Pelvic floor electrical stimulation (PFES) has been used successfully to treat stress incontinence by providing a form of passive exercise through contraction of smooth and striated pelvic floor muscles. Goode and colleagues performed a study to determine whether PFES enhances a multicomponent behavior-training intervention in treating stress incontinence.
The trial enrolled community-dwelling women older than 40 years who reported a pattern of stress incontinence that was confirmed with urodynamic testing. Patients were randomized into three groups: behavior training, which consisted of biofeedback-assisted pelvic floor muscle training, home exercises, and self-monitoring with diary entries; behavior training plus home PFES treatments; or a control group using self-administered training with a booklet. Treatment was implemented over eight weeks. Patients in all groups were instructed on muscle strengthening and urge-control strategies, and the PFES group also received a home PFES vaginal-stimulation unit to use every other day. At follow-up, patients completed post-treatment diaries and incontinence and satisfaction surveys, and they were encouraged to repeat uro-dynamic testing. The primary outcome was a reduction in the frequency of incontinence episodes as recorded in the diaries.
Of the 200 patients enrolled, 18.2 percent in the behavior group, 11.9 percent in the PFES group, and 37.3 percent in the self-help group did not complete the trial. Before treatment, the frequency of incontinence was similar across all groups. Behavior training resulted in a mean reduction of 68.6 percent in frequency of episodes; behavior training plus PFES resulted in a mean reduction of 71.9 percent; and self-help resulted in a mean reduction of 52.5 percent (P = .005). The results of behavior training, with or without PFES, were statistically equivalent, but both were more effective than the self-help approach.
No group differed in terms of number of cures (i.e., 100 percent improvement). In the subgroup that completed treatment, the outcomes did not differ by treatment group. In patients who elected to repeat urodynamic testing, the main effect for the treatment group was not significant. Although women in the PFES group thought they had much better outcomes than the behavior group, and the behavior group thought they had much better outcomes than the self-help group, the Incontinence Impact Questionnaire scores in all groups improved, without significant differences among groups.
PFES did not enhance the outcomes of biofeedback-assisted behavior training for treatment of stress incontinence in women. The self-help approach was less effective than the other interventions, mainly because of the high attrition rate. Behavior training for stress incontinence may work best when physicians can confirm that patients are exercising the correct muscles.