Cochrane for Clinicians

Putting Evidence into Practice

Pelvic Floor Muscle Training vs. Control for Urinary Incontinence in Women

 

Am Fam Physician. 2020 Apr 1;101(7):393.

Author disclosure: No relevant financial affiliations.

Clinical Question

Does pelvic floor muscle training improve the symptoms of urinary incontinence in women?

Evidence-Based Answer

Use of pelvic floor muscle training to treat women with all subtypes of urinary incontinence results in improvement or cure vs. no treatment (number needed to treat [NNT] = 2.5; 95% CI, 1.4 to 5.4). Treatment with pelvic floor muscle training also results in one fewer episode of leakage per day and a reduction in leakage volume of 9.7 g per hour. Treatment is cost-effective, and risks are minimal.1 (Strength of Recommendation: A, based on consistent, good-quality patient-oriented evidence.)

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SUMMARY TABLE

Pelvic Floor Muscle Training vs. No Intervention for All Types of Urinary Incontinence in Women

OutcomesAnticipated effects with no interventionAnticipated effects with pelvic floor muscle training (95% CI)ARR and NNT (95% CI)Participants (studies)

Participant-perceived cure after 8 to 12 weeks of treatment

62 per 1,000

329 per 1,000 (171 to 632)

ARR = 26.7% NNT = 3.7 (1.7 to 9.2)

290 (3 RCTs)

Participant-perceived cure or improvement after 6 to 8 weeks of treatment

288 per 1,000

687 per 1,000 (471 to 998)

ARR = 39.9% NNT = 2.5 (1.4 to 5.4)

166 (2 RCTs)

Leakage episodes in 24 hours (following 8 to 12 weeks of treatment)

1.06 to 2.50 episodes per 24 hours

Mean difference = 1 fewer episode per 24 hours (0.64 to 1.37)

NA

349 (3 RCTs)


ARR = absolute risk reduction; NA = not applicable; NNT = number needed to treat; RCT = randomized controlled trial.

SUMMARY TABLE

Pelvic Floor Muscle Training vs. No Intervention for All Types of Urinary Incontinence in Women

OutcomesAnticipated effects with no interventionAnticipated effects with pelvic floor muscle training (95% CI)ARR and NNT (95% CI)Participants (studies)

Participant-perceived cure after 8 to 12 weeks of treatment

62 per 1,000

329 per 1,000 (171 to 632)

ARR = 26.7% NNT = 3.7 (1.7 to 9.2)

290 (3 RCTs)

Participant-perceived cure or improvement after 6 to 8 weeks of treatment

288 per 1,000

687 per 1,000 (471 to 998)

ARR = 39.9% NNT = 2.5 (1.4 to 5.4)

166 (2 RCTs)

Leakage episodes in 24 hours (following 8 to 12 weeks of treatment)

1.06 to 2.50 episodes per 24 hours

Mean difference = 1 fewer episode per 24 hours (0.64 to 1.37)

NA

349 (3 RCTs)


ARR = absolute risk reduction; NA = not applicable; NNT = number needed to treat; RCT = randomized controlled trial.

Practice Pointers

Urinary incontinence affects an estimated 15% to 46% of community-dwelling older adults2 and has profound health impacts, limiting social engagement and sexual function. Urinary incontinence is a primary driver for initiation of nursing home care and contributes to skin breakdown and increased falls, with a projected cost of $82.6 billion in 2020.3 Historically, pelvic floor muscle training has been reserved primarily for stress incontinence, rather than mixed or urge incontinence.4 The authors of this Cochrane review sought to demonstrate whether pelvic floor muscle training can be applied to all types of urinary incontinence in women, as well as to confirm its effectiveness.

This Cochrane review included 31 trials and 1,817 patients, with a follow-up time of less than 12 months.1 Trials varied widely in study populations, outcome measures, and treatment characteristics. Only randomized controlled trials or quasi-randomized controlled trials were i

Author disclosure: No relevant financial affiliations.

References

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1. Dumoulin C, Cacciari LP, Hay-Smith EJC. Pelvic floor muscle training versus no treatment, or inactive control treatments, for urinary incontinence in women. Cochrane Database Syst Rev. 2018;(10):CD005654....

2. Gorina Y, Schappert S, Bercovitz A, et al. Prevalence of incontinence among older Americans. June 2014. Accessed February 21, 2020. https://www.cdc.gov/nchs/data/series/sr_03/sr03_036.pdf

3. Coyne KS, Wein A, Nicholson S, et al. Economic burden of urgency urinary incontinence in the United States: a systematic review. J Manag Care Pharm. 2014;20(2):130–140.

4. Ghaderi F, Oskouei AE. Physiotherapy for women with stress urinary incontinence: a review article. J Phys Ther Sci. 2014;26(9):1493–1499.

5. Committee on Practice Bulletins—Gynecology and the American Urogynecologic Society.. ACOG practice bulletin no. 155. Urinary incontinence in women. Obstet Gynecol. 2015;126(5):e66–e81.

These are summaries of reviews from the Cochrane Library.

This series is coordinated by Corey D. Fogleman, MD, assistant medical editor.

A collection of Cochrane for Clinicians published in AFP is available at https://www.aafp.org/afp/cochrane.

 

 

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