The effects of multidimensional exercise treatment on community-dwelling elderly Japanese women with stress, urge, and mixed urinary incontinence: a randomized controlled trial

Background

Urinary incontinence is one of the most prevalent health problems and a significant cause of disability and dependence in the elderly. Pelvic floor exercise is effective in reducing stress urinary incontinence, but few studies have investigated the effect of behavioral management on urge and mixed incontinence.

Objectives

To determine the effects of multidimensional exercise treatment on reducing urine leakage in elderly Japanese women with stress, urge, and mixed urinary incontinence.

Design

Randomized controlled, follow-up trial.

Settings

Urban community-based study.

Participants

127 community-dwelling women aged 70 and older with stress, urge, and mixed urinary incontinence were randomly assigned to the intervention (n = 63) or the control group (n = 64).

Methods

Urine leakage and fitness data were collected at baseline, and after the intervention and follow-up. The intervention group received a multidimensional exercise treatment twice a week for 3-month. After treatment, the participants were followed for 7-month.

Results

There were significant differences in changes of functional fitness and incontinence variables between the intervention and control groups. The intervention group showed urine leakage cure rates of 44.1% after treatment and 39.3% after follow-up (χ² = 21.96, p < 0.001); whereas, the control group showed no significant improvement. The multidimensional exercise treatment was significantly effective in decreasing all three types of urinary incontinence. However, the effects of the exercise treatment were greater on stress urinary incontinence than on urge or mixed urinary incontinence. At the 7-month follow-up, while cure rates of all three types of urinary incontinence were significantly maintained, a slight reversal was seen only in the urge and mixed urinary incontinence (χ² = 10.28, p = 0.008). According to the logistic regression model, urine leakage volume (adjusted odds ratio OR = 0.69, 95% confidence interval CI = 0.39–0.98), compliance (OR = 1.03, 95%CI = 1.01–1.16), and BMI reduction (OR = 0.67, 95%CI = 0.48–0.89) were significantly associated with the cure of urine leakage after intervention. The cure rate of urine leakage after the follow-up was significantly associated with compliance (OR = 1.13, 95%CI = 1.02–1.29) and BMI reduction (OR = 0.78, 95%CI = 0.60–0.96).

Conclusions

The intervention group showed higher urine leakage cure rates than control group. This result suggests that multidimensional exercise strategies may be effective for all three types of urinary incontinence. BMI reduction and compliance to the intervention was the consistent predictor for the effectiveness of the exercise treatment.     

Pelvic static magnetic stimulation to control urinary incontinence in older women: a randomized controlled trial

Objectives

To determine the efficacy of non-invasive static magnetic stimulation (SMS) of the pelvic floor compared to placebo in the treatment of women aged 60 years and over with urinary incontinence for 6 months or more.

Subjects and Methods

A single-blinded randomized, placebo-controlled, parallel-group trial. Subjects were excluded if they had an implanted electronic device, had experienced a symptomatic urinary tract infection, or had commenced pharmacotherapy for the same in the previous 4 weeks, or if they were booked for pelvic floor or gynecological surgery within the next 3 months. Once written consent was obtained, subjects were randomly assigned to the active SMS group (n=50) or the placebo group (n=51). Treatment was an undergarment incorporating 15 static magnets of 800–1200 Gauss anterior, posterior, and inferior to the pelvis for at least 12 hours a day for 3 months. Placebo was the same protocol with inert metal disks replacing the magnets. Primary outcome measure was cessation of incontinence as measured by a 24-hour pad test. Secondary outcomes were frequency and severity of symptoms as measured by the Bristol Female Lower Urinary Tract Symptoms questionnaire (BFLUTS-SF), the Incontinence Severity Index, a Bothersomeness Visual Analog scale, and a 24-hour bladder diary. Data were collected at baseline and 12 weeks later.

Results

There were no statistically significant differences between groups in any of the outcome measures from baseline to 12 weeks. Initial evidence of subjective improvement in the treatment group compared to the placebo group was not sustained with sensitivity analysis.

Conclusion

This study found no evidence that static magnets cure or decrease the symptoms of urinary incontinence. Additional work into the basic physics of the product and garment design is recommended prior to further clinical trials research.     

Kegel盆底肌训练治疗产后尿失禁35例效果观察

目的:探讨Kegel盆底肌训练治疗产后尿失禁的效果。方法:将67例自然分娩初产妇随机分为实验组35例和对照组32例,实验组于产后3个月开始进行12周的产后健康教育和Kegel盆底肌训练指导,对照组给予常规健康教育,两组均于产后3个月、6个月进行随访,通过问卷调查、盆底肌力测定及尿垫试验评价其排尿情况。结果:产后3个月两组排尿状况评分、盆底肌力评分、尿失禁发生率比较差异均无统计学意义(P>0.05),产后6个月两组比较差异均有统计学意义(P<0.05)。结论:Kegel盆底肌训练能有效治疗产后尿失禁。     

The role of diaphragmatic breathing exercise on urinary incontinence treatment: A pilot study

ObjectiveThe main aim of this pilot study was to examine the effect of diaphragmatic breathing exercise on urinary incontinence treatment. The secondary purpose was to compare the effect of pelvic floor muscle exercises and diaphragmatic breathing exercises on urinary incontinence women.DesignParticipants were randomized into two groups: pelvic floor muscle exercises (Group PFM n = 20) and diaphragmatic breathing exercises (Group DB n = 20). Exercise programs consisted of 1 set of contractions per day and each set included 30 repetitions for 6 weeks. Women were asked to complete forms of Incontinence Impact Questionnaire (IIQ-7) and the Urogenital Distress Inventory (UDI-6), Incontinence Quality of Life (I-QOL), and Overactive Bladder (OAB-V3) before starting the program and again at the end of the 6-week program.ResultsIIQ-7, I-QOL, and OAB-V3 scores significantly improved in both groups, after exercises. There were no difference between groups in the post-exercise scores. Total score of the UDI-6 was statistically significantly decreased higher in the DB exercises group. UDI-6 Urge Symptoms decreased statistically significantly only in the DB exercises group. Even though there was a decrease in the PFM group, but it was not significant.ConclusionDiaphragmatic breathing exercises may be an alternative to pelvic floor muscle exercises in the treatment of urinary incontinence.ClinicalTrials.gov IDNCT04991675.     

女性盆底肌锻炼的超声尿动力学实时观察

目的：应用超声尿动力学对女性压力性尿失禁盆底肌锻炼进行监测。方法：对30例压力性尿失禁患者盆底肌收缩与松弛动作进行观察，对照组为20例正常妇女。比较两组下尿路形态与盆底功能参数的差异。结果：盆底肌收缩较之松驰时，膀胱尿道连接部向前向上运动，尿道轴向上向前旋转，尿道最大关闭压、阴道压明显提高。病例组盆底肌收缩力度明显低于正常组。结论：超声尿动力学方法可以实时反映盆底肌运动时下尿路的解剖与盆底功能的改变，有利于对压力性尿失禁盆底肌的锻炼进行监测。     

Pelvic floor muscle training for stress urinary incontinence: A randomized,controlled trial comparing different conservative therapies

Background and Purpose. Pelvic floor muscle training (PFMT) is an effective therapy for stress urinary incontinence (SUI). There is little and inconsistent data about different strategies of PFMT. Finding the right, patient‐oriented treatment decision seems to be essential in order to achieve good results in conservative management of SUI. It was the aim of this prospective randomized controlled trial (RCT) to compare three different strategies using electromyography (EMG) biofeedback‐assisted PFMT with and without electrical stimulation (ES) for treatment of SUI in women capable of voluntarily contracting the pelvic floor when a home‐training device with vaginal electrode was used. Method. Three‐arm RCT comparing 1) EMG biofeedback‐assisted PFMT and conventional ES; 2) EMG biofeedback‐assisted PFMT and dynamic ES; and 3) EMG biofeedback‐assisted PFMT. Primary outcome measures were quality of life (King's Health Questionnaire) and degree of suffering (rated on a visual analogue scale from 1 to 10). Secondary outcome measures were number of pads used, pad weight test, contractility of the pelvic floor measured by digital palpation and intra‐vaginal EMG. Results. The quality of life significantly increased over the 12‐week training. The number of pads used was reduced, the pad weight test and the contractility of the pelvic floor significantly improved. There were no significant differences between the three groups. Conclusion. This RCT shows significant improvement in patients' quality of life for conservative therapy of SUI. Differences between the three therapeutic options analyzed could not be found. Additional ES showed no benefit for patients with SUI, capable of voluntary pelvic floor contraction. Copyright © 2010 John Wiley & Sons, Ltd.     

产后早期盆底肌功能训练对预防产后尿失禁的临床效果分析

目的探讨进行早期盆底肌功能训练预防产后尿失禁的效果。方法将1500例足月、初产、头位自然分娩的产妇,随机分A组、B组、C组各500例。使用不同的方法进行产后盆底肌功能训练,于产后3个月随访,进行效果评价、比较。结果 A、B组产妇漏尿发生率分别为4.49%、11.11%,较C组(漏尿发生率22.5%)低,差异有显著意义(P0.05)。结论产后早期进行盆底肌功能训练可降低尿失禁的发生率,但要为产妇提供个性化的训练方法。     

康复锻炼对女性尿失禁患者生活质量的影响

目的探讨康复锻练对女性尿失禁患者生活质量的影响。方法将104例女性尿失禁患者随机分为干预组和对照组,干预组患者进行康复锻练,主要包括耻骨肌锻炼、盆底肌锻炼,干预时间为2个月,对照组采用常规口头宣传。采用生活质量量表进行问卷调查,比较2组患者干预后生活质量水平。结果与对照组相比,干预组患者的生活质量明显提高。2组差异有统计学意义(p<0.001)。结论康复锻练能有效地提高女性尿失禁患者的生活质量。     

Effectiveness of pelvic floor muscle training and bladder training for women with urinary incontinence in primary care: a pragmatic controlled trial

Background

Although the efficacy of pelvic floor muscle training (PFMT) and bladder training are well established, there is a paucity of patient centered models using these interventions to treat women with UI at primary level of health assistance in Brazil.

盆底肌肉功能锻炼与手术治疗女性中度压力性尿失禁的比较研究

目的 比较观察盆底肌肉功能锻炼与手术治疗女性中度压力性尿失禁(SUI)的临床疗效,为寻找合适的治疗方法提供理论参考.方法 将114例中度SUI患者随机分为治疗组58例和对照组56例.对照组采用经闭孔阴道无张力吊带术(TVT-O)治疗,治疗组采用盆底肌肉功能锻炼治疗.连续治疗12周后评价临床疗效和生活质量,进行成本/效益分析.结果 治疗组临床疗效总有效率为86.2%,高于对照组的83.9%.治疗后2组患者的生活质量得分与治疗前比较显著上升,尿失禁问卷得分与治疗前比较显著下降,且治疗组与对照组之间有差异.成本/效益分析表明,治疗组患者的医疗总成本、临床总有效率每增长一个百分点需要花费的成本和生活质量增长1分需要花费的成本均显著低于对照组.结论 盆底肌肉功能锻炼是中度女性SUI患者的首选治疗方法,应当推广和应用.     

盆底肌肉功能锻炼与手术治疗女性中度压力性尿失禁的比较研究

目的比较观察盆底肌肉功能锻炼与手术治疗女性中度压力性尿失禁（SUI）的临床疗效,为寻找合适的治疗方法提供理论参考。方法将114例中度SUI患者随机分为治疗组58例和对照组56例。对照组采用经闭孔阴道无张力吊带术（TVT-O）治疗,治疗组采用盆底肌肉功能锻炼治疗。连续治疗12周后评价临床疗效和生活质量,进行成本／效益分析。结果治疗组临床疗效总有效率为86．2％,高于对照组的83．9％。治疗后2组患者的生活质量得分与治疗前比较显著上升,尿失禁问卷得分与治疗前比较显著下降,且治疗组与对照组之间有差异。成本／效益分析表明,治疗组患者的医疗总成本、临床总有效率每增长一个百分点需要花费的成本和生活质量增长1分需要花费的成本均显著低于对照组。结论盆底肌肉功能锻炼是中度女性SUI患者的首选治疗方法,应当推广和应用。     

日记式康复指导对女性压力性尿失禁患者盆底肌锻炼依从性的影响

目的探讨日记式康复指导对女性压力性尿失禁患者盆底肌锻炼依从性的影响。方法选取2017年12月至2018年12月我院收治的96例女性压力性尿失禁患者作为研究对象,随机将其等分为对照组和试验组,对照组给予常规康复干预,试验组在对照组基础上给予日记式康复指导。采用国际尿失禁咨询委员会尿失禁问卷调查简表(ICI-Q-SF)评估患者尿失禁症状的主观改善情况,比较两组患者干预前、干预后3个月自我效能得分、盆底肌锻炼依从性、主观改善情况、临床治疗效果。结果干预后3个月,两组患者自我效能得分均明显升高,试验组得分明显高于对照组(P<0.05);干预后3个月,两组患者盆底肌锻炼依从性均明显改善(P<0.05),试验组优于对照组(P<0.05);干预后3个月,两组ICI-Q-SF评分均明显降低,试验组低于对照组(P<0.05);试验组临床治疗效果明显高于对照组(P<0.05)。结论日记式康复指导能够明显提升女性压力性尿失禁患者盆底肌锻炼依从性,增强患者自我效能,有效改善尿失禁症状,明显提高临床治疗效果。     

微波并盆底肌锻炼治疗中老年尿失禁

目的 观察微波配合盆底甩锻炼对中老年尿失禁患者的治疗效果及远期疗效。方法 用随机对照双盲试验,通过尿失禁问卷式量表和１０分制排尿紧迫程度感的调查,在治疗前后及一３个月评价治疗效果。结果 微波配合／或盆底肌锻炼组与对照组比较（均Ｐ〈０．０１）,能显著减轻尿失禁患者排尿时紧迫感、频数和溢尿量,提高患者日常生活质量,并将此效果保持一段时间（３个月）。疗效以微波配合盆底锻炼组较显著（Ｐ〈０．０１）。结论     

电针刺激联合盆底肌训练治疗脑梗死后尿失禁43例效果观察

目的:探讨电针刺激联合盆底肌训练治疗脑梗死后尿失禁患者的效果.方法:将86例脑梗死后尿失禁患者随机分为实验组和对照组各43例,对照组给予单纯盆底肌训练,实验组采用电针刺激联合盆底肌训练.结果:实验组痊愈率、总有效率均高于对照组(P<0.05).结论:在科学的护理指导下,对脑梗死后尿失禁患者采取电针刺激和功能锻炼相结合的方法,可达到更理想的康复效果.     

The effectiveness of pelvic floor exercise on urinary incontinence in radical prostatectomy patients

Urinary incontinence (UI) is a major complication among patients after radical prostatectomy (RP). Although previous research supports the efficacy of pelvic floor exercises for male UI, there are both positive and no significant effects. The purpose of this study was to examine the effect of pelvic floor exercises on UI after RP. This was a quasi‐experimental, randomized, mixed‐method study design. All participants were older than 45 years and had undergone an RP. Outcome measurements included a 1‐h pad test, personal demographics, and disease‐related data. After catheter removal, participants were distributed into either an exercise group (n = 39) or a non‐exercise group (n = 28). Patients in the exercise group took part in a pelvic floor exercise during their regular daily activities. The non‐exercise group did not perform the prescribed exercise. We examined urinary function at 1, 3 and 6 months after catheter removal. Following a mixed‐model anova test for differences, the results of the pad test revealed significant differences for the main effect of time (F = 75·30,P < 0·001), indicating that the amount of urine leakage decreased over time regardless of the group. Results for the main effect of group were statistically significant (F = 8·85,p < 0·01), indicating that urine leakage also decreased over time in both groups, but that urinary control in the exercise group was better than in the non‐exercise group. Although improvements in surgical technique have significantly improved the outcome of prostate surgery, we believe that patient education regarding pelvic floor exercises by a nurse prior to and after surgery has a significant impact on the early recovery of urinary continence. We believe these exercises would certainly have a positive impact on our patients undergoing RP by improving the quality of life after major urological surgery.     

Pelvic floor muscle training effect on urinary incontinence knowledge, attitudes, and severity: an experimental study

This study of Taiwanese women investigated effects of pelvic floor muscle training (PFMT) on urinary incontinence (UI) severity and on participants' knowledge and attitudes regarding UI and PFMT. Of 114 participants in a 4-h PFMT program, 55 suffering from UI completed 2 questionnaires, 1 before and 1 after the program. Among them, 78% reported experiencing UI under increased abdominal pressure, and 82% had suffered the condition for more than 1 year. Participants achieved reductions in UI severity after PFMT; and the program produced a significant difference in their knowledge about, though not in their attitudes toward, both UI and PFMT.     

Biofeedback for pelvic floor muscle training in women with stress urinary incontinence: a systematic review with meta-analysis

Background

Several clinical effects have been attributed to the use of biofeedback (BF) as an adjuvant in the treatment of women with stress urinary incontinence (SUI).

超声评价女性压力性尿失禁

目的　探讨超声测量参数在女性压力性尿失禁(SUI)评价中的价值。方法　对31例SUI女性患者进行尿道外口超声检查。以耻骨联合下端为原点,沿耻骨联合线45°夹角分别建立X Y坐标轴。于安静状态和深吸气时,测量膀胱颈与耻骨下端的距离以及膀胱颈所对应的坐标值,分别为Dr、Xr、Yr和Ds、Xs、Ys。运用三角函数计算出两种状态下的膀胱颈角度θr、θs、旋转角度Δθ(θs-θr),以及深吸气时膀胱颈移动的距离M。结果　SUI患者深吸气时Y值增大,ΔY(Ys-Yr)明显高于ΔX。ΔY、Δθ、距离M随遗尿量增大而增加。结论　膀胱颈向下移动的距离ΔY、旋转角度Δθ、移动距离M与SUI的严重程度有相关性,能反映膀胱颈的活动度,对SUI的诊断有帮助。     

Impact of pelvic floor muscle training on sexual function of women with urinary incontinence and a comparison of electrical stimulation versus standard treatment (IPSU trial): a randomised controlled trial

Aims

To evaluate the clinical and cost-effectiveness of electric stimulation plus standard pelvic floor muscle training compared to standard pelvic floor muscle training alone in women with urinary incontinence and sexual dysfunction.