Remote pelvic floor muscle training in the treatment of stress urinary incontinence in women

Abstract

BACKGROUND: Stress urinary incontinence in women is a common condition that can develop at a young age and, even with mild severity, disrupts the quality of life. The first line of treatment for stress urinary incontinence is pelvic floor muscle training, which is the most effective in biofeedback mode. The low effectiveness of self-study is often associated with irregular and incorrect exercise.

AIM: The aim of this study was to evaluate the effectiveness of remote pelvic floor muscle training using the Tyulpan laser vaginal simulator under medical supervision in the treatment of mild and moderate stress urinary incontinence in women of reproductive and perimenopausal age, and to develop a predictive model for evaluating the effectiveness of treatment by this method.

MATERIALS AND METHODS: We examined 48 patients aged 41.3 ± 6.8 years (26–55) with complaints of mild to moderate stress urinary incontinence. After general clinical and special studies (analysis of seven-day urination diaries, King’s questionnaire and Pelvic Organ Prolapse / Urinary Incontinence Sexual Questionnaire (PISQ-12), urethrovesical segment ultrasound examination), a remote course of treatment was started using the Tyulpan laser vaginal simulator under medical supervision via videoconference for 35 patients within three months. The participants were re-examined one, three and four to six months after the start of the pelvic floor muscle training course.

RESULTS: The training course was fully completed by 25 participants. After one month of remote pelvic floor muscle training, according to urination diaries, a decrease in the number of stress urinary incontinence episodes was noted by 64.0% of patients and the absence of stress urinary incontinence episodes by 28.0% of patients (p < 0.001); after three months of remote pelvic floor muscle training, by 32.0% and 68.0% of patients, respectively (p < 0.001). A negative cough test after one month was detected in 62.5% of the participants (p = 0.002) and, after four to six months with the continuation of independent pelvic floor muscle training, in 81.9% of patients (p = 0.003). According to the ROC-analysis, the absence of stress urinary incontinence episodes was predicted when the amplitude of the simulator laser beam was greater than or equal to 90 cm (sensitivity 84.0%, specificity 96.0%; p < 0.001). Distance learning under medical supervision had a positive impact on the quality of life and relationships with a partner and improved the women’s psychological well-being (p < 0.001).

CONCLUSIONS: Remote pelvic floor muscle training is effective in women of reproductive and perimenopausal age with mild to moderate stress urinary incontinence who are able to contract their pelvic floor muscles and perform regular exercises. The effectiveness of the training course is 68.0% according to urination diaries and 81.9% according to the cough test. The absence of stress urinary incontinence episodes is predicted when the amplitude of the simulator laser beam is greater than or equal to 90 cm.

Keywords

stress urinary incontinence / pelvic floor muscle training / biofeedback / telemedicine technologies

References

[1] Abrams P, Cardozo L, Fall M, et al. The standardisation of terminology of lower urinary tract function: report from the Standardisation Sub-committee of the International Continence Society. Neurourol Urodyn. 2002;21(2):167–178. DOI: 10.1002/nau.10052

[2] Abrams P., Cardozo L., Fall M., et al. The standardisation of terminology of lower urinary tract function: report from the Standardisation Sub-committee of the International Continence Society // Neurourol. Urodyn. 2002. Vol. 21. No. 2. P. 167–178. DOI: 10.1002/nau.10052

[3] Ptak M, Brodowska A, Ciećwież S, et al. Quality of life in women with stage 1 stress urinary incontinence after application of conservative treatment – a randomized trial. Int J Environ Res Public Health. 2017;14(6). DOI: 10.3390/ijerph14060577

[4] Ptak M., Brodowska A., Ciećwież S., et al. Quality of life in women with stage 1 stress urinary incontinence after application of conservative treatment – a randomized trial // Int. J. Environ. Res. Public. Health. 2017. Vol. 14. No. 6. DOI: 10.3390/ijerph14060577

[5] Pandey D, Maturi C, Dhakar BPS, et al. Interventions and quality of life in stress urinary incontinence. Gynecol Minim Invasive Ther. 2019;8(3):106–112. DOI: 10.4103/GMIT.GMIT_72_18

[6] Pandey D., Maturi C., Dhakar B.P.S., et al. Interventions and quality of life in stress urinary incontinence // Gynecol. Minim. Invasive Ther. 2019. Vol. 8. No. 3. P. 106–112. DOI: 10.4103/GMIT.GMIT_72_18

[7] Mota RL. Female urinary incontinence and sexuality. Int Braz J Urol. 2017;43(1):20–28. DOI: 10.1590/S1677-5538.IBJU.2016.0102

[8] Mota R.L. Female urinary incontinence and sexuality // Int. Braz. J. Urol. 2017. Vol. 43. No. 1. P. 20–28. DOI: 10.1590/S1677-5538.IBJU.2016.0102

[9] Dumoulin C, Cacciari LP, Hay-Smith EJC. Pelvic floor muscle training versus no treatment, or inactive control treatments, for urinary incontinence in women. Cochrane Database Syst Rev. 2018;10(10). DOI: 10.1002/14651858.CD005654.pub4

[10] Dumoulin C., Cacciari L.P., Hay-Smith E.J.C. Pelvic floor muscle training versus no treatment, or inactive control treatments, for urinary incontinence in women // Cochrane Database Syst. Rev. 2018. Vol. 10. No. 10. DOI: 10.1002/14651858.CD005654.pub4

[11] Zhevlakova MM, Rusina EI. Stressovoe nederzanii mochi legkoi stepeni tyazhesti u zhenshchin reproduktivnogo i perimenopauzal’nogo vozrasta. In: Materialy XXII vserossiiskogo nauchno-obrazovatel’nogo foruma “Mat’ i ditya”; Krasnogorsk, 29 September – 1 October 2021. Moscow: MEDI Ekspo; 2021. (In Russ.) [cited 2023 Apr 12]. Available from: https://www.mediexpo.ru/fileadmin/user_upload/content/pdf/thesis/md_2021_thesis.pdf

[12] Жевлакова М.М., Русина Е.И. Стрессовое недержание мочи легкой степени тяжести у женщин репродуктивного и перименопаузального возраста // Материалы XXII всероссийского научно-образовательного форума «Мать и дитя». Москва: МЕДИ Экспо, 2021 [дата обращения: 12.04.2023]. Доступ по ссылке: https://www.mediexpo.ru/fileadmin/user_upload/content/pdf/thesis/md_2021_thesis.pdf

[13] Rossiyskoe obshchestvo urologov. Nederzhanie mochi. Klini cheskie rekomendatsii. 2020. (In Russ.) [cited 2023 Apr 12] Available from: https://static-0.minzdrav.gov.ru/system/attachments/attaches/000/054/889/original/%D0%9A%D0%BB%D0%B8%D0%BD%D0%B8%D1%87%D0%B5%D1%81%D0%BA%D0%B8%D0%B5_%D1%80%D0%B5%D0%BA%D0%BE%D0%BC%D0%B5%D0%BD%D0%B4%D0%B0%D1%86%D0%B8%D0%B8_%D0%9D%D0%B5%D0%B4%D0%B5%D1%80%D0%B6%D0%B0%D0%BD%D0%B8%D0%B5_%D0%BC%D0%BE%D1%87%D0%B8_2020.pdf?1614860910

[14] Российское общество урологов. Недержание мочи. Клинические рекомендации. 2020 [дата обращения 12.04.2023]. Доступ по ссылке: https://static-0.minzdrav.gov.ru/system/attachments/attaches/000/054/889/original/%D0%9A%D0%BB%D0%B8%D0%BD%D0%B8%D1%87%D0%B5%D1%81%D0%BA%D0%B8%D0%B5_%D1%80%D0%B5%D0%BA%D0%BE%D0%BC%D0%B5%D0%BD%D0%B4%D0%B0%D1%86%D0%B8%D0%B8_%D0%9D%D0%B5%D0%B4%D0%B5%D1%80%D0%B6%D0%B0%D0%BD%D0%B8%D0%B5_%D0%BC%D0%BE%D1%87%D0%B8_2020.pdf?1614860910

[15] Zheleznyakova IA. Optimizatsiya lecheniya stressovogo nederzhaniya mochi u zhenshchin s pomoshch’yu metoda ekstrakorpo ral’noy magnitnoy stimulyatsii: [abstract dissertation]. Moscow; 2011. (In Russ.) [cited 2023 Apr 12]. Available from: https://www.dissercat.com/content/optimizatsiya-lecheniya-stressovogo-nederzhaniya-mochi-u-zhenshchin-s-pomoshchyu-metoda-ekst/read

[16] Железнякова И.А. Оптимизация лечения стрессового недержания мочи у женщин с помощью метода экстракорпоральной магнитной стимуляции: автореф. дис. … канд. мед. наук. Москва, 2011 [дата обращения 12.04.2023]. Доступ по ссылке: https://www.dissercat.com/content/optimizatsiya-lecheniya- stressovogo-nederzhaniya-mochi-u-zhenshchin-s-pomoshchyu-metoda-ekst/read

[17] Bø K, Sundgot-Borgen J. Are former female elite athletes more likely to experience urinary incontinence later in life than non-athletes? Scand J Med Sci Sports. 2010;20(1):100–104. DOI: 10.1111/j.1600-0838.2008.00871.x

[18] Bø K., Sundgot-Borgen J. Are former female elite athletes more likely to experience urinary incontinence later in life than non-athletes? // Scand. J. Med. Sci. Sports. 2010. Vol. 20. No. 1. P. 100–104. DOI: 10.1111/j.1600-0838.2008.00871.x

[19] Paiva LL, Ferla L, Darski C, et al. Pelvic floor muscle training in groups versus individual or home treatment of women with urinary incontinence: systematic review and meta-analysis. Int Urogynecol J. 2017;28(3):351–359. DOI: 10.1007/s00192-016-3133-2

[20] Paiva L.L., Ferla L., Darski C., et al. Pelvic floor muscle training in groups versus individual or home treatment of women with urinary incontinence: systematic review and meta-analysis // Int. Urogynecol. J. 2017. Vol. 28. No. 3. P. 351–359. DOI: 10.1007/s00192-016-3133-2

[21] Chechneva MA. Ratsional’naya kontseptsiya kompleksnogo obsledovaniya zhenshchin s sindromom tazovoy disfunktsii i mochevoy inkontinentsii: [abstract dissertation]. Moscow; 2011. (In Russ.) [cited 2023 Apr 12]. Available from: https://www.dissercat.com/content/ratsionalnaya-kontseptsiya-kompleksnogo-obsledovaniya-zhenshchin-s-sindromom-tazovoi-destsen.

[22] Чечнева М.А. Рациональная концепция комплексного обследования женщин с синдромом тазовой дисфункции и мочевой инконтиненции: автореф. дис. ... д-ра мед. наук. Москва, 2011 [дата обращения 12.04.2023]. Доступ по ссылке: https://www.dissercat.com/content/ratsionalnaya-kontseptsiya-kompleksnogo-obsledovaniya-zhenshchin-s-sindromom-tazovoi-destsen

[23] Kegel AH. Progressive resistance exercise in the functional restoration of the perineal muscles. Am J Obstet Gynecol. 1948;56(2):238–248. DOI: 10.1016/0002-9378(48)90266-x

[24] Kegel A.H. Progressive resistance exercise in the functional restoration of the perineal muscles // Am. J. Obstet. Gynecol. 1948. Vol. 56. No. 2. P. 238–248. DOI: 10.1016/0002-9378(48)90266-x

[25] Bø K. Pelvic floor muscle training in treatment of female stress urinary incontinence, pelvic organ prolapse and sexual dysfunction. World J Urol. 2012;30(4):437–443. DOI: 10.1007/s00345-011-0779-8

[26] Bø K. Pelvic floor muscle training in treatment of female stress urinary incontinence, pelvic organ prolapse and sexual dysfunction // World J. Urol. 2012. Vol. 30. No. 4. P. 437–443. DOI: 10.1007/s00345-011-0779-8

[27] Radzimińska A, Strączyńska A, Weber-Rajek M, et al. 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. DOI: 10.2147/CIA.S160057

[28] Radzimińska A., Strączyńska A., Weber-Rajek M., et al. 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. Vol. 13. P. 957–965. DOI: 10.2147/CIA.S160057

[29] Romikh VV, Borisenko LS, Arkhireev AS. Biofeedback in treatment of stress urinary incontinence and dysfunctional voiding in women. Experimental and Clinical Urology. 2013(1):81–83. (In Russ.)

[30] Ромих В.В., Борисенко Л.Ю., Архиреев А.С. Метод биологической обратной связи при стрессовом недержании мочи и дисфункциональном мочеиспускании у женщин // Экспериментальная и клиническая урология. 2013. № 1. С. 81–83.

[31] Horng HC, Chao WT, Chen JF, et al. Home-based noninvasive pelvic floor muscle training device to assist women in performing Kegel exercise in the management of stress urinary incontinence. J Chin Med Assoc. 2022;85(4):484–490. DOI: 10.1097/JCMA.0000000000000660

[32] Horng H.C., Chao W.T., Chen J.F., et al. Home-based noninvasive pelvic floor muscle training device to assist women in performing Kegel exercise in the management of stress urinary incontinence // J. Chin. Med. Assoc. 2022. Vol. 85. No. 4. P. 484–490. DOI: 10.1097/JCMA.0000000000000660

[33] da Mata KRU, Costa RCM, Carbone É dos SM, et al. Telehealth in the rehabilitation of female pelvic floor dysfunction: a systematic literature review. Int Urogynecol J. 2021;32(2):249–259. DOI: 10.1007/s00192-020-04588-8

[34] da Mata K.R.U., Costa R.C.M., Carbone É dos S.M., et al. Telehealth in the rehabilitation of female pelvic floor dysfunction: a systematic literature review // Intl. Urogynecol. J. 2021. Vol. 32. No. 2. P. 249–259. DOI: 10.1007/s00192-020-04588-8

[35] Aukee P, Penttinen J, Airaksinen O. The effect of aging on the electromyographic activity of pelvic floor muscles. A comparative study among stress incontinent patients and asymptomatic women. Maturitas. 2003;44(4):253–257. DOI: 10.1016/s0378-5122(03)00044-6

[36] Aukee P., Penttinen J., Airaksinen O. The effect of aging on the electromyographic activity of pelvic floor muscles. A comparative study among stress incontinent patients and asymptomatic women // Maturitas. 2003. Vol. 44. No. 4. P. 253–257. DOI: 10.1016/s0378-5122(03)00044-6

[37] Chmielewska D, Stania M, Kucab-Klich K, et al. Electromyographic characteristics of pelvic floor muscles in women with stress urinary incontinence following sEMG-assisted biofeedback training and Pilates exercises. PLoS One. 2019;14(12). DOI: 10.1371/journal.pone.0225647

[38] Chmielewska D., Stania M., Kucab-Klich K., et al. Electromyographic characteristics of pelvic floor muscles in women with stress urinary incontinence following sEMG-assisted biofeedback training and Pilates exercises // PLoS One. 2019. Vol. 14. No. 12. DOI: 10.1371/journal.pone.0225647

[39] Alouini S, Memic S, Couillandre A. Pelvic floor muscle training for urinary incontinence with or without biofeedback or electrostimulation in women: a systematic review. Int J Environ Res Public Health. 2022;19(5). DOI: 10.3390/ijerph19052789

[40] Alouini S., Memic S., Couillandre A. Pelvic floor muscle training for urinary incontinence with or without biofeedback or electrostimulation in women: a systematic review // Int. J. Environ. Res. Public Health. 2022. Vol. 19. No. 5. DOI: 10.3390/ijerph19052789

RIGHTS & PERMISSIONS

Eсо-Vector