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  • Research Reaffirms Pelvic Floor Physical Therapy's Effectiveness for UI in Women After Menopause

    For women with urinary incontinence (UI), physical therapy that includes pelvic floor muscle training (PFMT) can offer long-lasting relief in a relatively short period of time, according to a new study. It's a finding that could be especially important for older women with osteoporosis and UI, whose urgency can both increase their risk for falls and interfere with the physical activity needed to battle loss of bone density.

    In an article e-published ahead of print in Menopause (abstract only available for free) researchers share data from a randomized controlled trial of 48 postmenopausal women at British Columbia Women's Hospital and Health Centre in Vancouver, Canada. The women, aged 55 and older, all had osteoporosis or low bone mineral density as well as stress, urge, or mixed UI for which they had not previously been treated. The incidence of UI is higher than average among women with osteoporosis.

    Half of the women received group osteoporosis education (taught by a physical therapist, dietician, and nurse clinician) on physical activity, diet, and medications, as well as a follow-up phone call. The other half underwent 12 individual physical therapy sessions over 3 months. The sessions included education on UI, pelvic floor muscle retraining using electromyography biofeedback, motor control exercises, functional pelvic floor muscle exercises, bladder habit retraining, dietary recommendations, and audio recordings for use at home. All participants maintained "bladder diaries" during the study to track UI episodes.

    After 3 months, the women who had completed physical therapy experienced 75% fewer leakage episodes compared with baseline, and had significantly improved scores on the Urogenital Distress Inventory (UDI), the Incontinence Impact Questionnaire (IIQ), and the perceived efficacy scale (both the UDI and the IIQ are available for download at PTNow). At 1 year, the physical therapy group maintained their previous improvement in leakage episodes and had significantly better results on the 24-hour pad test and the UDI compared with the osteoporosis education group.

    In contrast, the education group showed no improvement in UI episodes at 3 months, and the number of leakage episodes actually increased after 1 year.

    Prior studies also have found pelvic floor physical therapy effective for treating UI in women. What's unique about this study, according to the researchers, is the inclusion of "multiple, validated, and reliable UI outcome measures" that examine not just the number of leakage episodes, but the participants’ quality of life. Also different is the "individualized progression in exercise training" according to ability of each woman, rather than at the group level.

    "Many women believe there is nothing they can do, that UI is a normal part of aging for which the only options are costly drugs or invasive surgeries," authors write. "Given the negative impact of UI on physical activity levels and the importance of physical activity to improving bone density, our results should be used by physicians and other healthcare providers to educate clients with osteoporosis and UI: they can effectively reduce or cure their incontinence with this PFMT."

    APTA is a strong advocate for the role that physical therapy can play in transforming the lives of women experiencing UI, and has provided guidance to the Federal Agency for Healthcare Research and Quality (.pdf) in its research efforts around the condition. The association offers several relevant resources to members and the public, including the APTA Section on Women's Health and the PT's Guide to Incontinence, as well as a clinical summary on urinary incontinence in women. The effectiveness of physical therapy in the treatment of pelvic floor weakness—and the strides being made by members of the women's health section—was also the subject of a 2014 feature article in PT in Motion magazine.

    Research-related stories featured in PT in Motion News are intended to highlight a topic of interest only and do not constitute an endorsement by APTA. For synthesized research and evidence-based practice information, visit the association's PTNow website.

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    Comments

    • I would like to add that 100,000+ women in the USA alone are disabled and living in severe pelvic pain after surgery to treat SUI and POP with transvaginal mesh/bladder slings. Pelvic Physical Therapy should be the FIRST thing your doctor advises, prior to considering any surgical fix. If surgery is eventually needed, please consider a native tissue fascia repair, using your own muscle fascia rather than the very dangerous polypropylene synthetic mesh implant. But pelvic PT just might help you avoid surgery completely! It is well worth trying.

      Posted by Janet Lynn on 2/26/2016 7:36 PM

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