Comparative analysis of biofeedback and physical therapy for treatment of urinary stress incontinence in women

Objective: To compare the effectiveness of an intensive group physical ther apy program with individual biofeedback training for female patients with u rinary stress incontinence. Design: Randomized study of two therapeutic interventions consisting of a s pecific physical therapy program (PT) or biofeedback training (BF) daily fo r 4 wk, followed by a 2-mo, unsupervised home exercise program in both grou ps in an outpatient clinic of a large university hospital. Forty women, ref erred by gynecologists for nonoperative treatment of genuine stress inconti nence of mild-to-moderate severity, were included. Measurements of daytime/ nocturnal urinary frequency and subjective improvement of incontinence were the main outcome measures at initial presentation, after completion of the therapy program, and at follow-up after 3 mo. Standardized examinations of digital contraction strength, speculum tests, and manometric measurements were documented as secondary outcome measures. Results: In the PT group, the daytime urination frequency decreased 22% aft er 4 wk of therapy and 19% after 3 mo (P < 0.05) from baseline. The nocturn al urination frequency was reduced by 66% after 4 wk of therapy and 62% aft er 3 mo (P < 0.001). In the BF group, the daily urination frequency decreas ed 10% after 4 wk of therapy and 5% after 3 mo (P > 0.05). The nocturnal ur ination frequency declined 36% after 4 wk of therapy and 66% after 3 months (P < 0.05). Subjective assessment after 3 mo showed that in the PT group, 28% of patients were free of incontinence episodes, 68% reported improved s ymptoms (incontinence episodes improved by > 50%), and 4% were unchanged. I n the BF group, 62% were free of incontinence episodes, and 38% were improv ed. Results of the digital contraction strength assessments, speculum tests , and manometric measurements showed statistically significant improvement in all variables in both groups after 3 months. Conclusion: Four weeks of both intensive group physical therapy or individu al biofeedback training followed by an unsupervised home exercise program f or 2 mo are effective therapies for female urinary stress incontinence and result in a significantly reduced nocturnal urinary frequency and improved subjective outcome. Only group physical therapy resulted in reduced daytime urinary frequency. BF therapy resulted in a better subjective outcome and higher contraction pressures of the pelvic floor muscles.