Which patients benefit from pelvic floor muscle training for urinary incontinence?

Updated: Jan 22, 2021
  • Author: Sandip P Vasavada, MD; Chief Editor: Edward David Kim, MD, FACS  more...
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Answer

Individuals who benefit most tend to be young healthy women who can identify the levator ani muscles (specifically, the pubococcygeus portion) accurately. Older adults with weak pelvic muscle tone or women who have difficulty recognizing the correct muscles need adjunctive therapy such as biofeedback or electrical stimulation. Patients with severe neuromuscular damage to the pelvic floor may not be able to perform Kegel exercises, even with proper instruction.

Internet and mail-based treatment programs based on pelvic floor muscle training significantly improved symptoms and condition-related quality of life in a study of 250 community-dwelling women (aged 18-70 years) with stress urinary incontinence. At 1-year follow-up, 69.8% (60/86) of patients in the Internet treatment group and 60.5% (46/76) of patients in the postal treatment group reported continued satisfaction with their treatment result. At 2-year follow-up, these proportions were 64.9% (48/74) and 58.2% (46/79), respectively. [99]

However, the addition of pelvic muscle floor muscle exercises to incontinence surgery may not result in clinically important improvement. The Effects of Surgical Treatment Enhanced With Exercise for Mixed Urinary Incontinence (ESTEEM) trial compared outcomes in 207 patients who underwent midurethral sling surgery and 209 patients who received surgery combined with behavioral and pelvic muscle floor therapy (1 preoperative and 5 postoperative sessions through 6 months). Incontinence symptoms, measured by the Urogenital Distress Inventory (UDI) long form, fell from 178.0 points at baseline to 30.7 at 12 months in the combined group, and fell from 176.8 to 34.5 points in the surgery-only group. The model-estimated between-group difference did not meet the minimal clinically important difference threshold. [100]


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