Single blind, randomised controlled trial of pelvic floor exercises, electrical stimulation, vaginal cones, and no treatment in management of genuine stress incontinence in women
- 20 February 1999
- Vol. 318 (7182), 487-493
- https://doi.org/10.1136/bmj.318.7182.487
Abstract
Objective:To compare the effect of pelvic floor exercises, electrical stimulation,vaginal cones, and no treatment for genuine stress incontinence. Design:Stratified, single blind, randomised controlled trial. Setting:Multicentre. Participants: 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. Interventions: 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. Main outcome measures: Pad test with standardised bladder volume, and self report of severity. Results: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.This publication has 24 references indexed in Scilit:
- Conservative treatment of stress urinary incontinence in women: a systematic review of randomized clinical trialsBJU International, 1998
- Change in urethral pressure during voluntary pelvic floor muscle contraction and vaginal electrical stimulationInternational Urogynecology Journal, 1997
- Stress urinary incontinence: Where are we now, where should we go?American Journal of Obstetrics and Gynecology, 1996
- Long-term effect of pelvic floor muscle exercise 5 years after cessation of organized trainingObstetrics & Gynecology, 1996
- Pelvic floor electrical stimulation in the treatment of genuine stress incontinence: A multicenter, placebo-controlled trialAmerican Journal of Obstetrics and Gynecology, 1995
- Reproducibility of Instruments Designed to Measure Subjective Evaluation of Female Stress Urinary IncontinenceScandinavian Journal of Urology and Nephrology, 1994
- Pressure measurements during pelvic floor muscle contractions: The effect of different positions of the vaginal measuring deviceNeurourology and Urodynamics, 1992
- Pelvic floor muscle exercise for the treatment of female stress urinary incontinence: III. Effects of two different degrees of pelvic floor muscle exercisesNeurourology and Urodynamics, 1990
- Pelvic floor muscle exercise for the treatment of female stress urinary incontinence: II. Validity of vaginal pressure measurements of pelvic floor muscle strength and the necessity of supplementary methods for control of correct contractionNeurourology and Urodynamics, 1990
- Distress and delay associated with urinary incontinence, frequency, and urgency in women.BMJ, 1988