Urinary incontinence (UI) is common in women of all age groups, but postmenopausal women (MW) have a higher incidence of these symptoms. The International Continence Society suggests that women with UI should first try a conservative treatment, such as pelvic floor muscle training (PFMT), which aims to enhance the strength and rectify the activation patterns of the pelvic floor muscles. The aim of this study was to examine the effectiveness of PFMT, either on its own, or in conjunction with other physical therapy, in reducing the severity of UI symptoms in MW.
A comprehensive literature search was performed to identify relevant publications from major medical databases. A meta-analysis was carried out according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) model. In addition, the included studies were assessed for quality, heterogeneity and publication bias.
After screening, application of the inclusion/exclusion criteria, and bias assessment, five randomized controlled trials were evaluated. PFMT was found to have a significant and substantial impact on the level of UI in the total patient population (standardized mean difference between the intervention and control groups -1.30, 95%CI: -1.97, -0.62, pz ≤ 0.01, I2 = 88.5 %; probability of benefit = 0.92). A second analysis, after the removal of studies that combined PFMT with electrostimulation or biofeedback, returned similar results.
PFMT is an effective intervention for the management of UI in MW. Our analysis shows a 92% chance of significant improvement for patients receiving PFMT in comparison with controls. Future studies should examine its efficacy in MW subgroups with symptoms of genitourinary syndrome of menopause (GSM).
European journal of obstetrics, gynecology, and reproductive biology. 2024 Nov 26 [Epub ahead of print]
Effimia G Marcellou, Sophia Stasi, Vasileios Giannopapas, Kari Bø, Daphne Bakalidou, Manousos Konstadoulakis, George Papathanasiou
Laboratory of Neuromuscular and Cardiovascular Study of Motion (LANECASM), Physiotherapy Department, University of West Attica (UNIWA), Athens, Greece. Electronic address: ., Laboratory of Neuromuscular and Cardiovascular Study of Motion (LANECASM), Physiotherapy Department, University of West Attica (UNIWA), Athens, Greece., Laboratory of Neuromuscular and Cardiovascular Study of Motion (LANECASM), Physiotherapy Department, University of West Attica (UNIWA), Athens, Greece; Second Department of Neurology, Attikon University Hospital, Greece., Norwegian School of Sports Sciences, Department of Sports Medicine, Oslo, Norway and Akershus University Hospital, Department of Obstetrics and Gynecology, Lørenskørg, Norway., Department of Surgery, School of Medicine, Aretaieion Hospital, National and Kapodistrian University of Athens, Athens, Greece.