Pelvic floor rehabilitation in the treatment of incontinence.
This study assessed the effectiveness of a pelvic floor rehabilitation program in a clinical practice. A retrospective convenience sample of 48 women was evaluated pretreatment and posttreatment with follow-up interviews from six months to three years. This group consisted of 81% with stress urinary incontinence, 6% with unstable bladder and 10% with mixed incontinence. Fecal incontinence was present as well in 35% of the subjects. The patients were taught pelvic floor muscle exercises and instruction reinforced with electromyographic biofeedback. Neuromuscular electrical stimulation was used when clinically indicated. Two women did not continue the program beyond the first visit and were excluded. Sixty-two percent of patients with two or more visits demonstrated an improvement. Thirteen percent were completely dry, and 49% demonstrated a significant improvement. Patients with genuine stress urinary incontinence, unstable bladder and mixed incontinence showed a 66%, 33% and 50% improvement rate, respectively. Fecal incontinence was improved in 63% of women trained in pelvic floor muscle exercises. A significant decrease (P < .001) was found in the frequency of self-reported leakage at the six-month to three-year follow-up. The strength and duration of a pelvic muscle contraction was significantly greater between the first and last visit in all patients, regardless of the subjective improvement. A pelvic floor rehabilitation program was an effective alternative to surgical intervention in reducing the frequency of urinary leakage. Further studies are needed to identify factors predicting success and to determine the most cost-effective method of achieving pelvic floor rehabilitation.
McIntosh
L J
LJ
Department of Obstetrics and Gynecology, Wayne State University/Hutzel Hospital, Detroit, Michigan 48201.
Frahm
J D
JD
Mallett
V T
VT
Richardson
D A
DA
D001676:Biofeedback, Psychology / Q000379:methods; D004599:Electric Stimulation Therapy / Q000379:methods; D004576:Electromyography; D005081:Exercise Therapy / Q000379:methods; D005242:Fecal Incontinence / Q000150:complications / Q000503:physiopathology / Q000534:rehabilitation*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008875:Middle Aged; D009119:Muscle Contraction; D017773:Pelvic Floor; D015397:Program Evaluation; D012189:Retrospective Studies; D016896:Treatment Outcome; D014549:Urinary Incontinence / Q000145:classification / Q000150:complications / Q000503:physiopathology / Q000534:rehabilitation*; D014563:Urodynamics