Pelvic Floor Muscle Training for Urinary Incontinence Treats Other Pelvic Floor Disorders
Key findings
- Massachusetts General Hospital researchers previously conducted a randomized, controlled trial comparing a motion-based biofeedback device for pelvic floor muscle training (PFMT) with standard PFMT for treating urinary incontinence (UI)
- In this post hoc analysis, a team evaluated the prevalence of concomitant fecal incontinence (FI) and pelvic organ prolapse (POP) and evaluated changes in these symptoms following PFMT with vs. without the device
- 54% of 299 women recruited for UI treatment also reported FI, POP, or both, and at baseline, the women with additional symptoms reported worse overall health and more severe UI symptoms compared to those with UI only
- Home PFMT treated not only UI but also concomitant FI and POP
- Among the patients who had UI plus another pelvic floor disorder, the percentage who said they were "much better" or "very much better" was 85% in the intervention group vs. 34% in the control group (OR, 2.51; P=0.005)
Over the past few years, Massachusetts General Hospital researchers have been studying the Leva Pelvic Health System (Renovia, Boston, MA), an FDA-approved device that visually guides women through pelvic floor muscle training (PFMT). A vaginal insert lined with motion sensors detects movement during the exercises and communicates with a smartphone app to provide real-time feedback to the user.
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A randomized controlled trial showed that women who used Leva for PFMT at home had greater improvement in symptoms of stress or stress–dominant mixed urinary incontinence (UI) than those who followed a home program without the device. The longest-term results published to date appear in the International Urogynecology Journal.
In a post hoc analysis of that trial, the team found PFMT also improved symptoms of fecal incontinence (FI) and pelvic organ prolapse (POP) in women with UI, and in some respects, women with more than one pelvic floor disorder improved more with the Leva device than with conventional PFMT. Milena M. Weinstein, MD, co-director of the Mass General Center for Pelvic Floor Disorders, Holly E. Richter, PhD, MD, of the University of Alabama at Birmingham, and colleagues report in Urogynecology.
Gathering Patient Symptom Reports
At baseline, 8 weeks, and 6, 12, 18, and 24 months in the randomized trial, participants completed a battery of questionnaires, among them the Pelvic Floor Distress Inventory–20 (PFDI-20). It has three subscales: the Urogenital Distress Inventory Short Form (UDI-6), Pelvic Organ Prolapse Distress Inventory–6 (POPDI-6), and Colorectal Anal Distress Inventory–8 (CRADI-8).
The secondary analysis included 299 participants who completed at least one baseline and one follow-up survey.
Many Women With UI Had Other Symptoms
161 participants (54%) had at least one pelvic floor disorder at baseline besides UI:
- 37 (23%) had FI
- 69 (43%) had POP
- 55 (34%) had both FI and POP
Compared with the UI-only group, participants who had another pelvic floor disorder had significantly worse baseline scores on the UDI-6, PFDI-20, and the 20-Item Short Form Health Survey.
PFMT Effective for Symptoms of Concomitant Pelvic Floor Disorders
The overall cohort significantly improved on the UDI-6, POPDI-6, and CRADI-8 from baseline to 8 weeks, and at 6, 12, and 24 months, showing the benefit of PFMT. Participants who also had FI and/or POP reported significantly greater improvement on all three measures, at all timepoints, than those in the UI-only group.
The researchers also examine the efficacy of the intervention (Leva-guided PFMT) and control (unguided PFMT) against specific symptoms:
Participants With FI
- Significant improvement in CRADI-8 scores in both the intervention group and control group
- The intervention group had greater improvement in FI symptoms than the control group at 6 months (P=0.01)
- No differences between groups in the proportion of participants who met the minimum clinically important difference on the CRADI-8 at 24 months
Participants With POP
- Significant improvement in POPDI-6 scores in both the intervention group and control group
- The intervention group had greater symptom improvement than the control group at 12 months (P=0.03) and 24 months (P=0.02)
- No differences between groups in the proportion of participants who met the minimum clinically important difference on the POPDI-6 at 24 months
Improvement in Urinary Symptoms
The researchers also administered the Patient Global Impression of Improvement questionnaire, which in this study focused on urinary symptoms. At 24 months, among the patients who had UI plus another pelvic floor disorder, the percentage who said they were "much better" or "very much better" was 85% in the intervention group versus 34% in the control group (OR, 2.51; P=0.005).
It's possible that the greater improvement in FI and POP in the intervention group, in addition to improvement in UI, resulted in a greater overall sense of improvement in UI symptoms. It may also be that motion-based biofeedback allowed participants to achieve a more comprehensive and durable neuromuscular re-education.
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