Group Pelvic Floor-Muscle Training for Urinary Incontinence Noninferior to Individual Sessions

By Lisa Rappaport

August 05, 2020

(Reuters Health) - Older women with urinary incontinence may experience a similar reduction in episodes with group pelvic floor muscle training compared with one-on-one sessions, a new study suggests.

Researchers randomly assigned 362 older women with stress or mixed urinary incontinence to receive 12 weeks of pelvic floor muscle training in groups of eight women or individually. At one year, the median percentage reduction in episodes was similar for those who had group or individual pelvic floor muscle training (74% and 70%, respectively), and within the prespecified noninferiority margin of 10%.

The median number of leakage episodes per day declined for both groups, from 1.4 at baseline to 0.4 at one year with group sessions and from 1.6 at baseline to 0.4 at one year with individual sessions, the study also found.

"Group pelvic floor muscle training is as effective as individual," said lead study author Chantale Dumoulin of the University of Montreal, in Canada.

"Clinically it means that in areas where human and financial resources limit treatment delivery, group-based pelvic floor muscle training should be considered as an option to increase access," Dumoulin said by email.

Women included in the study were at least 60 years old and had experienced symptoms of stress or mixed urinary incontinence for at least three times per week during the prior three months.

Women were excluded from the study if they had obesity (BMI greater than 35), chronic constipation, important pelvic organ prolapse, other treatment for urinary incontinence in the past year, changes in hormone replacement therapy in the past six months, any leakage of stool or mucus, any urinary or vaginal infections in the past three months, or any other comorbidities or risk factors that might interfere with study outcomes.

Participants had a mean age of 67.9 years. Mean attendance for pelvic floor muscle training sessions was high for women assigned to both individual and group sessions (98% and 95%, respectively).

During the 12-week intervention period, most women assigned to both individual and group sessions also did pelvic floor muscle exercises at home four to five days a week (89% and 86%, respectively).

In addition, similar proportions of women randomized to both individual and group sessions reported feeling "much better" or "very much better" in terms of symptom improvement (85% and 86%, respectively) and in terms of overall satisfaction with the outcomes (90% and 91%, respectively).

There was no statistically significant difference between the groups in reduction in micturition and nocturia, or improvement in vaginal symptoms.

No serious adverse events were reported in either group. Minor adverse events included vaginal spotting and discomfort.

One limitation of the study is that results might not be generalizable to all women because of the intensive participation requirements for the intervention as well as the extensive exclusion criteria, the study team notes in JAMA Internal Medicine.

Even so, the results suggest that group sessions may be a viable option for making pelvic floor muscle training more widely available, said Dr. Alison Huang, an associate professor of medicine, epidemiology and biostatistics, and urology at the University of California, San Francisco, who wrote a commentary accompanying the study.

"Currently, group-based pelvic floor muscle training isn't available at many healthcare facilities, but I hope that the results of this study will change this," Dr. Huang told Reuters Health by email. "It's obviously much more efficient and cost-effective to provide training in a group setting rather than through one-on-one training sessions."

SOURCE: https://bit.ly/2EH0c5b and https://bit.ly/2PoGtt2 JAMA Internal Medicine, online August 3, 2020.

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