What Pelvic Floor Muscle Training Load is Optimal in Minimizing Urine Loss in Women with Stress Urinary Incontinence? A Systematic Review and Meta-Analysis

Esther García-Sánchez, Vicente Ávila-Gandía, Javier López-Román, Alejandro Martínez-Rodríguez, Jacobo Á Rubio-Arias, Esther García-Sánchez, Vicente Ávila-Gandía, Javier López-Román, Alejandro Martínez-Rodríguez, Jacobo Á Rubio-Arias

Abstract

Pelvic floor muscle training is commonly used for urine loss. However, research studies have not determined which training load is the most effective for women with stress urinary incontinence (SUI). Moreover, none of the previous reviews or studies have described the total effectiveness of pelvic floor muscle training (PFMT) with an objective test such as the pad test. The objectives were to analyze the effectiveness of pelvic floor muscle training in women with SUI and to determine which training load produces the greatest adaptations for decreasing urine loss. The search was conducted in three databases (PubMed, Web of Science and Cochrane), for randomized controlled trials (RCTs) that evaluated the effects of PFMT. Studies were included if they met the following criteria: participants were women; were older than 18; had SUI; were treated with PFMT; and the assessments of the effects were measured with a pad test. Finally, 10 articles (293 women) analyzed the pad test in women with SUI who performed PFMT. The meta-analysis showed that PFMT, independent of the protocol used in the study, resulted in decreased urine loss in women suffering from SUI. However, for large effects, the program should last 6-12 weeks, with >3 sessions/week and a length of session <45 min.

Keywords: exercise; incontinence; training; training load; women’s health issues.

Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Flow diagram of the process of study selection.
Figure 2
Figure 2
Funnel plot of the meta-analysis of the published studies. Each plotted point represents the standard error (SE) and the standardized mean difference (SMD) between post-intervention intervention urinary loss in women who received PFMT.
Figure 3
Figure 3
Funnel plot of the meta-analysis of the published studies. Each plotted point represents the standard error (SE) and the standardized mean difference (SMD) between post-intervention and pre-intervention urinary loss in women who received PFMT for a single study.
Figure 4
Figure 4
Standardized mean difference (SMD) (a) between post- and pre-intervention urinary loss in women who received PFMT and (b) post-intervention intervention urinary loss in women who received PFMT. Squares represent the SMD for each trial. Diamonds represent the pooled SMD across trials.

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