A PELVIC MUSCLE PRECONTRACTION CAN REDUCE COUGH-RELATED URINE LOSS INSELECTED WOMEN WITH MILD SUI

OBJECTIVES: To test the hypothesis that selected older women with mild -to-moderate stress urinary incontinence (SUI) can learn to demonstrat e significantly reduced urine loss in 1 week by intentionally contract ing the pelvic floor muscles before and during a cough (a skill we hav e termed ''The Knack''). DESIGN: A prospective, randomized, single-bli nd interventional study. SETTING: The Older American Independence Cent er, a federally sponsored research program affiliated with the Univers ity of Michigan in Ann Arbor, Michigan. PARTICIPANTS: Twenty-seven wom en with a mean (SD) age of 68.0 (5.5) years, self-reported SUI, and de monstrable urine loss during a deep cough. INTERVENTION: Women were ra ndomized to an immediate intervention group (Group I: n = 13) who were taught the Knack after their first clinic visit, or a wait-listed con trol group (Group II: n = 14) who were taught the Knack after 1 month. MEASUREMENTS: At 1 week after instruction, we tested the efficacy of the Knack in a standing stress test by (1) comparing the volumes of co ugh-related urine loss leaked by all subjects, with and without use of the Knack, and (2) comparing the volumes of cough-related wine loss l eaked by Group I, using the Knack, with Group II, which had not yet be en taught the Knack. RESULTS: Intra-individual results showed that at 1-week follow-up, the Knack was used to reduce urine loss resulting fr om a medium cough by an average of 98.2%, compared with that of a simi lar cough performed 1 minute before without the Knack (P = .009); like wise urine loss was reduced by an average of 73.3% (P = .003) in a dee p cough. Reduction in urine loss was not significantly correlated with a digital measure of pelvic floor muscle strength. CONCLUSION: Within I week, selected older women with mild-to-moderate SUI can acquire th e skill of using a properly-timed pelvic floor muscle contraction to s ignificantly reduce urine leakage during a cough.