Urinary incontinence — are Kegel exercises enough?

Aim of the study: Urinary incontinence (UI) is common in women of all age groups, but postmenopausal women (MW) have a higher incidence of these symptoms. The International Continence Society suggests that women with UI should first try a conservative treatment, such as pelvic floor muscle training (PFMT), which aims to enhance the strength and rectify the activation patterns of the pelvic floor muscles.

Results: After screening, applying the inclusion and exclusion criteria, and assessing bias, five randomized controlled trials were evaluated. PFMT was found to have a significant and substantial impact on the level of UI in the total patient population (standardized mean difference between the intervention and control groups -1.30, 95%CI: -1.97, -0.62, pz ≤ 0.01, I2 = 88.5 %; probability of benefit = 0.92). A second analysis, after the removal of studies that combined PFMT with electrostimulation or biofeedback, returned similar results. PFMT is an effective intervention for the management of UI in MW. Our analysis shows a 92% chance of significant improvement for patients receiving PFMT in comparison with controls. Future studies should examine its efficacy in MW subgroups with symptoms of genitourinary syndrome of menopause (GSM).

Aim of the study: Stress urinary incontinence (SUI) is a common disorder in women that has a negative impact on quality of life. Pregnancy and childbirth are considered important risk factors that directly affect the pelvic floor during pregnancy and labour, increasing the risk of pelvic floor dysfunction, with prevalence rates of SUI in the postpartum period ranging from 30 to 47% during the first 12 months.

Results: The results allowed us to establish that PFMT is used for pelvic floor muscles and that this intervention, applied with the appropriate methodology, can prevent or cure SUI. The application of PFMT in an early stage of pregnancy has positive effects on the continence capacity after delivery.

Aim of the study: Background and Objectives: Urinary incontinence (UI) is a condition that is more common in women than men and has an increasing prevalence with age. It provides a range of psychological and physical burdens that negatively affect the patient's quality of life (QoL).

Results: Ten articles were found for the systematic review and eight for the meta-analysis. Results: The QoL moderately increased when PFMT was used on women with UI, the results indicating an overall small effect on the QoL across the controlled studies and a moderate effect on the QoL across the one-group pre-post-studies. Conclusions: Specific QoL domains, such as social activities and general health, also demonstrated benefits from PFMT interventions. This study confirmed the effectiveness of PFMT on the QoL in women with UI, mainly for patients with stress urinary incontinence.

Aim of the study: This study aimed to evaluate the efficacy of integrating Qigong with pelvic floor muscle training (PFMT) for managing mild to moderate stress urinary incontinence (SUI) in postpartum women. The hypothesis was that the combined intervention would lead to better outcomes compared to PFMT alone by addressing both physical and psychological aspects of recovery.

Results: The QGPFMT group significantly improved pelvic floor muscle activity, urinary incontinence frequency, and the UDI-6 scores. However, the groups had no significant differences regarding psychological well-being measures, such as the IIQ-7 and PSS scores. The integration of Qigong with PFMT provides a promising holistic approach for managing postpartum SUI. While physical improvements were significant, psychological improvements may require a longer duration or additional psychological interventions to be fully realized. Future studies should consider the combination of psychological therapies to improve the overall efficacy of treatment for postpartum women with SUI.

Aim of the study: Pelvic floor dysfunction and urinary incontinence are two of the most frequent gynecological problems, and pelvic floor muscle training is recommended as a first-line treatment, with new approaches such as hypopressive exercises. This study aimed to analyze the efficacy of an 8-week supervised training program of hypopressive exercises on pelvic floor muscle strength and urinary incontinence symptomatology.

Results: The results showed an improvement in the hypopressive group in the pelvic floor muscle strength F (1117) = 89.514, p < 0.001, a significantly lower score for the PFIQ7 total score, t (112) = 28.895, p < 0.001 and FPDI20 t (112) = 7.037, p < 0.001 as well as an improvement in ICIQ-SF values after 8 weeks of intervention in comparison with the control group. After performing an 8-week of hipopressive exercises intervention, a decrease in pelvic floor disorders associated symptoms can be observed. In addition, pelvic floor muscle contractility is improved and a decrease in severity and symptoms associated with urinary incontinence has been reported.

Aim of the study: Electromagnetic stimulation (EMS) has emerged as a potential alternative for managing urinary incontinence in women. However, research directly comparing EMS to Kegel exercises in cases of postpartum stress urinary incontinence (SUI) is limited.

Results: However, the EMS group had significantly greater muscle strength than the Kegel group (16.5 vs 8.0 cmH2O, p = 0.006). The UDI-6 scores, 1-hour pad test results and patients' compliance were not significantly different between EMS and Kegel groups. EMS demonstrated a greater ability to enhance pelvic floor muscle strength than Kegel exercises. These findings suggest that EMS may be a more effective option for enhancing pelvic floor muscle strength in postpartum women.

Aim of the study: Provide guidelines for clinical practice concerning postpartum rehabilitation.

Results: Pelvic-floor rehabilitation using pelvic floor muscle contraction exercises is recommended to treat persistent urinary incontinence at 3 months postpartum (grade A), regardless of the type of incontinence. At least 3 guided sessions with a therapist is recommended, associated with pelvic floor muscle exercises at home. This postpartum rehabilitation improves short-term urinary incontinence (1 year) but not long-term (6-12 years). Early pelvic-floor rehabilitation (within 2 months following childbirth) is not recommended (grade C). Postpartum pelvic-floor rehabilitation in women presenting with anal incontinence, is associated with a lower prevalence of anal incontinence symptoms in short-term (1 year) (EL3) but not long-term (6 and 12) (EL3). Postpartum pelvic-floor rehabilitation is recommended to treat anal incontinence (grade C) but results are not maintained in medium or long term.

Aim of the study: Urinary incontinence in the postpartum period is related to biomechanical and hormonal changes that occur during the obstetric period and also related to perineal trauma during childbirth. Physiotherapy is currently presented as one of the conservative options for the treatment of urinary incontinence at this stage, so this review aims to go over scientific literature to assess the effect of physiotherapy on postpartum urinary incontinence.

Results: Out of the 51 articles identified, 8 were finally included that fit the criteria and the subject of the study. Regarding the intervention, we have found that all the articles refer to pelvic floor muscle training. In addition to urinary incontinence, these studies evaluated other variables such as strength, resistance, quality of life and sexual function, obtaining significant results in 6 out of all the studies consulted. Pelvic floor muscle training is beneficial for the treatment of urinary incontinence in the postpartum period, then supervised and controlled exercise combined with a home training routine is recommended. It is not clear whether the benefits are maintained over time.

Aim of the study: Pelvic floor muscle training (PFMT) is recommended as a first-line treatment for urinary incontinence (UI); however, treatment adherence among women with UI remains suboptimal. The effectiveness of mobile applications in delivering PFMT for women with UI is not yet well established.

Results: A total of 12 randomized controlled trials (RCTs) including 1,647 participants (mobile app group: 823; usual care group: 824) were included. The meta-analysis demonstrated that, compared with usual care, mobile app-based interventions significantly reduced the severity of UI (MD = -1.93, 95% CI: -2.87, -0.98; P < 0.0001) and the frequency of incontinence episodes (MD = -2.28, 95% CI: -3.62, -0.94; P = 0.0008). In addition, these interventions improved adherence (RR = 1.42, 95% CI: 1.26, 1.59; P < 0.00001), PGI-I (RR = 3.79, 95% CI: 1.27, 11.29; P = 0.02), and quality of life (MD = -2.78, 95% CI: -4.43, -1.14; P = 0.0009). This meta-analysis suggests that mobile app-based PFMT interventions may serve as an adjunctive approach to improve adherence and patient-reported outcomes among women with UI. However, the magnitude of symptom improvement may be below the threshold of clinical importance, and the certainty of evidence remains low.