A Randomised Interventional Parallel Study to Evaluate the Effect of Different Frequencies of Pelvic Floor Muscle Exercises with Core Stabilisation Using Three-dimensional Ultrasound: the PELSTAB Study

Overview

Journal Int Urogynecol J

Publisher Springer

Specialties Gynecology & Obstetrics
Urology

Date 2023 Mar 14

PMID 36917257

Authors

Magdalena Hagovska

Jan Svihra

Peter Urdzik

Eva Vaska

Affiliations

Soon will be listed here.

Abstract

Introduction And Hypothesis: The primary objective was to compare high- and low-frequency pelvic floor muscle training (PFMT) with the impact on urinary incontinence episode frequency over 1 week (IEF/week). The secondary objective was to compare the two groups with regard to pelvic floor muscle function, morphometry, incontinence quality of life, and patient global impression.

Methods: This was a randomised parallel controlled study. The setting was regional gynaecological and urological outpatient clinics. The subjects consisted of a sample of 86 women with stress urinary incontinence (SUI). Group A underwent high-frequency PFMT and group B underwent low-frequency PFMT for 12 weeks. We recorded the IEF/week. The International Consultation on Incontinence Questionnaire Urinary Incontinence Short Form (ICIQ-UI SF) was used. Pelvic floor muscle function was evaluated using a perineometer. Pelvic floor muscle morphometry was evaluated with 3D/4D ultrasound. The Urinary Incontinence Quality of Life Scale (I-QoL) was used.

Results: Significant differences between group A and B after treatment (p<0.001) were noted in favour of group A in IEF/week (group A 10.2±7.0/2.3±3.0 vs group B 9.3±4.7/6.3±4.9), in the ICIQ-UI SF (group A 9.7±3.0/3.7 ± 3.6 vs group B 9.9±3.2/9.4±3.4). Significant differences between groups A and B after treatment were noted in favour of group A for pelvic floor muscle function in terms of maximal voluntary contraction and its duration, and also for pelvic floor muscle morphometry in terms of a reduction of the hiatal area during rest, contraction, and the Valsalva manoeuvre.

Conclusions: High-frequency PFMT for 12 weeks significantly decreased IEF/week in comparison with low-frequency PFMT. In the high-frequency exercise group, women had significantly better pelvic floor muscle function, morphometry and quality of life than the low-frequency exercise group.

References

Abrams P, Andersson K, Apostolidis A, Birder L, Bliss D, Brubaker L . 6th International Consultation on Incontinence. Recommendations of the International Scientific Committee: EVALUATION AND TREATMENT OF URINARY INCONTINENCE, PELVIC ORGAN PROLAPSE AND FAECAL INCONTINENCE. Neurourol Urodyn. 2018; 37(7):2271-2272. DOI: 10.1002/nau.23551. 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

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. Int Urogynecol J. 2009; 21(1):5-26. DOI: 10.1007/s00192-009-0976-9. View

Kim E, Kim S, Oh D . Pelvic floor muscle exercises utilizing trunk stabilization for treating postpartum urinary incontinence: randomized controlled pilot trial of supervised versus unsupervised training. Clin Rehabil. 2011; 26(2):132-41. DOI: 10.1177/0269215511411498. View

Szumilewicz A, Dornowski M, Piernicka M, Worska A, Kuchta A, Kortas J . High-Low Impact Exercise Program Including Pelvic Floor Muscle Exercises Improves Pelvic Floor Muscle Function in Healthy Pregnant Women - A Randomized Control Trial. Front Physiol. 2019; 9:1867. PMC: 6363702. DOI: 10.3389/fphys.2018.01867. View

Szumilewicz A, Kuchta A, Kranich M, Dornowski M, Jastrzebski Z . Prenatal high-low impact exercise program supported by pelvic floor muscle education and training decreases the life impact of postnatal urinary incontinence: A quasiexperimental trial. Medicine (Baltimore). 2020; 99(6):e18874. PMC: 7015656. DOI: 10.1097/MD.0000000000018874. View

Cacciari L, Morin M, Mayrand M, Tousignant M, Abrahamowicz M, Dumoulin C . Pelvic floor morphometrical and functional changes immediately after pelvic floor muscle training and at 1-year follow-up, in older incontinent women. Neurourol Urodyn. 2020; 40(1):245-255. DOI: 10.1002/nau.24542. View

Cyr M, Dumoulin C, Bessette P, Pina A, Gotlieb W, Lapointe-Milot K . Characterizing Pelvic Floor Muscle Function and Morphometry in Survivors of Gynecological Cancer Who Have Dyspareunia: A Comparative Cross-Sectional Study. Phys Ther. 2021; 101(4). DOI: 10.1093/ptj/pzab042. View

Dietz H, Shek C, Clarke B . Biometry of the pubovisceral muscle and levator hiatus by three-dimensional pelvic floor ultrasound. Ultrasound Obstet Gynecol. 2005; 25(6):580-5. DOI: 10.1002/uog.1899. View

10.

Dietz H . Ultrasound imaging of the pelvic floor. Part I: two-dimensional aspects. Ultrasound Obstet Gynecol. 2004; 23(1):80-92. DOI: 10.1002/uog.939. View

11.

Cyr M, Kruger J, Wong V, Dumoulin C, Girard I, Morin M . Pelvic floor morphometry and function in women with and without puborectalis avulsion in the early postpartum period. Am J Obstet Gynecol. 2016; 216(3):274.e1-274.e8. DOI: 10.1016/j.ajog.2016.11.1049. View

12.

Fontaine F, Dumoulin C, Bergeron S, Mayrand M, Khalife S, Wadell G . Pelvic Floor Muscle Morphometry and Function in Women With Primary and Secondary Provoked Vestibulodynia. J Sex Med. 2018; 15(8):1149-1157. DOI: 10.1016/j.jsxm.2018.06.001. View

13.

Avery K, Donovan J, Peters T, Shaw C, Gotoh M, Abrams P . ICIQ: a brief and robust measure for evaluating the symptoms and impact of urinary incontinence. Neurourol Urodyn. 2004; 23(4):322-30. DOI: 10.1002/nau.20041. View

14.

Klovning A, Avery K, Sandvik H, Hunskaar S . Comparison of two questionnaires for assessing the severity of urinary incontinence: The ICIQ-UI SF versus the incontinence severity index. Neurourol Urodyn. 2009; 28(5):411-5. DOI: 10.1002/nau.20674. View

15.

Coyne K, Revicki D, Hunt T, Corey R, Stewart W, Bentkover J . Psychometric validation of an overactive bladder symptom and health-related quality of life questionnaire: the OAB-q. Qual Life Res. 2002; 11(6):563-74. DOI: 10.1023/a:1016370925601. View

16.

Coyne K, Payne C, Bhattacharyya S, Revicki D, Thompson C, Corey R . The impact of urinary urgency and frequency on health-related quality of life in overactive bladder: results from a national community survey. Value Health. 2004; 7(4):455-63. DOI: 10.1111/j.1524-4733.2004.74008.x. View

17.

Rahmani N, Mohseni-Bandpei M . Application of perineometer in the assessment of pelvic floor muscle strength and endurance: a reliability study. J Bodyw Mov Ther. 2011; 15(2):209-14. DOI: 10.1016/j.jbmt.2009.07.007. View

18.

Bushnell D, Martin M, Summers K, Svihra J, Lionis C, Patrick D . Quality of life of women with urinary incontinence: cross-cultural performance of 15 language versions of the I-QOL. Qual Life Res. 2005; 14(8):1901-13. DOI: 10.1007/s11136-005-5266-5. View

19.

Yalcin I, Bump R . Validation of two global impression questionnaires for incontinence. Am J Obstet Gynecol. 2003; 189(1):98-101. DOI: 10.1067/mob.2003.379. View

20.

Bo K, Hilde G, Tennfjord M, Staer-Jensen J, Siafarikas F, Ellstrom Engh M . Pelvic floor muscle variables and levator hiatus dimensions: a 3/4D transperineal ultrasound cross-sectional study on 300 nulliparous pregnant women. Int Urogynecol J. 2014; 25(10):1357-61. DOI: 10.1007/s00192-014-2408-8. View