Meta-Analysis of the Effect of Pelvic Floor Muscle Training in Reducing Urinary Incontinence and Elevating Quality of Life in Women
Abstract
Background: Urinary incontinence is a complaint of involuntary loss of urine and often occurs in women due to bladder dysfunction or weakened pelvic floor muscles. Pelvic floor muscle training (PMFT) is an exercise to treat urinary incontinence. This study aimed to analyze the effectiveness of pelvic floor muscle training to reduce urinary incontinence and improve quality of life in women.
Subjects and Method: This was a systematic review and meta-analysis. The data was obtained through journal databases including PubMed, Science Direct, and Google Scholar by selecting articles published in 2010-2020. The keywords used were ("pelvic floor muscle training" OR "pelvic floor exercise" OR "kegel") AND ("urinary incontinence" OR "leaking urine" OR "urinary leakage") AND ("women" OR "female") AND "quality of life" AND "randomized controlled trial". The inclusion criteria were full paper articles with the Randomized Controlled Trial (RCT) research method. The size relationship used's of Mean SD, the intervention given was pelvic floor muscle training; female research subjects were 20-75 years old and experienced urinary incontinence. Search articles were done by using the PICO model. Population= Women with urinary incontinence, Intervention= pelvic floor muscle training, Comparison= not given PMFT, and Outcome= decreased urinary incontinence and improved quality of life. Articles were collected by using PRISMA flow diagrams and analyzed using the Revman 5.3 application.
Results: Meta-analysis of 7 articles showed that pelvic floor muscle training could reduce urinary incontinence by 0.56 times higher compared to other interventions or no intervention (SMD= -0.56; 95% CI= -1.03 to -0.09; p= 0.020). Meta-analysis of 9 articles showed that pelvic floor muscle training improved quality of life by 0.32 times higher compared to other interventions or no intervention (SMD= -0.32; 95% CI= -0.66 to 0.02; p=0.070).
Conclusion: Pelvic Floor Muscle Training (PMFT) reduces urinary incontinence and improves the quality of life in women.
Keywords: pelvic floor muscle training, urinary incontinence, quality of life
Correspondence: Ragil Aidil Fitriasari Addini. Masters Program in Public Health, Universitas Sebelas Maret, Jl. Ir. Sutami 36A, Surakarta 57126, Central Java. Email: ragilaidilfa@gmail.com. Mobile: 089609133808.
Indonesian Journal of Medicine (2021), 06(03): 258-270
https://doi.org/10.269¬11/theijmed.2021.06.03.03
References
Agarwal M, GargA, Shankar U (2017). Kegel exercise and duloxetine hydrochloride for management of stress urinary incontinence (SUI). Indian J Obstet Gynecol Res. 4(3): 240–243. doi: 10.18231/2394-2754.2017.0054.
Aly W, Sweed H, Mossad N, Tolba M (2020). Prevalence and risk factors of urinary incontinence in frail elderly females. J Aging Res. 2020: 2425945. doi: 10.1155/2020 2425945.
Aoki Y, Brown H, Brubaker L, Nicolas J, Oliver J, Cartwright R (2017). Urinary incontinence in women. Nat Rev Dis Primers. 3. doi: 10.1038/nrdp.2017.-42.
Bardsley A (2016). An overview of urinary incontinence. Br J Nurs. 25(18): S14–S21. doi: 10.12968/bjon.2016.25.18.S-14.
Bertotto A, Schyartzman R, Uchôa S, Caleste M (2017). Effect of electromyographic biofeedback as an add-on to pelvic floor muscle exercises on neuromuscular outcomes and quality of life in postmenopausal women with stress urinary incontinence:A rando-mized controlled trial. Neurourol. Urodyn. 36(8): 2142–2147. doi: 10.1002/nau.23258.
Castro R, Arruda R, Zanetti M, Santos P, Sartoni M, Girão M (2008). 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. 63(4): 465–472. doi: 10.1590/S1807-59322008000400009.
Cavkaytar S, Kokanali M, Topcu O, Doğanay M (2015). Effect of home-based Kegel exercises on quality of life in women with stress and mixed urinary incontinence. J Obstet Gynaecol. 35 (4): 407–410.doi: 10.3109/01443615-.2014.960831.
Dumoulin C, Le Berre M (2020). Pelvic floor muscle training for older women with urinary incontinence. Curr Geriatr Rep. 9(2): 54–63. doi: 10.1007/s1-3670-020-00316-8.
Dumoulin C, Hay-Smith EJC, MacHabée-Séguin G (2014). Pelvic floor muscle training versus no treatment, or inactive control treatments, for urinary incontinence in women. Cochrane Database Syst Rev. doi: 10.1002/14651858.CD005654.pub3.
Eickmeyer SM (2017). Anatomy and physiology of the pelvic floor. Phys Med Rehabil Clin N Am. 28(3): 455–460. doi: 10.1016/j.pmr.2017.03.003.
Farzinmehr A, Moezy A, Koohpayehzadeh J, Kashanian M (2015). A comparative study of wholebody vibration training and pelvic floor muscle training on women's stress urinary incontinence: Three-month follow-up. J Family Reprod Health. 9(4): 147–154. http:-//www.ncbi.nlm.nih.gov/pubmed/27-07560%0Ahttp://www.pubmed-central.nih.go/articlerender.fcgi?artid=PMC4818376
García S, Rubio A, Ávila G, Ramos C, López R (2016). Effectiveness of pelvic floor muscle training in treating urinary incontinence in women: A current review. Arch Esp Urol. 40(5): 271–278. doi: 10.1016/j.acuroe.2016.03.0-11.
Goode PS, Burgio KL, Kraus SR, Kenton K, Litman HJ, Richter HE (2011). Correlates and predictors of patient satisfaction with drug therapy and combined drug therapy and behavioral training for urgency urinary incontinence in women. Int Urogynecol J. 22(3): 327–334. https://doi.org/10.-1007/s00192-010-1287-x.
Hall B, Woodward S (2015). Urinary Incontinence Postpartum. Br J Nurs. 24 (11). 576–579. https://doi.org/10.12-968/bjon.2015.24.11.576.
Kessler M, Augusto L, Uhlmann M, Pereira B, Mattos S, Thume E (2018). Prevalence of urinary incontinence among the elderly and relationship with physical and mental health indicators. Revista Brasileira de Geriatria e Gerontologia. 21(4): 397–407. http:-//dx.doi.org/10.1590/1981-2256201-8021.180015.
Lausen A, Marsland L, Head S, Jackson J, Lausen B (2018). Modified Pilates as an adjunct to standard physiotherapy care for urinary incontinence: A mixed methods pilot for a randomised controlled trial. BMC Women's Health. 18(1): 16. https://doi.org/10.1186/s12905-017-0503-y.
Lee BA, Kim JS, Choi DK, Kwon O, Na HR, Cho ST (2017). Effects of pelvic floor muscle exercise on urinary incontinence in elderly women with cognitive impairment. Int Neurourol J. 21(4): 295–301. doi: 10.5213/inj.-1734956.478.
Lukacz ES, Santiago YL, Albo ME, Brubaker L (2017). Urinary incontinence in women a review. J Am Med Assoc. 318(16): 1592–1604. doi: 10.1001/ja-ma.2017.12137.
Murray AS (2019). Pelvic floor muscle training versus no treatment, or inactive control treatments, for urinary incontinence in women. Res. Nurs. Health. 42(3). 234–235. doi: 10.1002/nur.21946.
Radzimińska A, Strączyńska A, Weber M, Styczyńska H, Strojek K, Piekorz Z (2018). The impact of pelvic floor muscle training on the quality of life of women with urinary incontinence: a systematic literature review. Clin Interv Aging. 13:957–965. https://doi.org/10.2147/cia.s160057.
Schreiber L, Lose G, Terp M, Elsner S, Waldmann A, Rudnicki M (2017). Prevalence of urinary incontinence among women and analysis of potential risk factors in Germany and Denmark. Acta Obstet. Gynecol. Scand. 96(8). 939–948. doi: 10.1111/aogs.13149.
Sherburn M, Bird M, Carey M, Bo K, Galea M (2011). Incontinence improves in older women after intensive pelvic floor muscle training: An assessor-blinded randomized controlled trial. Neurourol. Urodyn. doi: 10.1002/nau.20968.
Soni N, Rahule AS, Sagdeo V (2014). Evaluation of Effect of Kegel Exercise for the Management of Stress Incontinence in Women of Gujrat, India. Int. J. Contemp. Med. 2(3): 20–23. doi: 10.18049/jcmad/234.
Topuz, Ş, Seviğ E (2016). Effects of kegel exercises applied to urinary ıncontinence on sexual satisfaction. Int. J. Clin. Exp. Med. 9(6): 12365–12374.
