Physiospot Womens Health

The integrated continence system: A manual therapy approach to the treatment of stress urinary incontinence

Stress urinary incontinence (SUI) constitutes a large-scale public health concern. The integrated continence system (ICS) developed by the authors is an evidence-based model that demonstrates how urinary incontinence is maintained through the interaction of three structural systems (intrinsic urethral closure, urethral support and lumbopelvic stability) and three modifiable factors (motor control, musculoskeletal and behavioural). The purpose of the ICS is first, to demonstrate the important role that manual physiotherapists can play in the treatment of SUI and second, to guide clinical practice decisions in order to improve clinical outcomes among women with SUI.

Manual Therapy, 2008, 13(5),  375-386

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A phase II exploratory cluster randomized controlled trial of a group mobility training and staff education intervention to promote urinary continence in UK care homes

Sackley, C. M, Rodriguez, N. A, van den Berg, M., Badger, F., Wright, C., Besemer, J., van Reeuwijk, K. T., van Wely, L.

The objective of this study was to assess feasibility, acceptability and potential efficacy of group exercise and staff education intervention to promote continence in older people residing in care homes.  Thirty-four care home residents, 23 with cognitive impairments, undertook physiotherapy-led group exercise and staff continence and mobility facilitation training.  The results showed that group mobility training and staff education to promote continence is feasible and acceptable for use with care home residents, including those with cognitive impairment.

Clinical Rehabilitation, Vol. 22, No. 8, 714-721

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Stability, continence and breathing: The role of fascia following pregnancy and delivery

D.G. Lee, L.J. Lee and L. McLaughlin

Pregnancy-related pelvic girdle pain (PRPGP) has a prevalence of approximately 45% during pregnancy and 20–25% in the early postpartum period.  Current evidence suggests that the muscles and fascia of the lumbopelvic region play a significant role in musculoskeletal function as well as continence and respiration.  Biomechanical aspects of the myofascial piece of the clinical puzzle as it pertains to the abdominal canister during pregnancy and delivery, in particular trauma to the linea alba and endopelvic fascia and/or the consequence of postpartum non-optimal strategies for load transfer, is the focus of the first two parts of this paper.  A possible physiological explanation for fascial changes secondary to altered breathing behaviour during pregnancy is presented in the third part.

Journal of Bodywork and Movement Therapies, 1 July 2008, online article ahead of publish

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Pelvic floor muscle training in the prevention and treatment of urinary incontinence in women - what is the evidence?

Brostrøm S, Lose G

Many women suffer from urinary incontinence (UI). During and after pregnancy, women are advised to perform pelvic floor muscle training (PFMT) to prevent the development of UI. In established UI, PFMT is prescribed routinely as first-line treatment. This article argues that previous studies lack validity and that the available evidence suggests a lack of long-term efficacy of peripartum PFMT. In established UI, there seems to be a modest immediate response to PFMT. They suggest that a critical reappraisal of PFMT is needed, and judgments on the place of PFMT in current clinical practice should be reserved until further evidence, including cost-benefit analyses, has unequivocally demonstrated a clinically relevant efficacy.

Acta Obstetricia et Gynecologica Scandinavica, 2008, 87(4), 384-402

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Pelvic floor muscle training versus no treatment for urinary incontinence in women. A Cochrane systematic review.

Dumoulin C, Hay-Smith J

The aim of this systematic review was to determine the effects of pelvic floor muscle training for women with urinary incontinence in comparison to no treatment, placebo or sham treatments, or other inactive control treatments. The review included randomized or quasi-randomized trials in women with stress, urge or mixed urinary incontinence. Thirteen trials involving 714 women met the inclusion criteria; however, only six trials (403 women) contributed to data analysis.

This review provides support for the widespread recommendation that pelvic floor muscle training be included in first-line conservative management programs for women with stress, urge or mixed urinary incontinence.        

European Journal of Physical Medicine and Rehabilitation, 2008, 44(2), 47-63

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Results of conservative non-pharmacological therapy in female patients with urinary incontinence

Krhut J, Holanová R, Muronová I, Gärtner M

This study assesses both subjective and objective results of the conservative non-pharmacological therapy and its effect to the quality of life in the set of female patients with urinary incontinence of all types. 69 female patients suffering from urinary incontinence were treated in a complex way in accordance with principles of the so-called "Ostrava concept" of the conservative non-pharmacological therapy. Subjective results were evaluated before the therapy started and 6 months after using the visual-analog scale (VAS) while objective results were evaluated by the perineometric measurement of the pelvic floor.

Based on results obtained the conservative non-pharmacological therapy is an efficient treatment method in case of the incontinence. Due to its non-invasive character and the absence of adverse effects it should be considered to be the first choice treatment in case of female patient with urinary incontinence.

Ceska Gynekologic, 2007, 72(6), 406-9

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Bladder training versus combination of propiverine with bladder training for female urinary frequency. A prospective, randomized, comparative study.

Kim SW, Song SH, Ku JH

The objective of this study was to evaluate the effect of bladder training with or without pharmacotherapy in women with only a frequency symptom. 48 patients were randomized to either bladder training alone or propiverine combined with bladder training. All patients were treated during 3 months. After treatment, there was no significant difference of functional bladder capacity and average voided volume between the two groups and the changes of daytime frequency, functional bladder capacity and average voided volume were not significantly different in the groups. Of total patients, 15 in the bladder training group and 21 in the combination therapy group were rated as responders.

Bladder training with or without pharmacotherapy may improve the subjective and objective frequency symptom in women with only a frequency symptom. When anticholinergics combined with bladder training are compared with bladder training alone, symptomatic improvement is not superior.

Gynecologic and Obstetric Investivation, 2008, 65(2), 123-7

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Systematic review: randomized, controlled trials of nonsurgical treatments for urinary incontinence in women.

Shamliyan TA, Kane RL, Wyman J, Wilt TJ

The purpose of this systematic review was to synthesize evidence of management of urinary incontinence in women.  Moderate levels of evidence suggest that pelvic floor muscle training and bladder training resolved urinary incontinence in women. Anticholinergic drugs resolved urinary incontinence, with similar effects from oxybutynin or tolterodine. Duloxetine improved but did not resolve urinary incontinence. The effects of electrostimulation, medical devices, injectable bulking agents, and local estrogen therapy were inconsistent.

Annals of Internal Medicine, 2008, 148(6), 459-73

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The integrated continence system: A manual therapy approach to the treatment of stress urinary incontinence

Heather Grewar and Linda McLean

This article describes the integrated continence system (ICS) which was developed by the authors.  It is an evidence-based model that demonstrates how urinary incontinence is maintained through the interaction of three structural systems (intrinsic urethral closure, urethral support, and lumbopelvic stability) and three modifiable factors (motor control, musculoskeletal and behavioral). The purpose of the ICS is first, to demonstrate the important role that manual physiotherapists can play in the treatment of SUI and second, to guide clinical practice decisions in order to improve clinical outcomes among women with SUI.

Manual Therapy, 12 March 2008, online article ahead of print

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Rehabilitation versus drug therapy for urge urinary incontinence: long-term outcomes.

Kafri R, Shames J, Raz M, Katz-Leurer M

The objective of this study was to compare the residual effect of a 3-month rehabilitation treatment and a standard drug treatment for urge urinary incontinence 21 months post intervention. Forty-four women who were diagnosed with overactive bladder were divided into 2 treatment groups over 3 months: 24 women received rehabilitation and 20 women were treated with medication with oxybutynin ER (MED). Outcomes measures included frequency of urination, quality of life, and number of side effects, which were measured upon entry into the study, completion of the intervention, and at follow-up 3 and 21 months after completion of treatment. In the long-term, the women received rehabilitation maintained and even improved the achievements of the intervention period while the women were treated with medication deteriorated to baseline values in urinary frequency.

Women with urge urinary incontinence maintained improvements in the long term following rhabilitation compared with women who received oxybutynin ER.

Internationl Urogynecology Journal of Pelvic Floor Dysfunction, 2008, 19(1), 47-52

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