Clinical Pilates in Practice: Pelvic Floor Muscle Training for Stress Urinary Incontinence (December 2020)
"The aims of the present systematic review and meta-analysis were:
- To analyze the effectiveness of pelvic floor muscle exercises ... in women with stress urinary incontinence (SUI), and
- To determine which pelvic floor muscle training characteristics (length of the program, frequency, duration, exercises) produced the greatest adaptations for decreasing urine loss."
García-Sánchez E, Ávila-Gandía V, López-Román J, Martínez-Rodríguez A, Rubio-Arias JÁ. What Pelvic Floor Muscle Training Load is Optimal in Minimizing Urine Loss in Women with Stress Urinary Incontinence? A Systematic Review and Meta-Analysis. Int J Environ Res Public Health. 2019 Nov 8;16(22):4358. doi: 10.3390/ijerph16224358. PMID: 31717291; PMCID: PMC6887794
KEY POINTS: PELVIC FLOOR MUSCLE TRAINING FOR STRESS URINARY INCONTINENCE
- 10% of the female population experience stress urinary incontinence (UI) weekly, with 25%-45% of the population experiencing UI occasionally; stress urinary incontinence (SUI) is the most common form of UI.
- While overweight and obesity are the main risk factors for UI, others include:
- Mode of delivery.
- Race and ethnicity.
- Hormone replacement therapy.
- Socioeconomic status.
- Physical activity levels.
- Comorbidities (diabetes, depression, other physical impairments).
- Conservative treatment includes pelvic floor muscle training, biofeedback, physical therapy, the use of vaginal cones, and electro-stimulation.
- Electro-stimulation and/or biofeedback should only be used for women who cannot actively contract their pelvic floor muscles.
Continence Foundation of Australia (2011)
- Women who engage in pelvic floor muscle training show significant changes in SUI, but the literature shows that there are many different training regimens.
- Women who train with equipment or accessories (e.g. vaginal cone) show significant improvements compared to the pelvic floor muscle training groups that did not use equipment.
- Greater improvements are seen when training with equipment versus biofeedback.
- Pelvic floor muscle training is helpful regardless of age or BMI.
- Increased frequency of training, with shorter sessions, is more useful than fewer, longer training sessions.
- Significant differences were observed when training 3-7 days per week, versus training programs of less than three sessions per week.
Training sessions of 10-45 minutes for a period greater than 12 weeks showed the most improvement.
- It is not advised that the number of muscle contractions should exceed 200 per day.
- Slow and rapid contractions for pelvic floor muscle training should be combined.
CLINICAL PILATES IN PRACTICE
- The authors of the study propose the following parameters for pelvic floor muscle training:
- Training program should run for a minimum of 6 weeks.
- Slow contractions should be held for 5-10s.
- Rapid contractions should be held for 1, 2, and 3s.
- 1-12s recovery time between contractions/repetitions.
- Maximum of 9 sets per training session; 1-3 minutes recovery between sets.
- Add vaginal weights and biofeedback to complement training, as appropriate.
1. "Female Pelvic Floor Muscles." Continence Foundation of Australia. Last modified March 26, 2019. https://www.continence.org.au/who-it-affects/women/female-pelvic-floor-muscles.
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