Urinary Incontinence

Outcomes of studies that compare pelvic muscle exercises alone to pelvic muscle exercises with biofeedback emphasize the importance of appropriate PFM identification. Bergio et al.10 concluded that both groups significantly reduced the frequency of incontinence. The biofeedback group averaged a 75.9% reduction in incontinence, significantly greater than the 51% reduction shown by the verbal feedback group. Furthermore, whereas the biofeedback group improved in the strength and selective control of the PFMs, the same improvement was not seen in the verbal group. In a review of randomized clinical trials of physical therapy for stress urinary incontinence (SUI) and based on levels of evidence criteria, strong evidence was found to suggest that PFM exercises are effective in reducing the symptoms of SUI.11 They found no evidence that PFM exercises with biofeedback were more effective than PFM exercises alone. In contrast in, a meta-analysis of studies that examined the patients with SUI, PFM exercises with biofeedback were more effective than PFM exercises alone.12 Patients who do undergo biofeedback have a more rapid reduction in leakage compared with those who perform pelvic floor exercises alone.13 In clinical practice, behavioral therapy is often combined with drug therapy. A randomized controlled study of 197 women with urge urinary incontinence or mixed incontinence with urge as the predominant pattern compared the effectiveness of biofeedback-assisted behavioral treatment with drug treatment.14 Subjects were randomized to four sessions of biofeedback-assisted behavioral treatment, drug treatment with oral immediate-release oxybutynin chloride, or a placebo control group. Behavioral treatment, which yielded a mean of 80.7% reduction of incontinent episodes, was significantly more effective than drug treatment (mean 39.4% reduction). Patient-perceived improvement was greatest for behavioral treatment. Only 14% of patients receiving behavioral treatment wanted to change to another treatment versus 75% in each of the other groups. Multimodality approaches, combining physiotherapy, drug therapy, and behavioral pattern modification, seem to have the highest success rate.15

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