Pelvic floor muscle training versus no treatment, or inactive control treatments, for urinary incontinence in women.

BACKGROUND: Pelvic floor muscle training is the most commonly used physical therapy treatment for women with stress urinary incontinence. It is sometimes recommended for mixed and less commonly urge urinary incontinence.

OBJECTIVES: To determine the effects of pelvic floor muscle training for women with urinary incontinence in comparison to no treatment, placebo or sham treatments, or other inactive control treatments.

SEARCH STRATEGY: The Cochrane Incontinence Group Specialised Trials Register (searched 18 February 2009) and the reference lists of relevant articles were searched.

SELECTION CRITERIA: Randomised or quasi-randomised trials in women with stress, urge or mixed urinary incontinence (based on symptoms, signs, or urodynamics). One arm of the trial included pelvic floor muscle training (PFMT). Another arm was a no treatment, placebo, sham, or other inactive control treatment arm.

DATA COLLECTION AND ANALYSIS: Trials were independently assessed for eligibility and methodological quality. Data were extracted then cross-checked. Disagreements were resolved by discussion. Data were processed as described in the Cochrane Handbook (Higgins 2008). Trials were subgrouped by diagnosis. Formal meta-analysis was not undertaken because of study heterogeneity.

MAIN RESULTS: Fourteen trials involving 836 women (435 PFMT, 401 controls) met the inclusion criteria; twelve trials (672) contributed data to the analysis. Many studies were at moderate to high risk of bias, based on the trial reports. There was considerable variation in interventions used, study populations, and outcome measures.Women who did PFMT were more likely to report they were cured or improved than women who did not. Women who did PFMT also reported better continence specific quality of life than women who did not. PFMT women also experienced fewer incontinence episodes per day and less leakage on short office-based pad test. Of the few adverse effects reported, none were serious. The trials in stress urinary incontinent women which suggested greater benefit recommended a longer training period than the one trial in women with detrusor overactivity (urge) incontinence.

AUTHORS' CONCLUSIONS: The review provides support for the widespread recommendation that PFMT be included in first-line conservative management programmes for women with stress, urge, or mixed, urinary incontinence. Statistical heterogeneity reflecting variation in incontinence type, training, and outcome measurement made interpretation difficult. The treatment effect seems greater in women with stress urinary incontinence alone, who participate in a supervised PFMT programme for at least three months, but these and other uncertainties require testing in further trials.