A comparison of effectiveness of biofeedback and pelvic muscle exercise treatment of stress incontinence in older community-dwelling women. A comparison of effectiveness of bladder training and pelvic muscle exercise on female urinary incontinence. Controlled trial of pelvic floor exercises in the treatment of urinary stress incontinence in general practice. [The value of physical therapy in genuine female stress incontinence]. Behavioral vs drug treatment for urge urinary incontinence in older women: a randomized controlled trial. Effectiveness of multidimensional exercises for the treatment of stress urinary incontinence in elderly community-dwelling Japanese women: a randomized, controlled, crossover trial. Single blind, randomised controlled trial of pelvic floor exercises, electrical stimulation, vaginal cones, and no treatment in management of genuine stress incontinence in women. Biofeedback and pelvic floor exercises for the rehabilitation of urinary stress incontinence. Single-blind, randomized, controlled trial of pelvic floor muscle training, electrical stimulation, vaginal cones, and no active treatment in the management of stress urinary incontinence.
Research using biofeedback as a treatment for sphincteric incontinence began with Kegel's early studies using a perineometer and pelvic muscle exercises demonstrating a 90% improvement in urine loss symptoms. More recent studies using varying combinations of biofeedback and pelvic muscle exercises found symptom reduction rates of 78% to 90%, but these studies lacked the rigor of a "phase three," or randomized controlled clinical trial.
                A randomized controlled trial assessed the efficacy of biofeedback for older women for treatment of sphincteric incompetence. One hundred thirty-five community-dwelling women were randomized in a single-blind trial to three groups: biofeedback, pelvic muscle exercise, or control. Incontinent episodes were monitored over 8 weeks of treatment and at 3 and 6 months thereafter.
                The number of incontinent episodes decreased significantly in the biofeedback and pelvic muscle exercise subjects but not in the control subjects for all severity of incontinence frequency subgroups. Improvement was maintained within the moderate and severe symptom subgroups for both treatments for at least 6 months but declined in subjects with mild incontinence frequency. Pelvic muscle activity (EMG) was significantly correlated with decreases in incontinent episodes, and only the biofeedback subjects showed significant improvement in EMGs.
                Biofeedback and pelvic muscle exercises are efficacious for sphincteric incompetence in older women. Benefits are maintained and improvement continues for at least 6 months postintervention. These therapies may be useful before considering invasive treatment. This study compared the effectiveness of bladder training versus pelvic muscle exercises in the treatment of urinary incontinence in women. It was revealed that the two intervention groups showed improvement compared with the control group, but differed in their effects on outcome measures. The pelvic muscle exercise group was more effective in increasing the peak and the average pressures of pelvic muscle contraction. The bladder-training group was more effective in reducing urinary frequency and in increasing voided volume. Further research is needed to explore the relationship among the various outcome measures of urinary incontinence.
                Copyright 2002 Elsevier Science Ltd. The aim of this study was to assess the usefulness of pelvic floor exercises in the treatment of urinary incontinence in women and to analyse the factors which determine a successful outcome. The study involved 66 women who had reported 'genuine stress incontinence' to their general practitioner. They were assigned at random to the treatment or control group. The treatment group received instructions in pelvic floor exercises from a general practitioner. The control group received no therapy. At the start of the trial the severity of the patients' incontinence was assessed objectively. This assessment was repeated after three months and patients were also asked for their own perception of whether their incontinence had improved. After the three months' evaluation the patients in the control group were also given instructions in pelvic floor exercises. After another three months they were assessed in the same way. About 60% of the patients in the treatment group were dry or mildly incontinent after three months compared with only one patient in the control group; the mean weekly frequency of incontinence episodes fell from 17 to five in the treatment group but remained virtually unchanged in the control group; and about 85% of the women in the treatment group felt that their incontinence had improved or was cured compared with no one in the control group. These results were later corroborated by those for the control group. The most important factor in the success of the treatment was the patients' motivation, as demonstrated by their adherence to the daily exercises.(ABSTRACT TRUNCATED AT 250 WORDS) In a prospective randomized study the efficiacy of physical therapy in female stress incontinence could be verified. The greatest success rate was achieved by medical gymnastics, whereas the perineal electrical stimulation should be used as supporting measure like a biofeedback mechanism because of its low effective intensity. Despite of the good therapeutic success (51.5%) with lasting effects no objective criteria to the use of physical therapy in female stress incontinence were found. Urinary incontinence is a common condition caused by many factors with several treatment options.
                To compare the effectiveness of biofeedback-assisted behavioral treatment with drug treatment and a placebo control condition for the treatment of urge and mixed urinary incontinence in older community-dwelling women.
                Randomized placebo-controlled trial conducted from 1989 to 1995.
                University-based outpatient geriatric medicine clinic.
                A volunteer sample of 197 women aged 55 to 92 years with urge urinary incontinence or mixed incontinence with urge as the predominant pattern. Subjects had to have urodynamic evidence of bladder dysfunction, be ambulatory, and not have dementia.
                Subjects were randomized to 4 sessions (8 weeks) of biofeedback-assisted behavioral treatment, drug treatment (with oxybutynin chloride, possible range of doses, 2.5 mg daily to 5.0 mg 3 times daily), or a placebo control condition.
                Reduction in the frequency of incontinent episodes as determined by bladder diaries, and patients' perceptions of improvement and their comfort and satisfaction with treatment.
                For all 3 treatment groups, reduction of incontinence was most pronounced early in treatment and progressed more gradually thereafter. Behavioral treatment, which yielded a mean 80.7% reduction of incontinence episodes, was significantly more effective than drug treatment (mean 68.5% reduction; P=.04) and both were more effective than the placebo control condition (mean 39.4% reduction; P<.001 and P=.009, respectively). Patient-perceived improvement was greatest for behavioral treatment (74.1% "much better" vs 50.9% and 26.9% for drug treatment and placebo, respectively). Only 14.0% of patients receiving behavioral treatment wanted to change to another treatment vs 75.5% in each of the other groups.
                Behavioral treatment is a safe and effective conservative intervention that should be made more readily available to patients as a first-line treatment for urge and mixed incontinence. To evaluate the effectiveness of pelvic floor muscle (PFM) and fitness exercises in reducing urine leakage in elderly women with stress urinary incontinence (UI).
                Randomized, crossover, follow-up trial.
                Urban community in Japan.
                Seventy women aged 70 and older who reported urine leakage one or more times per month; 35 were randomly assigned to intervention and the other 35 to control.
                The intervention group attended an exercise class aimed at enhancing PFMs and fitness. Duration of the exercise was 60 minutes per session twice a week for 3 months. After 3 months of exercise, the intervention group was followed for 1 year.
                Body mass index (BMI), urine leakage, walking speed, and muscle strength were measured at baseline, after the intervention, and at follow-up.
                In the intervention group, maximum walking speed and adductor muscle strength increased significantly after the intervention; there were no significant changes in the control group. After 3 months of exercise, 54.5% of the intervention group and 9.4% of the control group reported being continent. Within the cured group of UI, a significantly higher proportion had decreased their BMI at 3 months (P=.03) and increased walking speed at 3 (P=.04) and 12 (P=.047) months.
                Decrease in BMI and increase in walking speed may contribute to the treatment of UI, although the data do not support a positive correlation between strengthening of adductor muscle and improvement of UI, which needs more research. To compare the effect of pelvic floor exercises, electrical stimulation, vaginal cones, and no treatment for genuine stress incontinence.
                Stratified, single blind, randomised controlled trial.
                Multicentre.
                107 women with clinically and urodynamically proved genuine stress incontinence. Mean (range) age was 49.5 (24-70) years, and mean (range) duration of symptoms 10.8 (1-45) years.
                Pelvic floor exercise (n=25) comprised 8-12 contractions 3 times a day and exercise in groups with skilled physical therapists once a week. The electrical stimulation group (n=25) used vaginal intermittent stimulation with the MS 106 Twin at 50 Hz 30 minutes a day. The vaginal cones group (n=27) used cones for 20 minutes a day. The untreated control group (n=30) was offered the use of a continence guard. Muscle strength was measured by vaginal squeeze pressure once a month.
                Pad test with standardised bladder volume, and self report of severity.
                Improvement in muscle strength was significantly greater (P=0.03) after pelvic floor exercises (11.0 cm H2O (95% confidence interval 7.7 to 14.3) before v 19.2 cm H2O (15.3 to 23.1) after) than either electrical stimulation (14.8 cm H2O (10. 9 to 18.7) v 18.6 cm H2O (13.3 to 23.9)) or vaginal cones (11.8 cm H2O (8.5 to 15.1) v 15.4 cm H2O (11.1 to 19.7)). Reduction in leakage on pad test was greater in the exercise group (-30.2 g; -43. 3 to 16.9) than in the electrical stimulation group (-7.4 g; -20.9 to 6.1) and the vaginal cones group (-14.7 g; -27.6 to -1.8). On completion of the trial one participant in the control group, 14 in the pelvic floor exercise group, three in the electrical stimulation group, and two in the vaginal cones group no longer considered themselves as having a problem. Conclusion: Training of the pelvic floor muscles is superior to electrical stimulation and vaginal cones in the treatment of genuine stress incontinence. We investigated the effectiveness of pelvic floor muscle (PFM) exercises or biofeedback for the treatment of urinary stress incontinence (USI). Fifty patients with USI were included in this randomized, controlled, prospective study. Twenty patients were taught PFM exercises via digital palpation and instructed to perform regularly as home program. The second group of 20 patients had PFM exercises via biofeedback three times a week for 2 months. The third group of 10 patients did not have any exercises. The patients were evaluated via pad test, perineometry, digital palpation based PFM strength, incontinence frequency, and visual analog scale based social activity index prior to and 8 weeks after the treatment. The first two groups had significant improvement in USI with respect to the control group (p < 0.001). The rise in PFM strength with perineometry of the biofeedback group was higher than in the digital palpation group after treatment (p < 0.001). PFM exercises are effective for the treatment of USI; the biofeedback method revealed better PFM strength results with respect to digital palpation.
                Copyright 2003 S. Karger AG, Basel To compare the effectiveness of pelvic floor exercises, electrical stimulation, vaginal cones, and no active treatment in women with urodynamic stress urinary incontinence.
                One hundred eighteen subjects were randomly selected to receive pelvic floor exercises (n=31), ES (n=30), vaginal cones (n=27), or no treatment (untreated control) (n=30). Women were evaluated before and after completion of six months of treatment by the pad test, quality of life questionnaire (I-QOL), urodynamic test, voiding diary, and subjective response.
                In the objective evaluation, we observed a statistically significant reduction in the pad test (p=0.003), in the number of stress urinary episodes (p<0.001), and a significant improvement in the quality of life (p<0.001) in subjects who used pelvic floor exercises, electrical stimulation, and vaginal cones compared to the control group. No significant difference was found between groups in the urodynamic parameters. In the subjective evaluation, 58%, 55%, and 54% of women who had used pelvic floor exercises, electrical stimulation, and vaginal cones, respectively, reported being satisfied after treatment. In the control group, only 21% patients were satisfied with the treatment.
                Based on this study, pelvic floor exercises, electrical stimulation, and vaginal cones are equally effective treatments and are far superior to no treatment in women with urodynamic stress urinary incontinence.
The review provides support for the widespread recommendation that PFMT be included in first-line conservative management programmes for women with stress, urge, or mixed, urinary incontinence. Statistical heterogeneity reflecting variation in incontinence type, training, and outcome measurement made interpretation difficult. The treatment effect seems greater in women with stress urinary incontinence alone, who participate in a supervised PFMT programme for at least three months, but these and other uncertainties require testing in further trials.