EFFICACY OF PELVIC FLOOR MUSCLE EXERCISES IN WOMEN WITH STRESS, URGE,AND MIXED URINARY-INCONTINENCE

OBJECTIVES: Our purpose was (1) to evaluate the efficacy on an intent- to-treat basis of a 3-month course of pelvic floor muscle exercises as first-line therapy for urinary incontinence in consecutive women seen in a tertiary care center with stress, urge, and mixed urinary incont inence and (2) to evaluate whether a specially designed audiotape impr oves compliance and efficacy of the exercises. STUDY DESIGN: A prospec tive randomized trial was conducted with 71 women seen for treatment o f urinary incontinence in two tertiary care center referral clinics (i n the departments of gynecology and urology). The primary outcome meas ure was the number of incontinent episodes, as documented with a 3-day voiding diary, Statistical analysis included t tests and Wilcoxon sig ned-ranks test, as appropriate. A value of p less than or equal to 0.0 5 was considered significant. RESULTS: Forty-four percent of ail enrol lees had a greater than or equal to 50% improvement in the number of i ncontinent episodes per day. This increased to 56% of enrollees who co mpleted the treatment course. For all enrollees the mean number of inc ontinent episodes per day decreased from 2.6 to 1.7 for genuine stress incontinence, from 3.5 to 2.3 for detrusor instability, and from 3.9 to 3.2 for mixed incontinence, For enrollees who completed the 3-month course the mean number of incontinent episodes per day decreased from 2.5 to 1.4 for genuine stress incontinence, from 2.8 to 0.5 for detru sor instability, and from 3.0 to 1.7 for mixed incontinence, Six month s after completing the course of exercises approximately one third of all enrollees reported that they continued to note good or excellent i mprovement and desired no further treatment. There was no difference i n outcome measures and no difference in compliance between the women w ho exercised with the aid of the audiotape and those who exercised acc ording to our usual office routine (p > 0.05). CONCLUSIONS: One third of all participants remained improved to the patient's satisfaction 6 months after completion of a risk-free, inexpensive, simply provided t herapy. Our audiotape did not improve our success rate or decrease the dropout rate. In this study the exercises were equally effective for all three urodynamic diagnoses. Inexpensive methods that could be used by primary care providers to improve the success rate of this therapy merits further attention.