Treatment of urinary incontinence in cystic fibrosis.
BACKGROUND
Urinary incontinence (UI) is a newly recognised problem in cystic fibrosis. Whilst prevalence is well documented, there are no reports of assessment and treatment of the problem.


METHODS
A previous study reports the prevalence of UI in women with CF to be 51/75 (68%). Nineteen women subsequently requested help for the problem and were referred to a physiotherapist specialising in women's health. A digital assessment was performed to measure pelvic floor muscle strength and endurance. An individualised programme of pelvic floor muscle exercises (PFME) was taught based on the assessment. A questionnaire addressed issues of assessment and treatment.


RESULTS
12 women were assessed. The median (range) age, FEV1% predicted and BMI were 20.9 (19.3-46.1) years, 45.9 (14.8-82.7) and 20.5 (16.1-26.0), respectively. The median strength of the pelvic floor muscle was moderate (Oxford Scale grade 3) with a hold time (endurance) of 5 s. At reassessment (median time 13.1 weeks), there was an improvement in endurance (P = 0.04), with no change in strength. This was supported by a subjective improvement in symptoms. Patients found the exercises were difficult to perform, difficult to fit into their treatment programme and adherence was poor.


CONCLUSIONS
PFME are effective at improving endurance and reducing leakage over the short-term. Women are reluctant to be assessed and the CF team should provide support and encouragement with treatment. Long-term outcome and the mechanisms of UI in this group of patients need further evaluation.
Manchester Adult Cystic Fibrosis Centre, South Manchester University Hospitals NHS Trust, Southmoor Road, Manchester M23 9LT, UK.
R J
RJ
McVean
A
A
Orr
A K
AK
Webb
A
A
Bradbury
L
L
Kay
E
E
Philips
M E
ME
Dodd
D000293:Adolescent; D000328:Adult; D015331:Cohort Studies; D003550:Cystic Fibrosis / Q000150:complications* / Q000175:diagnosis; D005081:Exercise Therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008875:Middle Aged; D017773:Pelvic Floor; D015995:Prevalence; D018570:Risk Assessment; D012720:Severity of Illness Index; D018709:Statistics, Nonparametric; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D014549:Urinary Incontinence / Q000453:epidemiology / Q000209:etiology* / Q000628:therapy*; D014550:Urinary Incontinence, Stress / Q000209:etiology / Q000628:therapy