Supervised Versus Unsupervised Pelvic Floor Muscle Training in the Treatment of Women with Urinary Incontinence - a Systematic Review and Meta-analysis

Overview

Journal Int Urogynecol J

Publisher Springer

Specialties Gynecology & Obstetrics
Urology

Date 2023 Feb 22

PMID 36811635

Authors

Ghazal Kharaji

Shabnam ShahAli

Ismail Ebrahimi-Takamjani

Javad Sarrafzadeh

Fateme Sanaei

Sanaz Shanbehzadeh

Affiliations

Soon will be listed here.

Abstract

Introduction And Hypothesis: This study synthesized the effects of supervised and unsupervised pelvic floor muscle training (PFMT) programs on outcomes relevant to women's urinary incontinence (UI).

Methods: Five databases were searched from inception to December 2021, and the search was updated until June 28, 2022. Randomized and non-randomized control trials (RCTs and NRCTs) comparing supervised and unsupervised PFMT in women with UI and reported urinary symptoms, quality of life (QoL), pelvic floor muscles (PFM) function/ strength, the severity of UI, and patient satisfaction outcomes were included. Risk of bias assessment of eligible studies was performed by two authors through Cochrane risk of bias assessment tools. The meta-analysis was conducted using a random effects model with the mean difference or standardized mean difference.

Results: Six RCTs and one NRCT study were included. All RCTs were assessed as "high risk of bias", and the NRCT study was rated as "serious risk of bias" for almost all domains. The results showed that supervised PFMT is better than unsupervised for QoL and PFM function of women with UI. There was no difference between supervised and unsupervised PFMT for urinary symptoms and improvement of the severity of UI. Results of patient satisfaction were inconclusive due to the sparse literature. However, supervised and unsupervised PFMT with thorough education and regular reassessment showed better results than those for unsupervised PFMT without educating patients about correct PFM contractions.

Conclusions: Supervised and unsupervised PFMT programs can both be effective in treating women's UI if training sessions and regular reassessments are provided.

Citing Articles

Effectiveness of breathing exercises on urinary symptoms, muscle activity, and strength in women with multiple sclerosis and urinary incontinence-a study protocol for a randomized controlled trial study.

Nazem A, ShahAli S, Dadgoo M, Mohsenifar H, Ebrahimi Takamjani I, Abadi Marand L Trials. 2025; 26(1):18.

PMID: 39819343 PMC: 11740495. DOI: 10.1186/s13063-025-08721-0.

Online vs. Supervised Training in Relieving Urinary Incontinence and Diastasis Recti Abdominis in Early Postpartum.

Tim S, Mazur-Bialy A J Clin Med. 2025; 13(24.

PMID: 39768653 PMC: 11677346. DOI: 10.3390/jcm13247730.

Comparisons of approaches to pelvic floor muscle training for urinary incontinence in women.

Hay-Smith E, Starzec-Proserpio M, Moller B, Aldabe D, Cacciari L, Pitangui A Cochrane Database Syst Rev. 2024; 12:CD009508.

PMID: 39704322 PMC: 11660230. DOI: 10.1002/14651858.CD009508.pub2.

A Comparison of Pelvic Floor Muscle Exercises and Spinal Stabilization Exercises in Women with Stress Urinary Incontinence.

Bayramoglu Demirdogen E, Ulcay T, Bagbanci M, Toprak Celenay S Int Urogynecol J. 2024; .

PMID: 39560763 DOI: 10.1007/s00192-024-05978-y.

Effects of Unsupervised Gluteal Muscle Contraction Versus Unsupervised Pelvic Floor Muscle Training in Women with Symptoms of Stress Urinary Incontinence: A Randomized Controlled Trial.

Ninomiya S, Okayama H, Naito K, Morikawa S Int Urogynecol J. 2024; 35(9):1829-1837.

PMID: 39080002 DOI: 10.1007/s00192-024-05880-7.

References

Tettamanti G, Altman D, Iliadou A, Bellocco R, Pedersen N . Depression, neuroticism, and urinary incontinence in premenopausal women: a nationwide twin study. Twin Res Hum Genet. 2013; 16(5):977-84. DOI: 10.1017/thg.2013.60. View

Farage M, Miller K, Berardesca E, Maibach H . Psychosocial and societal burden of incontinence in the aged population: a review. Arch Gynecol Obstet. 2007; 277(4):285-90. DOI: 10.1007/s00404-007-0505-3. View

Aoki Y, Brown H, Brubaker L, Cornu J, Daly J, Cartwright R . Urinary incontinence in women. Nat Rev Dis Primers. 2017; 3:17042. PMC: 5878864. DOI: 10.1038/nrdp.2017.42. View

Russo E, Caretto M, Giannini A, Bitzer J, Cano A, Ceausu I . Management of urinary incontinence in postmenopausal women: An EMAS clinical guide. Maturitas. 2020; 143:223-230. DOI: 10.1016/j.maturitas.2020.09.005. View

Haylen B, Ridder D, Freeman R, Swift S, Berghmans B, Lee J . An International Urogynecological Association (IUGA)/International Continence Society (ICS) joint report on the terminology for female pelvic floor dysfunction. Neurourol Urodyn. 2009; 29(1):4-20. DOI: 10.1002/nau.20798. View

Freeman R . The role of pelvic floor muscle training in urinary incontinence. BJOG. 2005; 111 Suppl 1:37-40. DOI: 10.1111/j.1471-0528.2004.00464.x. View

Castro R, Arruda R, Zanetti M, Santos P, Sartori M, Girao M . Single-blind, randomized, controlled trial of pelvic floor muscle training, electrical stimulation, vaginal cones, and no active treatment in the management of stress urinary incontinence. Clinics (Sao Paulo). 2008; 63(4):465-72. PMC: 2664121. DOI: 10.1590/s1807-59322008000400009. View

Bo K, Talseth T, Holme I . Single blind, randomised controlled trial of pelvic floor exercises, electrical stimulation, vaginal cones, and no treatment in management of genuine stress incontinence in women. BMJ. 1999; 318(7182):487-93. PMC: 27740. DOI: 10.1136/bmj.318.7182.487. View

Bo K, Frawley H, Haylen B, Abramov Y, Almeida F, Berghmans B . An International Urogynecological Association (IUGA)/International Continence Society (ICS) joint report on the terminology for the conservative and nonpharmacological management of female pelvic floor dysfunction. Neurourol Urodyn. 2016; 36(2):221-244. DOI: 10.1002/nau.23107. View

10.

Moher D, Liberati A, Tetzlaff J, Altman D . Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med. 2009; 6(7):e1000097. PMC: 2707599. DOI: 10.1371/journal.pmed.1000097. View

11.

Hinneburg I . ROBINS-1: A tool for asssessing risk of bias in non-randomised studies of interventions. Med Monatsschr Pharm. 2018; 40(4):175-7. View

12.

Diniz Zanetti M, Castro R, Rotta A, Santos P, Sartori M, Girao M . Impact of supervised physiotherapeutic pelvic floor exercises for treating female stress urinary incontinence. Sao Paulo Med J. 2007; 125(5):265-9. PMC: 11041512. DOI: 10.1590/s1516-31802007000500003. View

13.

Konstantinidou E, Apostolidis A, Kondelidis N, Tsimtsiou Z, Hatzichristou D, Ioannides E . Short-term efficacy of group pelvic floor training under intensive supervision versus unsupervised home training for female stress urinary incontinence: a randomized pilot study. Neurourol Urodyn. 2007; 26(4):486-491. DOI: 10.1002/nau.20380. View

14.

Felicissimo M, Carneiro M, Saleme C, Pinto R, Fonseca A, Silva-Filho A . Intensive supervised versus unsupervised pelvic floor muscle training for the treatment of stress urinary incontinence: a randomized comparative trial. Int Urogynecol J. 2010; 21(7):835-40. DOI: 10.1007/s00192-010-1125-1. View

15.

Bellotto Leme Nagib A, Silva V, Martinho N, Marques A, Riccetto C, Botelho S . Can Supervised Pelvic Floor Muscle Training Through Gametherapy Relieve Urinary Incontinence Symptoms in Climacteric Women? A Feasibility Study. Rev Bras Ginecol Obstet. 2021; 43(7):535-544. PMC: 10301951. DOI: 10.1055/s-0041-1733979. View

16.

Mishra D, Vaishnav S, Phatak A . Comparison of Effectiveness of Home-Based Verses Supervised Pelvic Floor Muscle Exercise in Women with Urinary Incontinence. J Midlife Health. 2022; 13(1):74-79. PMC: 9190959. DOI: 10.4103/jmh.jmh_83_21. View

17.

Parkkinen A, Karjalainen E, Vartiainen M, Penttinen J . Physiotherapy for female stress urinary incontinence: individual therapy at the outpatient clinic versus home-based pelvic floor training: a 5-year follow-up study. Neurourol Urodyn. 2004; 23(7):643-8. DOI: 10.1002/nau.20065. View

18.

Al Belushi Z, Al Kiyumi M, Al-Mazrui A, Jaju S, Alrawahi A, Al Mahrezi A . Effects of home-based pelvic floor muscle training on decreasing symptoms of stress urinary incontinence and improving the quality of life of urban adult Omani women: A randomized controlled single-blind study. Neurourol Urodyn. 2020; 39(5):1557-1566. DOI: 10.1002/nau.24404. View

19.

Radziminska A, Straczynska A, Weber-Rajek M, Styczynska H, Strojek K, Piekorz Z . The impact of pelvic floor muscle training on the quality of life of women with urinary incontinence: a systematic literature review. Clin Interv Aging. 2018; 13:957-965. PMC: 5962309. DOI: 10.2147/CIA.S160057. View

20.

Alewijnse D, Mesters I, Metsemakers J, Adriaans J, van den Borne B . Predictors of intention to adhere to physiotherapy among women with urinary incontinence. Health Educ Res. 2001; 16(2):173-86. DOI: 10.1093/her/16.2.173. View