effective for home treatment of UI, with significant control of symptoms and improved quality of life. The device effectively monitored compliance and performance of exercises.
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Affiliation(s)
- Adriana P Schmidt
- Obstetrics and Gynecology Department, Hospital de Clínicas de Porto Alegre of Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.
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Allen WA, Leek H, Izurieta A, Moore KH. Update: the "Contiform" intravaginal device in four sizes for the treatment of stress incontinence. Int Urogynecol J 2008; 19:757-61. [PMID: 18183342 DOI: 10.1007/s00192-007-0519-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2007] [Accepted: 11/13/2007] [Indexed: 10/22/2022]
Abstract
The aim of this study was to evaluate the efficacy of the Contiform intravaginal device for stress incontinence after the addition of a fourth size. We offered the device to a cohort of 73 women with a main complaint of stress incontinence but no prolapse. Of the 73 women invited to participate, 65 enrolled, of whom 52 were fitted. Of these 52 women, 37 (71%) completed the study protocol. Outcome measures were the 24-h pad test, St George score, and quality of life tests. Urine loss on pad test was significantly reduced from a median 6.6 g (interquartile range [IQR] = 4.3-22.6) to 2.2 g (IQR = 0.5-8.2; P = 0.0016) after 4 weeks with significant benefit seen on the Incontinence Impact Questionnaire and Urinary Distress Inventory. The insertion technique was quickly learnt, and the device was well tolerated. The recently developed medium/large size of Contiform was used by 6/37 (16%) women.
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Affiliation(s)
- W A Allen
- Pelvic Floor Unit, St George Hospital, Gray St, Kogarah, NSW 2217, Australia
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9
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Chiarelli P. Urinary stress incontinence and overactive bladder symptoms in older women. Contemp Nurse 2007; 26:198-207. [PMID: 18041971 DOI: 10.5172/conu.2007.26.2.198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Urinary incontinence - the accidental leaking of urine - is a major problem in Australia and has a significant impact on quality of life, affecting the social, psychological, physical and financial aspects of living. The prevalence of urinary incontinence is significantly higher in women than in men. While urine loss itself is a devastating symptom, older women are also likely to suffer lower urinary tract symptoms associated with the overactive bladder syndrome such as urgency, frequency, mixed incontinence and nocturia which are reported more frequently in older women. These symptoms disrupt activities of daily living as well as seriously disturbing sleep and general health status. Conservative nurse interventions have been shown to be effective in the management of these symptoms. Simple assessment tools suitable for use by primary level clinicians and conservative management strategies are discussed within the paper.
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Affiliation(s)
- Pauline Chiarelli
- School of Health Sciences, University of Newcastle, Callaghan NSW, Australia
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Juarranz Sanz M, Terrón Barbosa R, Roca Guardiola M, Soriano Llora T, Villamor Borrego M, Calvo Alcántara MJ. [Treatment of urinary incontinence]. Aten Primaria 2002; 30:323-32. [PMID: 12372215 PMCID: PMC7684188 DOI: 10.1016/s0212-6567(02)79035-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Affiliation(s)
- M Juarranz Sanz
- Médico. Centro de Salud Canal de Panamá. Area Sanitaria 4. Madrid. Spain
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11
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Affiliation(s)
- K P Jünemann
- Department of Urology, University Hospital Klinikum Mannheim gGmbH, Mannheim, Germany.
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