Evaluation of the effect of pelvic floor muscle training (PFMT or Kegel exercise) and assisted pelvic floor muscle training (APFMT) by a resistance device (Kegelmaster device) on the urinary incontinence in women “comparison between them: a randomized trial”

https://doi.org/10.1016/j.ejogrb.2011.06.037Get rights and content

Abstract

Objective

To evaluate the effect of pelvic floor muscle training (PFMT) or Kegel exercise with and without assistance by a resistance device (Kegelmaster device) on the urinary incontinence in women.

Study design

A randomized clinical trial was performed on 91 women with the complaint of urinary incontinence.

In the assisted pelvic floor muscle training (APFMT) group (n = 41), after complete training, Kegelmaster device were used twice daily for 15 min each session, for a total duration of 12 weeks.

In the pelvic floor muscle training (PFMT) group (n = 50) after complete training, kegel exercises were done (including perineal muscle contractions for 6–8 s with 6 s rest in between), twice daily for 15 min each session and for a total duration of 12 weeks.

These two groups were then compared according to the scores of special questionnaires for quality of life, strength of pelvic floor muscles, capability to participate in social activities, severity of urinary incontinence, and the number of involuntary urine passage, taken before, and after 1 and 3 months after finishing interventions.

Results

85 women out of 91 women finished the study (46 in the PFMT group and 39 in the APFMT group). Strength of pelvic floor muscles, capability to participate in social activities, score of quality of life according to three world questionnaires of IQOL (incontinence Quality Of Life), IIQ (Incontinence Impact Questionnaire), UDI (Urogenital Distress Inventory), showed no difference between the two groups 1 and 3 months after interventions.

Pair t test showed a significant improvement in both groups 1 and 3 months after intervention, according to IQOL score (P = 0.000), UDI score (P = 0.000), IIQ score (P = 0.000), strength of pelvic floor muscles, (P = 0.000), capability to participate in social activities (P = 0.000), severity of urinary incontinence (P = 0.000) and the number of involuntary urine passage (P = 0.000).

Conclusion

Pelvic floor muscle training with or without Kegelmaster show no apparent difference to each other, however, these two methods are effective for improvement of urinary incontinence in women.

Introduction

Urinary incontinence is a common complaint in women, which can have an important influence on the quality of her life [1]. Its prevalence is between 10% and 40%, and the most common form is stress urinary incontinence (SUI).

Age, body mass index (BMI), genetic factors, pregnancy and delivery, and a history of hysterectomy, smoking, race, constipation and menopause have been considered as its risk factors [2], [3], [4], [5], [6], [7], [8], [9]

Exclusive caesarean delivery may not prevent the occurrence of SUI [10]. In the past surgery was the main treatment of the patients suffering urinary incontinence (UI) and SUI, whilst nowadays, conservative management has been considered the first line of treatment for uncomplicated urinary incontinence by the International Continence Society [1], [11], and pelvic floor muscle training (PFMT) has an essential role for prevention and treatment of UI.

The rationale for the effect of PFMT is the fact that powerful contractions of pelvic floor muscles may clump urethra, and therefore, increases intra urethral pressure, and prevents the urine leakage during an increase in the intra abdominal pressure. In the cases of urge urinary incontinence, these PFMT, may inhibit reflexively or voluntarily the involuntary detrusore contraction [1].

In a study [12], the effect of PFMT on SUI and mixed urinary incontinence was evaluated. PFMT for 8 weeks, could improve significantly the pelvic floor muscle strength and quality of life, and decreased the number of involuntary urine leakage episodes.

A Cochran study [13] concluded that PFMT is an appropriate treatment for women suffering UI, in antenatal and postnatal women but it needs more studies, especially for continued long-term effectiveness, and the other Cochran study [11] concluded that PFMT should be the first-line conservative management of SUI, urge and mixed urinary incontinence.

One of the conservative treatments for UI is physical therapy, including pelvic floor muscle training or exercise, with or without assistance with special devices such as vaginal cones or electrical stimulation [12]. Another new device (the present device), has been planned for applying PFMT in order to perform them more correctly. Foe the first time, in 1948, Kegel and co-workers [14], [15], reported an improvement rate of 84%, in the different cases of UI using PFMT, and PFMT has considered as an effective conservative treatment for UI.

A study [16], proposed that special devices such as vaginal cones or biofeedback or electrical stimulation, might make these exercises more accurate and more effective. In this study, 3 methods of vaginal cone, electrical stimulation and PFMT were compared against no treatment for the relief of SUI. However, the researchers concluded that PFMT is superior to electrical stimulation and vaginal cones (as assisted PFMT), but there were no differences between vaginal cone and electrical stimulation, and both methods were more effective than no treatment.

Women in this study found some of these methods difficult, and reported some adverse effects, while, PFMT was found to be more effective than vaginal cone, electrical stimulation or no treatment. The researchers proposed that PFMT is a safe and effective treatment for SUI, and should be the first line of the conservative treatments. The other study by Ferguson et al. [17] compared exercise program with or without intravaginal balloon and found no difference between these two methods for improving SUI, but stated that both methods were effective.

Assisted pelvic floor muscle training with other special devices has been considered as another methods for improving the UI, and a new device named Golden Kegel (Ronas Teb, Tehran, Iran) or Kegelmaster has been planned for this purpose.

The aim of this study was to evaluate the effect of PFMT with or without assisted device (Kegelmaster), on the UI and make a comparison between them. As the best knowledge, it is the first study to evaluate this device.

Section snippets

Materials and method

A randomized controlled trial was performed in Akbarabadi Teaching Hospital and 12 Bahman Hospital, in Tehran, Iran, between March 2009 and February 2010 on the women suffering SUI and mixed urinary incontinence (according to patient's complains not urodynamic study).

Inclusion criteria were: SUI and mixed urinary incontinence, reproductive age (before menopause) and normal urinalysis and negative urine culture.

Exclusion criteria were: pregnancy or post partum period (6 weeks after delivery),

Results

39 and 46 patients finished the study in the APFMT and PFMT groups respectively. The women of the two groups, did not have statistically significant difference according to age, BMI, parity, mode of delivery, duration of UI, severity of UI, the number of episodes of involuntary urine leakage, capability to participate in social activities, and the scores of IQOL, IIQ, UDI, the pelvic floor muscle strength, and educational status (Table 1).

Severity of UI (P = 0.514), pelvic muscle strength (P = 

Comments

In the present study APFMT did not show any merits over PFMT alone, and it's complications were more than PFMT alone also, however, both PFMT and APFMT with Kegelmaster, could considerably improve the conditions of patients according to IQOL, IIQ, UDI, pelvic floor muscle strength and number of times when involuntary urine leakage occurs.

In a Cochran study [11], [28] the effects of PFMT have been compared with no treatment or inactive control treatment. These studies concluded that PFMT was

Acknowledgement

This work has been supported by Iran University of Medical Sciences, Deputy of Research and Technology, Project No. 816.

References (32)

  • J.Z. Press et al.

    Does cesarean section reduce post partum urinary incontinence? A systematic review

    Birth

    (2007)
  • C. Dumoulin et al.

    Pelvic floor muscle training versus no treatment, or inactive control treatments, for urinary incontinence in women

    Cochran Database Syst Rev

    (2010)
  • D. Sar et al.

    The effect of pelvic floor muscle training on stress and mixed urinary incontinence and quality of life

    J Wound Ostomy Continence Nurs

    (2009)
  • J. Hay-Smith et al.

    Pelvic floor muscle training for prevention and treatment of urinary and fecal incontinence in antenatal and postnatal women

    Cochrane Database Syst Rev

    (2008)
  • E. Aslan et al.

    Bladder training and kegel exercises for women with urinary complaints living in a rest home

    Gerontology

    (2008)
  • A.H. Kegel

    Progressive resistance exercise in the functional restoration of the perineal muscles

    AMJ Obstet Gynecol

    (1948)
  • Cited by (0)

    View full text