Clinical Question: Can physical therapy cure stress urinary incontinence in women with symptoms persisting longer than three months postpartum?

Setting: Outpatient (specialty)

Study Design: Randomized controlled trial (single-blinded)

Allocation: Concealed

Synopsis: Investigators enrolled 52 women who had persistent stress urinary incontinence for at least three months after delivery. The diagnosis was made with a standardized test using 20 minutes of exercises such as jumping jacks and measuring the difference in weight of a perineal pad to determine urine leakage. The women were stratified into four groups according to the amount of incontinence at baseline and parity. The women were randomized into three groups that each had eight weekly physiotherapy sessions. The women were aware of group assignment but were asked not to reveal it to the physicians and outcome assessors.

One intervention group had sessions including electrical stimulation of the pelvic floor muscles for 15 minutes and exercises with biofeedback for 25 minutes. They also were instructed to do exercises at home five days per week. A second group had the same intervention, plus 30 minutes of deep abdominal muscle training. The control group had weekly massages of the back and extremities and were asked not to do pelvic floor exercises during the study. Analysis was by treatment, and the authors reported that the intention-to-treat analysis was virtually identical. Only two subjects dropped out of the study.

At the conclusion of the study, the pad test was repeated with a standardized volume in the bladder. To be considered cured, the leakage could not exceed 2 g. Leakage did not occur in 56 percent of the women receiving electrical stimulation/biofeedback and 74 percent of the women also receiving abdominal muscle training, but all of the women in the control group had leakage. The difference between the active treatment groups was not significant. Improvement was not predicted by pelvic floor muscle dynamometer measurements.

Bottom Line: Eight weekly sessions of pelvic floor muscle physiotherapy, including electrical stimulation and biofeedback exercises, cured stress urinary incontinence in 70 percent of the treated women. None of the control patients who received massage only was cured. Instructions for a home exercise program alone is usual care and would have been a better control intervention. (Level of Evidence: 1b)