Multimodality pelvic physiotherapy treatment of urinary incontinence in adult women

The aim of the study was to evaluate the effectiveness of in-office physiotherapy for stress, mixed and urge incontinence. All subjects underwent urodynamics. Those with stress incontinence received pressure biofeedback pelvic floor exercises and electrical stimulation. Those with detrusor instability and mixed incontinence received bladder drills, anticholinergic medications, electrical stimulation and pressure biofeedback pelvic floor exercises. All those with atrophic vaginitis received vaginal estrogen. Weekly treatment sessions for 4 weeks and then monthly for 2 months were directed by a trained gynecologic nurse. Weekly bladder diaries were kept. Outcome measures included diary-recorded incontinence episodes and subjective reporting of continence. One hundred and four women completed the program. Weekly incontinence episodes decreased from 22 to 2 (<0.05) in both stress and detrusor instability/mixed incontinence groups. An average of 4.5 sessions over 6.1 weeks was necessary for optimal response; 86% reported subjective improvement. It was concluded that multimodality treatment of incontinence leads to a 90% reduction in incontinence episodes. The relative contribution of each treatment modality requires further study.Editorial Comment: The authors report their experience using a multimodality approach to the conservative management of urinary incontinence. They clearly outline their protocols in patients with stress, urge and mixed incontinence. They chose a subjective parameter of outcome with seemingly good compliance, probably as a result of their stressing the educational component of their approach. Such re-enforcement allows them to report relatively good results using their protocols. The exact role of each modality and its contribution to the management of these patients will have to await well controlled prospective and randomized studies.