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• We aimed to understand biomechanical changes from pelvic floor muscle training (PFMT). • Examined PFMT impact on pelvic floor biomechanics in SUI women using Vaginal Tactile Imager. • The clinically Improved Group showed significant differences in three key VTI parameters. • Findings suggest specific muscle changes can guide personalized SUI interventions. Our study aimed to improve the understanding of the biomechanical changes occurring in the pelvic floor due to pelvic floor muscle training (PFMT), which is responsible for improving stress urinary incontinence (SUI) symptoms. In this prospective cohort study, we examined the impact of a six-week PFMT program in women with stress or stress-predominant urinary incontinence on the biomechanical parameters of the pelvic floor. Fifty-two biomechanical parameters were measured by Vaginal Tactile Imager (VTI) at baseline and at a six-week follow-up. In addition, we have assessed the Urinary Distress Inventory (UDI-6), Incontinence Impact Questionnaire (IIQ-7), and Patient's Global Impression of Severity (PGI-S) scores at enrolment and at six-week follow-up. We have divided our cohort into two groups, Improved Group (IG) and Not-improved Group (NIG), based on the change in UDI-6 score after six weeks and compared the biomechanical changes within and between the two groups. The overall cohort included twenty women with stress or stress-predominant SUI based on MESA questionnaire [MESA SUI index (mean ± SD) 63.3 % ± 24.0 %, MESA UUI index (mean ± SD) 13.3 % ± 15.3 %, p < 0.01]. Nine of the 52 VTI parameters have changed significantly after six weeks of PFMT in the entire cohort. Eleven women (IG) achieved the minimum 11-point change in the UDI-6 scaled score. In IG, we found that three VTI parameters differed significantly: Parameter 1: the maximum value of force measured during the VTI probe insertion [(N, mean ± SD) 0.55 ± 0.18 vs. 0.78 ± 0.31, p < 0.049], parameter 18: the maximum gradient at the upper third of the vagina (posterior) [(kPa/mm, mean ± SD) 0.16 ± 0.05 vs. 0.36 ± 0.28, p < 0.048], and parameter 47: integral force change in the anterior compartment at reflex pelvic muscle contraction (cough) [(N, mean ± SD) 1.61 ± 0.85 vs. 1.97 ± 0.71, p < 0.045]. Our study revealed a significant association between the improvement of strength in targeted muscle groups and a reduction in urinary incontinence symptoms. Identifying specific muscles changing PFMT provides valuable insights for specific interventions. Our findings may help to create personalized and targeted interventions to improve the quality of life of women affected by SUI. [ABSTRACT FROM AUTHOR]

• Combination therapy is efficacious in treating women with OAB. • Rapid effect and persistent clinical improvement were evident from week 2. • There were fewer side effects over time. We hypothesized that combination therapy would provide a synergistic effect to improve treatment outcomes for overactive bladder (OAB), thus enhancing the motivation for continuous exercise, and that it would be associated with fewer adverse events than monotherapy. Therefore, we investigated whether biofeedback-assisted pelvic floor muscle training (PFMT), drug therapy, or a combination of both would be more effective in improving the symptoms of OAB. This randomized controlled trial included women diagnosed with OAB. Group 1 received biofeedback-assisted pelvic muscle floor training (PFMT) for 12 weeks; group 2 took 5 mg of solifenacin/day for 12 weeks; and group 3 received 5 mg of solifenacin/day in combination with biofeedback-assisted PFMT during the first 4 weeks and biofeedback-assisted PFMT for another 8 weeks. All participants had 5 follow-up visits. The primary outcomes were objective improvement of OAB symptoms and quality of life. The secondary outcomes were treatment-related adverse events, subjective improvement of OAB symptoms, and electromyographic activity of pelvic floor muscle (PFM) contraction. All participants reported significant improvement of OAB symptoms and quality of life. Participants in group 2 experienced more pronounced adverse events than those in group 3. Intervention duration was positively associated with subjective improvement in OAB symptoms in groups 2 and 3. Drug-related adverse events, including dry mouth, myalgia, and restlessness, had a negative impact on the subjective improvement of OAB symptoms in group 2. In group 1, exercise adherence was positively correlated with subjective improvement of OAB symptoms, whereas in group 3, PFM contraction and biofeedback effect were positively correlated with symptom improvement. Combination therapy is efficacious in treating women with OAB. [ABSTRACT FROM AUTHOR]

The aim of the study is to determine how electromagnetic stimulation and visceral manipulation can improve pelvic floor strength and reduce the severity of symptoms of postmenopausal stress urinary incontinence (SUI). This randomized controlled trial was conducted on 50 postmenopausal female participants aged 50–66 years with a body mass index (BMI) ≥ 30 kg/m2. Participants were equally randomized into the study (A) and control (B) groups. The study group (A) underwent 36 pulsed electromagnetic stimulation (PEMS) sessions (20 min/session; 3 sessions a week/12 weeks), 12 sessions of visceral manipulation therapy (VMT) maneuvers (once weekly/weeks), and 24 supervised pelvic floor muscle training (PFMT) sessions (45–60 min/session; twice weekly/12 weeks), along with general advice. For 12 weeks, the control group (B) received the same PFMT and general advice. Kegel perineometer was used to measure vaginal squeeze pressure (VSP) and the urogenital distress inventory questionnaire-short form (UDI-6) to assess the severity of urinary incontinence (UI) symptoms in both groups before and after the treatment. The results revealed statistically significant improvements (p < 0.05) in both VSP and UDI-6 scores in group A compared to group B. Electromagnetic stimulation combined with visceral manipulation and supervised PFMT is more efficient than PFMT alone on SUI in postmenopausal women. Therefore, it is advisable to incorporate this combined approach into pelvic floor rehabilitation programs. [ABSTRACT FROM AUTHOR]

This study was conducted to investigate the effect of biofeedback (BF) on the rehabilitation of children with nonneurological dysfunctional voiding (NDV). RCTs were retrieved from various databases (published from inception to February 29, 2024). The effects of the BF and non-BF treatments were compared. A random-effects model was used to evaluate the combined data. Meta-analysis revealed that BF increased the maximum urinary flow rate (SMD = 3.78, 95% CI 1.33∼6.22), improved urination time (SMD = 5.88, 95% CI 3.75∼8.01), and reduced the postvoid residual (SMD = −19.18, 95% CI -27.03∼-11.33) and urinary tract infection incidence (RR = 0.43, 95% CI 0.21∼0.87). Electromyogram activity (RR = 0.46, 95% CI 0.25∼0.84) and abnormal urination patterns (RR = 0.51, 95% CI 0.35∼0.74) improved, with effects persisting for more than 1 year. However, the effect of BF on the mean urinary flow rate in children with NDV was significant only after 1 year of follow-up (SMD = 1.90, 95% CI 0.87∼2.92). Existing evidence indicates that BF can enhance urinary parameters and patterns in children with NDV. However, its effectiveness in addressing constipation, daytime urinary incontinence, and nocturnal urinary incontinence is not substantial. High-quality randomized controlled trials can offer additional insights. [ABSTRACT FROM AUTHOR]

• PFMT-P is a valid and reliable measurement tool suitable for Turkish culture that consists of knowledge, knowledge source and implementation variables. • The PFMT-P is a short, comprehensive and useful tool that can be used in both reproductive and menopausal women. Although there are several patient reported outcome measures (PROM) regarding knowledge, source of knowledge and practice about pelvic floor muscle training (PFMT), there is a lack of a valid and reliable PROM that includes the practice component of PFMT along with knowledge and source of knowledge. There is no valid and reliable measurement tool in Turkish used for this purpose. In this context, the aim of our study is to evaluate the psychometric properties of Pelvic Floor Muscle Training Patient Reported Outcome Measures (PROM) (PFMT-P) and to test whether it is a valid and reliable measurement tool for Turkish women. This study has been carried out psychometric testing (validity and reliability) of a new assessment tool concerning PFMT-P. A total of 170 female healthcare professionals (midwives, nurses, doctors, physiotherapists) who were between the ages of 23 and 49 and who volunteered to participate were included in the study. SPSS 25.0 and LİSREL 8.80 statistical programs were used for the analysis of data. Descriptive statistics were evaluated with numbers, percentages and means. Content validity index and confirmatory factor analysis were used for validity. Cronbach Alpha value and test–retest were used for reliability. Level of significance was p < 0.05. Content validity index (CVI) was found to be 0.96 for the overall scale. Model fit indices were found as perfect and good matched. Cronbach's alpha coefficient was found as 0.813 for the overall scale. Test-retest correlation was found as 0.658, it was 0.998 for practice component and 0.997 for source of knowledge component and a positive, significant and high correlation was found. It has been determined that PFMT-P is a valid and reliable measurement tool suitable for Turkish culture. With this, it is a short, comprehensive and useful tool that can be used in both pregnancy and the postpartum period for women of reproductive age or menopause. [ABSTRACT FROM AUTHOR]

• The intervention is beneficial on genitourinary symptoms and quality of life. • The group with supervised group practice displays greater intervention effects. • The intervention can be delivered by advanced practice nurses. • The intervention can be practiced at various locations in community. This parallel-two-group randomized experimental study including a supervised group and an unsupervised group examined the longitudinal effects of pelvic floor muscle training (PFMT) combined with yoga on genitourinary symptoms and the health-related quality of life (HRQOL), and compared practice adherence rates of the two groups. A sample of women experiencing ≥1 genitourinary symptom(s) were recruited and assigned to a supervised group or an unsupervised group. The supervised group attended supervised group practice sessions and performed at-home practice of PFMT and yoga. The unsupervised group performed at-home practice of PFMT and yoga. Information was collected at five time points (n = 91). Generalized estimating equation procedures were used to examine the intervention effects. An independent t- test was conducted to compare the practice adherence rates. Both groups' genitourinary symptoms and HRQOL significantly improved over time. The supervised group displayed greater improvements in genitourinary symptoms and HRQOL and better adherence than did the unsupervised group. [ABSTRACT FROM AUTHOR]

This study aimed to investigate the efficacy of pelvic floor muscle training in treating female sexual dysfunction. A systematic review of databases, including PubMed, Ovid Medline, CINAHL, Embase, BVSalud, Scopus, and Cochrane Library, was performed in July 2021 and updated in May 2023. Full-text articles of randomized controlled trials comparing pelvic floor muscle training with no intervention or another conservative treatment were included. At least 1 arm of these trials aimed to improve women's sexual function or treat sexual dysfunction. The data for this review were extracted and analyzed by 2 independent reviewers. Data on the characteristics of each intervention were extracted using the Consensus on Exercise Reporting Template. The risk of bias and certainty of evidence were assessed using the Physiotherapy Evidence Database (PEDro) scale and the GRADE (Grading of Recommendations Assessment, Development and Evaluation) criteria, respectively. A meta-analysis was conducted considering the posttreatment mean score difference in the Female Sexual Function Index between the control and treatment groups. A total of 21 randomized controlled trials were included in this review. The Consensus on Exercise Reporting Template revealed varying quality of the pelvic floor muscle training protocols. Four studies were included in the meta-analysis showing that pelvic floor muscle training improved arousal (1.49; 95% confidence interval, 0.13–2.85), orgasm (1.55; 95% confidence interval, 0.13–2.96), satisfaction (1.46; 95% confidence interval, 0.14–2.77), pain (0.74; 95% confidence interval, 0.11–1.37), and the Female Sexual Function Index overall score (7.67; 95% confidence interval, 0.77–14.57). Very low certainty of evidence due to the data's high clinical and statistical heterogeneity was found according to the GRADE criteria. No side effects of the interventions were reported. This systematic review and meta-analysis showed that pelvic floor muscle training improved female Female Sexual Function Index total score and several subscales; however, the certainty of the evidence is low. [ABSTRACT FROM AUTHOR]

Objective: To verify the effect of Pilates training combined with biofeedback training, Kegel training combined with biofeedback training, and Kegel training alone on post-prostatectomy incontinence in male patients.Material and Methods: Forty-two patients were randomly divided into 3 groups. The changes occurring to the 3 groups before and after treatment and the differences between the 3 groups were assessed using a 1-hour pad test, number of incontinent episodes, the ICIQ questionnaire, and the Oxford Grading Scale. The 3 groups were required to undergo daily training for an 8-week period.Results: At 8 weeks, groups A, B and C experienced a 34.3%, 61.9%, and 67% improvement in the 1-hour pad test, respectively, and 32.1%, 52.9%, and 58.8% reduction in the number of urinary incontinence episodes, respectively, and a 29.4%, 50%, and 64.7% reduction in the ICIQ Scale, respectively, and a 33.3%, 50%, and 50% in Oxford Grading Scale improvement, respectively. The graph results showed that the effect was noted after 3 weeks of treatment and a significant effect occurred by the eighth week of treatment.Conclusion: Three methods were shown to optimize urinary continence and pelvic floor muscle strength of patients with post-prostatectomy incontinence. The treatment effect of group C was better than group B, but there was no statistically significant difference in the 1-hour pad tests. It is particularly important to understand the time sensitivity for patient training. [ABSTRACT FROM AUTHOR]

Objective: There are several Patient reported Outcome Measures (PROM) of knowledge, source of knowledge and practice of pelvic floor muscle training (PFMT), in different combinations but few integrating all three in one instrument. The objective of this study was the initial psychometric testing of a new PFMT PROM (PFMT-P), which aims to describe the knowledge, source of knowledge, and practices of PFMT for use by general female population, in order to contribute to preliminary validity and reliability.Study Design: This study offered psychometric testing (validity and reliability) of a new assessment tool concerning PFMT (PFMT-P). The sample included 323 non-pregnant women, aged 20-50, who were heath care professionals and ancillary staff in one medical center in northern Israel. The PFMT-P was developed in Hebrew and composed of 3 sections: knowledge (score range 0-3), source of knowledge (initially scored), and practice (score range 3-35). A demographic and general health questionnaire was included.Results: The face and content validity of the PFMT-P were evaluated by five experts with a factor analysis done on the practice component. Test-retest scores for internal consistency were reported for a group of 20 women, to whom the tool was administered 2 weeks apart. The results of the questionnaire components were knowledge, r= 0.538, p=0.014, and practice r=0.878, p<0.001. The component, source of knowledge on practice, showed non-significant results (p=0.796). Cronbach's alpha for the PFMT-P was 0.921 for the practice component.Conclusion: The PFMT-P was employed for the first time in a descriptive, correlational study, where its validity and reliability was tested and shows promise. The questionnaire is brief and easy to use. Continued research using this new PROM needs to be done to establish it as an assessment tool for PFMT programs. [ABSTRACT FROM AUTHOR]

Objectives: Obstetric Anal Sphincter Injury (OASI) is associated with significant morbidity in the form of pelvic floor dysfunction, both in the immediate period of healing and long term. The aim of this study was to determine the prevalence of urinary, anorectal and sexual symptoms arising from OASI within 6 weeks after delivery at their first physiotherapy appointment (immediate postnatal) and 3-6 months after delivery following completion of physiotherapy (intermediate postnatal). Symptom prevalence were compared between the two time periods and the impact of pelvic floor physiotherapy analysed to determine any changes in symptomology.Study Design: This prospective observational study, conducted at a tertiary teaching hospital, involved completion of a paper questionnaire by pelvic floor physiotherapists at the immediate postnatal review and by consultant gynaecologists at the intermediate postnatal review. Data were then compared to determine changes in symptoms using Fisher Exact tests and Mann Whitney U tests.Results: Of the 131 women seen within 6 weeks of delivery, follow-up data at 3-6 months were collected for 96. There was a significant improvement in pain on defecation (P = 0.008), rectal bleeding on wiping (P = 0.0233) and women's ability to defer a bowel motion (P = 0.0001) however faecal incontinence did not improve significantly even with supervised physiotherapy. Urinary symptoms including stress incontinence, urgency and nocturia also significantly improved at P = 0.0097, P = 0.0045 and P < 0.0001, respectively. For the sexual domain, significantly more women had resumed intercourse (P < 0.0001) and started using contraception (P < 0.0001) by the follow up appointment.Conclusion: This study shows that physiotherapy is valuable in the treatment of urinary symptoms after delivery but does not have the same impact on faecal incontinence. Further investigation is required to confirm if early anal symptomology may be a predictor of long-term adverse outcomes. [ABSTRACT FROM AUTHOR]

What is the most cost-effective way of providing pelvic floor muscle training (PFMT) to prevent or treat postpartum incontinence? Meta-analysis and cost-effectiveness analysis of models of care included in a recent Cochrane systematic review. Pregnant and postnatal women. Supervised PFMT for preventing or treating urinary and/or faecal incontinence. Postpartum urinary or faecal incontinence. We examined the comparative incremental cost effectiveness of different approaches to successfully prevent or cure one case of incontinence. Costs were valued in Australian dollars using publicly available market rates and enterprise agreements as of 2019. Comparisons involving group-based treatment approaches were subject to sensitivity analyses where the numbers of patients attending each group were varied to identify thresholds where recommendations change. Seventeen trials were included for meta-analysis. Three models of care were clinically effective: individually supervised PFMT during pregnancy to prevent urinary incontinence (Model 1), group-based PFMT during pregnancy to prevent or treat urinary incontinence (Model 2) and individually supervised postnatal PFMT to treat urinary incontinence and prevent or treat faecal incontinence (Model 3). The health service costs per urinary incontinence case prevented or cured were $768 for Model 1, and $1,970 for Model 3. However, Model 2 generated a cost saving of $14 if there were eight participants per session, with greater savings if more participants attend. The health service cost per faecal incontinence case prevented or cured was $2,784 (Model 3). Providing group-based PFMT for all women during pregnancy is likely more efficient than individual PFMT for incontinent women postnatally; however, providing PFMT for postnatal women with urinary incontinence should not be discounted because of the added known benefit for preventing and treating faecal incontinence. [ABSTRACT FROM AUTHOR]

Pelvic organ prolapse is a common condition with 1 in 10 women undergoing surgery during their lifetime. In the community 8% of women complain of the symptom of a vaginal bulge which is the symptom that most closely correlates with the finding of a prolapse on examination. Pelvic organ prolapse can impair urinary, bowel and sexual function. The NICE National Guideline Urinary Incontinence and Pelvic Organ prolapse in Women: Management makes recommendations on the assessment and treatment of pelvic organ prolapse. The most important part of prolapse management is obtaining a comprehensive pelvic floor history and understanding the woman's treatment goals and expectations. A standardised examination aids further decision making. Conservative treatment options include observation, lifestyle advice, pelvic floor muscle training and use of a pessary. Treatment choice is guided by patient preference. [ABSTRACT FROM AUTHOR]

Objectives: To evaluate the efficacy of 12-week pelvic floor muscle training (PFMT) using bio-assisted surface electromyography (EMG) feedback in women with complex pelvic floor dysfunction (PFD); to further differentiate the effect of exercise adherence from the biofeedback per se; and to assess and compare the severities of overactive bladder (OAB) symptoms, stress urinary incontinence (SUI), and stage of prolapse with the women's perception of symptom cure or improvement following the program.Study Design: This prospective observational study was conducted between December 2015 and November 2018 at a medical center in Taiwan. It included 83 women with PFD, manifesting solely as either OAB or SUI with (group 1) or without (group 2) concomitant stages I and II pelvic organ prolapse (POP). All women underwent a 12-week bio-assisted PFMT. The main outcome was the electromyographic activity of the pelvic floor muscles (PFMs). The severities of OAB symptoms, SUI, and stage of POP were assessed both subjectively and objectively before and after the intervention.Results: A notable improvement of PFM function was identified after 12 weeks of training in all women with PFD. The number of effective PFM contractions achieved during bio-assisted PFMT was positively correlated with the improvement of PFM function in both groups of women in different body positions, except in the standing position in group 2. Exercise adherence, however, had no significant impact on the efficacy of the training. There was a significant improvement over time and high consistency between subjective and objective improvements of OAB symptoms and SUI severity after the completion of PFMT. Nonetheless, only the Ba point of the POP-Quantification system in women with POP showed a significant improvement after the intervention.Conclusion: PFMT using surface EMG biofeedback significantly improves PFM function in women with complex PFD, and thus, has a significant therapeutic effect on OAB, SUI, and bladder prolapse. [ABSTRACT FROM AUTHOR]

Urinary incontinence is common after radical prostatectomy. Pelvic floor muscle training provides a plausible solution. Although early trials provided promising results, systematic reviews have questioned the efficacy of this intervention. A major consideration is that most clinical trials in men have applied principles developed for pelvic floor muscle training for stress urinary incontinence in women, despite differences in anatomy between sexes and differences in the mechanisms for continence/incontinence. Literature regarding continence control in men has been conflicting and often based on erroneous anatomy. New understanding of continence mechanisms in men, including the complex contribution of multiple layers of striated pelvic floor muscles, and detailed consideration of the impact of radical prostatectomy on continence anatomy and physiology, have provided foundations for a new approach to pelvic floor muscle training to prevent and treat incontinence after prostatectomy. An approach to training can be designed to target the pathophysiology of incontinence. This approach relies on principles of motor learning and exercise physiology, in a manner that is tailored to the individual patient. The aims of this review are to consider new understanding of continence control in men, the mechanisms for incontinence after radical prostatectomy, and to review the characteristics of a pelvic floor muscle training program designed to specifically target recovery of continence after prostatectomy. [ABSTRACT FROM AUTHOR]

In women undergoing surgery for pelvic organ prolapse (POP), what is the average effect of the addition of perioperative pelvic floor muscle training on pelvic organ prolapse symptoms, pelvic floor muscle strength, quality of life, sexual function and perceived improvement after surgery? Randomised controlled trial with concealed allocation, blinded assessors, and intention-to-treat analysis. Ninety-six women with an indication for POP surgery. The experimental group received a 9-week pelvic floor muscle training protocol with four sessions before the surgery and seven sessions after the surgery. The control group received surgery only. Symptoms were assessed using the Pelvic Floor Distress Inventory (PFDI-20), which is scored from 0 'unaffected' to 300 'worst affected'. Secondary outcomes were assessed using vaginal manometry, validated questionnaires and Patient Global Impression of Improvement, which is scored from 1 'very much better' to 7 'very much worse'. All participants were evaluated 15 days before surgery, and at Days 40 and 90 after surgery. There was no substantial difference in POP symptoms between the experimental and control groups at Day 40 (31 (SD 24) versus 38 (SD 42), adjusted mean difference −6, 95% CI −25 to 13) or Day 90 (27 (SD 27) versus 33 (SD 33), adjusted mean difference −4, 95% CI −23 to 14). The experimental group perceived marginally greater global improvement than the control group; mean difference −0.4 (95% CI −0.8 to −0.1) at Day 90. However, the estimated effect of additional perioperative pelvic floor muscle training was estimated to be not beneficial enough to be considered worthwhile for any other secondary outcomes. In women undergoing POP surgery, additional perioperative pelvic floor muscle training had negligibly small effects on POP symptoms, pelvic floor muscle strength, quality of life or sexual function. ReBEC, RBR–29kgz5. [ABSTRACT FROM AUTHOR]

Highlights • Women with stress UI were eight times more likely to report cure after PFMT. • Women with combined UI types were five times more likely to report cure after PFMT. • PFMT improves symptoms and QoL in women with stress, urge and combined UI types. • Results support the recommendation of PFMT as first-line treatment for UI in women. Abstract Background Pelvic floor muscle training is the most commonly used physical therapy treatment for women with urinary incontinence. Objectives To assess the effects of Pelvic floor muscle training for women with urinary incontinence in comparison to a control treatment and to summarize relevant economic findings. Methods Cochrane Incontinence Group Specialized Register (February 12, 2018). Selection criteria: Randomized or quasi-randomized trials in women with stress, urgency or mixed urinary incontinence (symptoms, signs, or urodynamic). Data collection and analysis: Trials were independently assessed by at least two reviewers authors and subgrouped by urinary incontinence type. Quality of evidence was assessed by adopting the Grading of Recommendations, Assessment, Development and Evaluation approach. Results The review included thirty-one trials involving 1817 women from 14 countries. Overall, trials were small to moderate size, and many were at moderate risk of bias. There was considerable variation in the intervention's content and duration. Based on data available, we can be confident that Pelvic floor muscle training can cure or improve symptoms of stress and all other types of urinary incontinence. It may reduce the number of leakage episodes and the quantity of leakage, while improving reported symptoms and quality of life. Women were more satisfied with Pelvic floor muscle training, while those in control groups were more likely to seek further treatment. Long-term effectiveness and cost-effectiveness of Pelvic floor muscle training needs to be further researched. Conclusions The addition of ten new trials did not change the essential findings of the earlier review, suggesting that Pelvic floor muscle training could be included in first-line conservative management of women with urinary incontinence. [ABSTRACT FROM AUTHOR]

To evaluate the effects of pelvic floor muscle training (PFMT) and perineal massage during late pregnancy on postpartum pelvic floor function in nulliparas. Randomised controlled trial. The Peking University First Hospital, a teaching hospital in China. Two-hundred nulliparas were included. Nulliparas were randomised into four groups in a 1:1:1:1 ratio. Group A, control; group B, perineal massage; group C, pelvic floor muscle training (PFMT); group D, perineal massage and PFMT. The intervention group received the corresponding intervention from 34 weeks of gestation until delivery. Changes in pelvic floor function from 34 weeks of gestation to 6 weeks postpartum were assessed using pelvic floor electromyography (EMG), pelvic organ prolapse quantitation (POP-Q), and pelvic floor distress inventory-20 (PFDI-20). Those with PFMT (groups C and D) had a smaller decline in pelvic floor EMG of fibre II than those without PFMT (groups A and B) [− 0.2 (− 7.1, 11.3) µV vs 6.1 (− 0.2, 15.2) µV, P = 0.040]. The same scenario was observed in the pelvic floor EMG of fibre I. The Aa point measurement differences of those with PFMT (groups C and D) were smaller than those without PFMT (groups A and B) [0.0 (0.0, 2.0) cm vs 1.0 (0.0, 3.0) cm, P = 0.006]. The same result was observed for point Ba. No difference was observed in EMG and POP-Q in nulliparas with (groups B and D) or without perineal massage (groups A and C). No differences were observed in PFDI-20 scores. PFMT during late pregnancy enhanced pelvic floor EMG, while perineal massage alone or PFMT combined with perineal massage did not. PFMT in late pregnancy enhances pelvic floor function. • The effect of pelvic floor muscle training and perineal massage in the last trimester on nulliparas. • Pelvic floor muscle training alone enhances pelvic floor electromyography. • Perineal massage alone or combine with pelvic floor muscle training don't. [ABSTRACT FROM AUTHOR]

Pelvic organ prolapse is a common condition with one in 10 women undergoing surgery during their lifetime. In the community 8% of women complain of the symptom of a vaginal bulge which is the symptom that most closely correlates with the finding of a prolapse on examination. Pelvic organ prolapse can impair urinary, bowel and sexual function. The most important part of prolapse management is obtaining a comprehensive pelvic floor history and understanding the woman's treatment goals and expectations. A standardised examination aids further decision making. Conservative treatment options include observation, lifestyle advice, pelvic floor muscle training and use of a pessary. Treatment choice is guided by patient preference. [ABSTRACT FROM AUTHOR]

Background Pompoir is a technique poorly studied in the literature that claims to improve pelvic floor strength and coordination. This study aims to investigate the pelvic floor muscles' coordination throughout the vaginal canal among Pompoir practitioners and non-practitioners by describing a high resolution map of pressure distribution. Methods This cross-sectional, study included 40 healthy women in two groups: control and Pompoir. While these women performed both sustained and “waveform” pelvic floor muscle contractions, the spatiotemporal pressure distribution in their vaginal canals was evaluated by a non-deformable probe fully instrumented with a 10 × 10 matrix of capacitive transducers. Findings Pompoir group was able to sustain the pressure levels achieved for a longer period (40% longer, moderate effect, P = 0.04). During the “waveform” contraction task, Pompoir group achieved lower, earlier peak pressures (moderate effect, P = 0.05) and decreased rates of contraction (small effect, P = 0.04) and relaxation (large effect, P = 0.01). During both tasks, Pompoir group had smaller relative contributions by the mid-region and the anteroposterior planes and greater contributions by the caudal and cranial regions and the latero-lateral planes. Interpretation Results suggest that specific coordination training of the pelvic floor muscles alters the pressure distribution profile, promoting a more-symmetric distribution of pressure throughout the vaginal canal. Therefore, this study suggests that pelvic floor muscles can be trained to a degree beyond strengthening by focusing on coordination, which results in changes in symmetry of the spatiotemporal pressure distribution in the vaginal canal. [ABSTRACT FROM AUTHOR]

Objectives This systematic review and metaanalysis compared the effects of biofeedback-assisted pelvic floor muscle training with those of pelvic floor muscle training alone in patients with urinary incontinence after radical prostetactomy. Design A review and metaanalysis study design. Data sources The metaanalysis was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and MetaAnalyses guidelines. A systematic search of PubMed/Medline OVID, the Cumulative Index to Nursing and Allied Health Literature, Cochrane Library, BioMed Central, Web of Science, Chinese Electronic Periodical Services, Chinese Journal and Thesis Database, and China National Knowledge Infrastructure was performed for retrieving records. Review methods For determining the effects of training type on urinary incontinence, randomized controlled trials on biofeedback-assisted pelvic floor muscle training with or without electrical stimulation were compared with those on pelvic floor muscle training with or without electrical stimulation, respectively, in the metaanalysis. The Cochrane Collaboration tool in the Cochrane Handbook for Systematic Review of Interventions 5.1.0 was used to assess the methodological quality of the included trials. Subjective and objective measurement of urinary incontinence improvement and the quality of life were the primary and secondary outcome measures, respectively. Data were analyzed using Comprehensive Meta-Analysis software 2.0. In addition, subgroup analyses and metaregression were performed to explore the possible sources of heterogeneity. Results Thirteen randomized controlled trials involving 1108 patients with prostatectomy incontinence were included. The immediate-, intermediate-, and long-term effects of objectively measured biofeedback-assisted pelvic floor muscle training on urinary incontinence were significant (mean effect size = −0.316, −0.335, and −0.294; 95% CI: −0.589 to −0.043, −0.552 to −0.118 and −0.535 to −0.053; p = 0.023, 0.002, and 0.017, respectively) when compared with those of pelvic floor muscle training alone. However, when urinary incontinence was measured subjectively, only the intermediate and long-term effects of biofeedback were found ( p = 0.034 and 0.005, respectively). Small-to-moderate immediate- and intermediate-term effects on the quality of life were observed when biofeedback-assisted pelvic floor muscle training was compared with pelvic floor muscle training alone. No publication bias was observed among studies. Conclusions Biofeedback can be an adjunct treatment to pelvic floor muscle training for reducing urinary incontinence in patients who have undergone radical prostatectomy. [ABSTRACT FROM AUTHOR]

Objective: To make evidence-based recommendations for the postpartum management of women and their newborns, regardless of the mode of delivery.Material and Methods: Systematic review of articles from the PubMed database and the Cochrane Library and of recommendations from the French and foreign societies or colleges of obstetricians.Results: Because breast-feeding is associated with reductions in neonatal, infantile, and childhood morbidity (lower frequency of cardiovascular, infectious, and atopic diseases and infantile obesity) (LE2) and improved cognitive development in children (LE2), exclusive and extended breastfeeding is recommended (grade B) for at least 4-6 months (professional consensus). Pharmacological treatments for inhibition of lactation should not be given routinely to women who do not wish to breastfeed (professional consensus). Because of potentially serious adverse effects, bromocriptine is contraindicated in inhibiting lactation (professional consensus). For women aware of the risks of pharmacological treatments to inhibit lactation but choose to take them, lisuride and cabergoline are the preferred drugs (professional consensus). Regardless of the mode of delivery, only women with bleeding or symptoms of anemia should be tested for it (professional consensus). Immediate postoperative monitoring after cesarean delivery should be performed in the postanesthesia care unit (PACU). An analgesic multimodal protocol for analgesia, preferring oral administration, should be developed by the medical team and be available for all staff (professional consensus) (grade B). Thromboprophylaxis with compression stockings should begin the morning of all cesarean deliveries and maintained for at least 7 postoperative days (professional consensus) with or without the addition of LMWH, depending on the presence and severity (major or minor) of additional risk factors. It is recommended that women be informed of the dangers of closely spaced pregnancies (LE3), that effective contraception begin no later than 21 days post partum for women who do not want such a pregnancy (grade B), and that it be prescribed at the maternity ward (professional consensus). In view of the postpartum risk of venous thromboembolism, use of combination hormonal contraception is not recommended before six weeks post partum (grade B). Pelvic floor rehabilitation in asymptomatic women to prevent urinary or anal incontinence in the medium or long term is not recommended (professional consensus). Rehabilitation using pelvic floor muscle contraction exercises is recommended to treat persistent urinary incontinence at 3 months post partum (grade A), regardless of the type of incontinence. Postpartum pelvic floor rehabilitation is recommended to treat anal incontinence (grade C), but not to treat or prevent prolapse (grade C) or dyspareunia (grade C). The months following the birth are a period of transition and of psychological changes for all parents (LE2) and are still more difficult for those with psychosocial risk factors (LE2). Situations of evident psychological difficulties can have a significant effect on the child's psychological and emotional development (LE3). Among these difficulties, postpartum depression is most common, but the risk of all mental disorders is generally higher in the perinatal period (LE3).Conclusion: The postpartum period presents clinicians with a unique and privileged opportunity to address the physical, psychological, social, and somatic health of women and babies. [ABSTRACT FROM AUTHOR]

To (i) compare the acceptance of a newly developed, novel biofeedback device (PelviSense) with that of conventional biofeedback (CB) using an intravaginal probe for the treatment of stress urinary incontinence (SUI) in women, (ii) examine the feasibility and safety of using the PelviSense device as a pelvic floor muscle (PFM) training (PFMT) adjunct, and (iii) compare the PFMT adherence and effectiveness of CB, the PelviSense device, with PFMT alone for women with SUI. An assessor-blinded, three-arm, randomized controlled pilot trial was conducted among 51 women with SUI. Women were randomly allocated to one of three study groups (PelviSense-assisted PFMT, CB-assisted PFMT, or PFMT alone [control]). Outcome measures included the International Consultation on Incontinence Questionnaire-Short Form, the 1-h pad test, and the Modified Oxford Scale. Participants in the PelviSense-assisted PFMT group expressed good device acceptance. PFMT adherence was greater in the PelviSense-assisted PFMT group than in the unassisted or CB-assisted PFMT groups. Between-groups analysis revealed significant effects on improved SUI symptoms, urine loss severity, and PFM strength for the PelviSense-assisted PFMT group compared with the CB-assisted and PFMT alone groups. The pilot trial results demonstrated moderate to high PFMT adherence in the PelviSense-assisted PFMT group and supported the safety of using the PelviSense device. The preliminary results of the pilot trial showed that PelviSense-assisted PFMT was more effective for reducing SUI symptoms among women than unassisted or CB-assisted PFMT. Trial registration: This trial was registered in http://ClinicalTrials.gov (reference number: NCT04638348) before the recruitment of the first participant. • The results from this pilot trial were encouraging regarding adherence, safety, and the acceptability of the PelviSense device. • This pilot study demonstrate that the methodology is feasible for a fully powered study in recruitment and retention. • The preliminary results show that the PelviSense device may be effective in reducing the symptoms of UI and the severity of urine loss in women with SUI. [ABSTRACT FROM AUTHOR]

Objective: Pregnancy and delivery are the most prominent risk factors for the onset of pelvic floor injuries and - later-on - urinary incontinence. Supervised pelvic floor muscle training during and after pregnancy is proven effective for the prevention of urinary incontinence on the short term. However, only a minority of women do participate in preventive pelvic floor muscle training programs. Our aim was to analyze willingness to participate (WTP) in an intensive preventive pelvic floor muscle training (PFMT) program and influencing factors, from the perspective of postpartum women, for participation.Study Design: We included 169 three-month postpartum women in a web-based survey in the Netherlands. Demographic and clinical characteristics, knowledge and experience with PFMT and preconditions for actual WTP were assessed. Main outcome measures were frequencies and percentages for categorical data. Cross tabulations were used to explore the relationship between WTP and various independent categorical variables. A linear regression analysis was done to analyze which variables are associated with WTP.Results: A response rate of 64% (n=169) was achieved. 31% of the women was WTP, 41% was hesitating, 12% already participated in PFMT and 15% was not interested (at all). No statistically significant association was found between WTP and risk or prognostic pelvic floor dysfunction factors. Women already having symptoms of pelvic floor dysfunction such as incontinence and pelvic organ prolapse symptoms were more WTP (p=0.010, p=0.001, respectively) as were women perceiving better general health (p<0.001). Preconditions for women to participate were program costs, and travel time not exceeding 15min.Conclusions: From the perspective of postpartum women, there is room for improvement of preventive pelvic floor management. Further research should focus on strategies to tackle major barriers and to introduce facilitators for postpartum women to participate in PFMT programs. [ABSTRACT FROM AUTHOR]

Objectives The purpose of this study was to investigate if a specific pelvic floor muscle training (PFMT) program effectively increases pelvic floor muscle (PFM) contractility and decreases anterior pelvic organ prolapse (POP) as well as urogynecological symptoms, in postmenopausal women. The mean outcome measure of this study was the pelvic floor surface electromyography (sEMG) activity. Study design A clinical, randomized, blinded-assessor and controlled study was conducted with 46 postmenopausal women. Thirty women completed this study (mean age of 65.93 years), divided into two groups: Treatment Group – TG ( n = 18) and Control Group – CG ( n = 12). The evaluation was carried out using digital palpation, sEMG, pelvic organ prolapse quantification (POP-Q) as well as validated questionnaires by the International Consultation on Incontinence Questionnaires to investigate urogynecological symptoms. The treatment protocol consisted of 12 group sessions, twice a week, with 30 min of duration each. These data were then submitted to statistical analyses by the Statistical Analysis System for Windows software , with a significance level of 5%. Results The pelvic floor muscle contractility increased after PFMT, evaluated by sEMG ( p = 0.003) and digital palpation ( p = 0.001), accompanied by a decrease in urinary symptoms ( p < 0.001 for ICIQ-OAB scores e 0.036 for ICIQ UI-SF) as well as anterior pelvic organ prolapse ( p = 0.03). Conclusion This preliminary study suggests that the applied PFMT program could be an effective way to increase PFM contractility, as well as to decrease both anterior pelvic organ prolapse and urinary symptoms, in postmenopausal women. [ABSTRACT FROM AUTHOR]

Résumé Notre objectif est de faire le point sur les résultats de la rééducation périnéale dans le traitement de l’incontinence urinaire et des symptômes du prolapsus génital. Le renforcement des muscles du plancher pelvien permet de réduire les symptômes de l’incontinence urinaire. La rééducation encadrée par un rééducateur permet une guérison dans plus de la moitié des cas de l’incontinence urinaire d’effort. La visualisation de la contraction grâce au biofeedback améliore les résultats, mais cet effet pourrait être expliqué par une prise en charge plus intense et prolongée avec le rééducateur. La place de l’électrostimulation reste à préciser. Les résultats obtenus grâce à l’utilisation des cônes vaginaux sont équivalents au renforcement musculaire avec ou sans biofeedback ou à l’électrostimulation. On ne sait pas si l’effet de la rééducation périnéale avec renforcement musculaire a encore un effet après un an. Dans l’incontinence urinaire d’effort, la rééducation périnéale encadrée par un rééducateur en première intention évite l’intervention chirurgicale dans la moitié des cas à un an. La rééducation périnéale est le traitement de première intention de l’incontinence urinaire du post-partum. Son effet préventif est incertain. Le renforcement des muscles du plancher pelvien semble réduire les symptômes associés au prolapsus génital. En conclusion, la rééducation périnéale encadrée par un rééducateur est un traitement efficace, à court terme, pour réduire les symptômes d’incontinence urinaire ou de prolapsus génital. Our goal is to provide an update on the results of pelvic floor rehabilitation in the treatment of urinary incontinence and genital prolapse symptoms. Pelvic floor muscle training allows a reduction of urinary incontinence symptoms. Pelvic floor muscle contractions supervised by a healthcare professional allow cure in half cases of stress urinary incontinence. Viewing this contraction through biofeedback improves outcomes, but this effect could also be due by a more intensive and prolonged program with the physiotherapist. The place of electrostimulation remains unclear. The results obtained with vaginal cones are similar to pelvic floor muscle training with or without biofeedback or electrostimulation. It is not known whether pelvic floor muscle training has an effect after one year. In case of stress urinary incontinence, supervised pelvic floor muscle training avoids surgery in half of the cases at 1-year follow-up. Pelvic floor muscle training is the first-line treatment of post-partum urinary incontinence. Its preventive effect is uncertain. Pelvic floor muscle training may reduce the symptoms associated with genital prolapse. In conclusion, pelvic floor rehabilitation supervised by a physiotherapist is an effective short-term treatment to reduce the symptoms of urinary incontinence or pelvic organ prolapse. [ABSTRACT FROM AUTHOR]

Pelvic organ prolapse (POP) is a common female problem which is defined as the symptomatic descent of the walls or apex of the vagina. Symptoms of a vaginal bulge or protrusion, pelvic heaviness, bladder, bowel and sexual dysfunction are often associated with the problem. Treatments include surgery and conservative management. Conservative approaches to the treatment of prolapse are often used in cases of mild to moderate prolapse; for those who wish to have more children; the frail or those unwilling to undergo surgery; and those awaiting surgery. This article describes the conservative methods available to women presenting with pelvic organ prolapse including lifestyle advice, pelvic floor muscle training and vaginal pessaries. [ABSTRACT FROM AUTHOR]

Introduction To determine the efficacy of combining of Boswellia serrata L. resin and the root of Cyperus scariosus L. plus PFMT in reproductive age women with stress urinary incontinence. Methods A prospective, single-blind, placebo-controlled, randomized trial was conducted. The patients were randomized to receive orally either combination of equal quantity of B. serrata and C. scariosus (2g) ( n = 30) or placebo ( n = 30) respectively twice daily for 8 weeks in addition to pelvic floor muscle training in both groups. The outcome was one hour pad test. The results were analyzed using parametric and nonparametric test. Results The improvement in the test and control group was 60% and 37% respectively. Between the group comparison was statistically significant ( P = 0.035). The intra group comparison of one hour pad test was statistically significant in both groups ( P < 0.001). No adverse effects were noted. Conclusion The test group was more effective than control group in women with SUI. [ABSTRACT FROM AUTHOR]

Abstract: Pelvic floor muscle training (PFMT) and pessaries are commonly used in the conservative treatment of pelvic organ prolapse (POP). Because there is a lack of evidence regarding the optimal choice between these two interventions, we designed the “Pelvic Organ prolapse in primary care: effects of Pelvic floor muscle training and Pessary treatment Study” (POPPS). POPPS consists of two parallel open label randomized controlled trials performed in primary care, in women aged ≥55 years, recruited through a postal questionnaire. In POPPS trial 1, women with mild POP receive either PFMT or watchful waiting. In POPPS trial 2, women with advanced POP receive either PFMT or pessary treatment. Patient recruitment started in 2009 and was finished in December 2012. Primary outcome of both POPPS trials is improvement in POP-related symptoms. Secondary outcomes are quality of life, sexual function, POP-Q stage, pelvic floor muscle function, post-void residual volume, patients’ perception of improvement, and costs. All outcomes are measured 3, 12, and 24 months after the start of treatment. Cost-effectiveness will be calculated based on societal costs, using the PFDI-20 and the EQ-5D as outcomes. In this paper the POPPS design, the encountered challenges and our solutions, and participant baseline characteristics are presented. For both trials the target numbers of patients in each treatment group are achieved, giving this study sufficient power to lead to promising results. [Copyright &y& Elsevier]

Abstract: Background: The efficacy of preoperative pelvic floor muscle training (PFMT) for urinary incontinence (UI) after open radical prostatectomy (ORP) and robot-assisted laparoscopic radical prostatectomy (RARP) is still unclear. Objective: To determine whether patients with additional preoperative PFMT regain urinary continence earlier than patients with only postoperative PFMT after ORP and RARP. Design, setting, and participants: A randomized controlled trial enrolled 180 men who planned to undergo ORP/RARP. Intervention: The experimental group (E, n =91) started PFMT 3 wk before surgery and continued after surgery. The control group (C, n =89) started PFMT after catheter removal. Outcome measurements and statistical analysis: The primary end point was time to continence. Patients measured urine loss daily (24-h pad test) until total continence (three consecutive days of 0g of urine loss) was achieved. Secondary end points were 1-h pad test, visual analog scale (VAS), International Prostate Symptom Score (IPSS), and quality of life (King's Health Questionnaire [KHQ]). Kaplan-Meier analysis and Cox regression with correction for two strata (age and type of surgery) compared time and continence. The Fisher exact test was applied for the 1-h pad test and VAS; the Mann-Whitney U test was applied for IPSS and KHQ. Results and limitations: Patients with additional preoperative PFMT had no shorter duration of postoperative UI compared with patients with only postoperative PFMT (p =0.878). Median time to continence was 30 and 31 d, and median amount of first-day incontinence was 108g and 124g for groups E and C, respectively. Cox regression did not indicate a significant difference between groups E and C (p =0.773; hazard ratio: 1.047 [0.768–1.425]). The 1-h pad test, VAS, and IPSS were comparable between both groups. However, “incontinence impact” (KHQ) was in favor of group E at 3 mo and 6 mo after surgery. Conclusions: Three preoperative sessions of PFMT did not improve postoperative duration of incontinence. Trial registration: Netherlands Trial Register No. NTR 1953. [Copyright &y& Elsevier]

Objective: To assess the effect of a research prioritization partnership that aimed to influence the research agenda relating to urinary incontinence (UI). Study Design and Setting: Research often neglects important gaps in existing evidence so that decisions must be made about treatments without reliable evidence of their effectiveness. In 2007-2009, a United Kingdom partnership of eight patient and 13 clinician organizations identified and prioritized gaps in the evidence that affect everyday decisions about treatment of UI. The top 10 prioritized research questions were published and reported to research funders in 2009. A year later, new research or funding applications relating to the prioritized topics were identified through reviews of research databases and consultation with funding organizations, elements of the research community, and organizations that participated in the partnership. Results: Since dissemination of the prioritized topics, five studies are known to have been funded, three in development; five new systematic reviews are under way, one is being updated; five questions are under consideration by a national research commissioning body. Conclusion: The partnership successfully developed and used a methodology for identification and prioritization of research needs through patienteclinician consensus. Prioritization through consensus can be effective in informing the development of clinically useful research. [ABSTRACT FROM AUTHOR]

Abstract: Vaginal probes may induce changes in pelvic floor muscle (PFM) recruitment by the very presence of the probes. Fine-wire electrodes allow us to detect muscle activation parameters without altering the natural position and shape of the PFMs. The purpose of this study was to determine whether PFM activation is altered by changes in sensory feedback, muscle length or tissue position caused by two different vaginal probes used to record surface electromyography (EMG). Twelve continent women (30.1±5.4years), performed PFM maximal voluntary contractions (MVCs) in supine while fine-wire EMG was recorded bilaterally from the PFMs under three conditions: (a) without any probe inserted into the vagina, (b) while a Femiscan™ probe was in situ, and (c) while a Periform™ vaginal probe was in situ. The reliability of the fine wire EMG data was assessed using intra-class correlation coefficients (ICCs) and coefficients of variation (CV). A repeated measures analysis of variance (ANOVA) model was used to determine if there were differences in EMG amplitude recorded when the different vaginal probes were in situ. For each condition the between-trial reliability was excellent, ICC(3,1) =0.93–0.96, (p <0.001) and CV=11.2–21.8%. There were no differences in peak EMG amplitude recorded during the MVCs across the three conditions (no probe 63.4±48.4μV, Femiscan™ 55.3±42.4μV, Periform™ 59.4±42.2μV, p =0.178). These results suggest that women produce consistent MVCs over multiple contractions, and that PFM muscle activation is not affected by different probes inserted into the vagina. [Copyright &y& Elsevier]

Abstract: Pelvic organ prolapse (POP) is a common female problem which is defined as the symptomatic descent of the walls or apex of the vagina. Symptoms of a vaginal bulge or protrusion, pelvic heaviness, bladder, bowel and sexual dysfunction are often associated with the problem. Treatments include surgery and conservative management. Conservative approaches to the treatment of prolapse are often used in cases of mild to moderate prolapse; for those who wish to have more children; the frail or those unwilling to undergo surgery; and those awaiting surgery. This article describes the conservative methods available to women presenting with pelvic organ prolapse including lifestyle advice, pelvic floor muscle training and vaginal pessaries. [Copyright &y& Elsevier]

Abstract: Objective: To compare the effects of pelvic floor muscle training (PFMT) performed during group treatment sessions (GT) and individual treatment sessions (IT) to a control group (CG) of women with stress urinary incontinence (SUI). Hypothesis: The group treatment sessions would have better effects compared to individual treatment sessions. Study design: This randomized controlled pilot study included women aged over 18 years, who complained of urinary leakage on stress and who had not undergone physical therapy for SUI before. Forty-nine women were randomly allocated to the PFMT in group treatment session (GT) (n =17), PFMT in individual treatment session (IT) (n =17) and control group (CG) (n =15). The study was carried out in an outpatient physical therapy department in São Carlos, Brazil. Subjects on intervention groups were treated with the same PFMT protocol for 6 weeks, with two 1-h weekly sessions. The GT group carried out the PFMT in group treatment session and IT group in individual treatment session. The CG did not receive any treatment during the corresponding time. They were evaluated before and after treatment for primary outcome, urinary loss, and secondary outcomes, King''s Health Questionnaire, pressure perineometry, pelvic floor muscle strength by digital palpation and subjective satisfaction. Participants, evaluator and the physical therapist were not blinded. Forty-five women completed the study and were included in the analysis. The statistical analysis was performed using Wilcoxon test for intragroup analysis and Kruskal–Wallis and Mann–Whitney test for intergroup analysis (p <0.05). Results: In intragroup analysis, there was a significant reduction in urinary loss measured by pad test only in the IT group. For primary outcome, there was a significant difference only after treatment between GT and CG (p <0.0001; effect size −0.91; 95% confidence interval from 0.56 to 5.80) as well as between IT and CG (p <0.0001; effect size −0.90; 95% confidence interval from 0.54 to 5.84). There were differences after treatment in GT and IT groups for secondary outcomes: perineometry, muscle strength and in the domains of the quality of life questionnaire. For the CG group, there were not significant differences in any variables. In intergroup analysis for all variables, there were no differences between GT and IT groups. The two treated groups had similar subjective satisfaction (86%). There were no complaints of adverse effects due to treatment from either group. Conclusion: The results indicated similar improvement in clinical variables and in satisfaction with the treatment between IT and GT. [Copyright &y& Elsevier]

Abstract: Context: In recent years, despite improvement in the surgical technique, the prevalence of postprostatectomy incontinence has increased due to a rise in the number of radical prostatectomies performed annually. Objective: The aim of this review is to evaluate contemporary noninvasive and invasive treatment options for postprostatectomy incontinence. Evidence acquisition: In August 2010, a review of the literature was performed using the Medline database. Evidence synthesis: All articles concerning noninvasive and invasive treatment for postprostatectomy incontinence were included. Conclusions: No randomised controlled trials exist to compare currently used noninvasive and invasive treatments for postprostatectomy incontinence. Pelvic floor muscle training is recommended for the initial treatment of stress urinary incontinence (SUI). Additionally, antimuscarinic therapy should be applied for urgency or urge incontinence. For decades, the artificial urinary sphincter was the reference standard for persistent SUI. Nowadays, male slings are an alternative for men with mild to moderate postprostatectomy SUI. [Copyright &y& Elsevier]

Abstract: Urinary incontinence is a common problem among adults and conservative management is recommended as the first-line treatment. Physical therapies, particularly pelvic floor muscle exercise, are the mainstay of such conservative management. The purpose of this review is to summarise current literature and describe trends in the use of pelvic floor muscle exercise in the management of urinary incontinence in women. Our review confirms that pelvic floor muscle exercise is particularly beneficial in the treatment of urinary stress incontinence in females. Studies have shown up to 70% improvement in symptoms of stress incontinence following appropriately performed pelvic floor exercise. This improvement is evident across all age groups. There is evidence that women perform better with exercise regimes supervised by specialist physiotherapists or continence nurses, as opposed to unsupervised or leaflet-based care. There is evidence for the widespread recommendation that pelvic floor muscle exercise helps women with all types of urinary incontinence. However, the treatment is most beneficial in women with stress urinary incontinence alone, and who participate in a supervised pelvic floor muscle training programme for at least three months. [ABSTRACT FROM AUTHOR]

Abstract: Objective: The aim of this study was to evaluate the impact of Global Postural Re-education (GPR) on stress urinary incontinence symptoms and to compare it to Pelvic Floor Muscle Training (PFMT). Study design: Fifty-two women with stress urinary incontinence were distributed into two groups: Group 1 (G1) was submitted to weekly sessions of GPR for three months and Group 2 (G2) performed Pelvic Floor Muscle Training four times a week for three months. Patients were evaluated through the King''s Health Questionnaire, a three-day voiding diary including daily pad use and a Functional Evaluation of the Pelvic Floor (FEPF), before treatment (T0), at the end of treatment (T1) and six months after treatment (T2). Results: The number of leaking episodes dropped significantly in both groups at the end of treatment and at six months follow-up, with a significantly greater decrease in G1. Daily pad use dropped significantly in both groups. At the end of treatment, 72% of the patients in G1 and 41% of the patients in G2 needed no pads and at six-month follow-up, 84% and 50%, respectively. FEPF improved significantly in both groups, with no significant difference between the groups (P =0.628). The King''s Health Questionnaire demonstrated significant improvement in both groups and in all domains. The GPR group presented higher adherence to treatment, with no dropouts. Conclusions: GPR could represent an alternative method to treat stress urinary incontinence in women, should the results be long lasting. [Copyright &y& Elsevier]

Abstract: Urinary incontinence is a frequent affliction in women and may be disabling and costly {LE1}. When consulting for urinary incontinence, it is recommended that circumstances, frequency and severity of leaks be specified {Grade B}. The cough test is recommended prior to surgery {Grade C}. Urodynamic investigations are not needed before lower urinary tract rehabilitation {Grade B}. A complete urodynamic investigation is recommended prior to surgery for urinary incontinence {Grade C}. In cases of pure stress urinary incontinence, urodynamic investigations are not essential prior to surgery provided the clinical assessment is fully comprehensive (standardised questionnaire, cough test, bladder diary, post-void residual volume) with concordant results {PC}. It is recommended to start treatment for stress incontinence with pelvic floor muscle training {Grade C}. Bladder training is recommended at first intention in cases with overactive bladder syndrome {Grade C}. For overweight patients, loss of weight improves stress incontinence {LE1}. For surgery, sub-urethral tape (retropubic or transobturator route) is the first-line recommended technique {Grade B}. Sub-urethral tape surgery involves intraoperative risks, postoperative risks and a risk of failure which must be the subject of prior information {Grade A}. Elective caesarean section and systematic episiotomy are not recommended methods of prevention for urinary incontinence {Grade B}. Pelvic floor muscle training is the treatment of first intention for pre- and postnatal urinary incontinence {Grade A}. Prior to any treatment for an elderly woman, it is recommended to screen for urinary infection using a test strip, ask for a bladder diary and measure post-void residual volume {Grade C}. It is recommended to carry out a cough test and look for occult incontinence prior to surgery for pelvic organ prolapse {Grade C}. It is recommended to carry out urodynamic investigations prior to pelvic organ prolapse surgery when there are urinary symptoms or occult urinary incontinence {Grade C}. [Copyright &y& Elsevier]

Summary: Urinary incontinence has been found to be common in girls and women with cystic fibrosis (CF). This often can have a marked impact on daily activities and quality of life. It may also lead to potential deterioration of respiratory status due to reduced adherence to forced expiratory manoeuvres (cough, lung function tests and exercise) by the girls trying to avoid occurrence of urinary incontinence (UI). Analysis of the literature is limited by the fact that different definitions and a variety of questionnaires have been used. There is little literature regarding UI in men and boys which is thought to be less common than in females. National guideline recommendations in the management of CF in Australia and the United Kingdom have in recent years changed to incorporate screening and management of UI. No studies to date have looked at outcomes of interventions in children and adolescents with CF or other respiratory conditions; however those working with this population need to be aware of the problem of UI as it is a treatable condition and could potentially be prevented. [Copyright &y& Elsevier]

• Patients with Multiple sclerosis (MS) benefit from pelvic floor muscle training (PFMT). • PFMT appear to moderately decrease urine leakage in patients with MS. • PFMT likely decrease neurogenic bladder symptoms in patients with MS. • PFMT may moderately increase muscle endurance and power in patients with MS. Pelvic floor muscle training (PFMT) is a conservative treatment program for the management of lower urinary tract dysfunction (LUTD). This systematic review aimed to investigate the overall effectiveness of PFMT on LUTD in people with multiple sclerosis (MS). Seven databases (PubMed/Medline, Scopus, PEDro, WOS, CINAHL, Cochrane, and Embase) were searched between 1990 and July 2019. We investigated urine leakage as our primary outcome. The secondary outcomes were neurogenic bladder symptoms measured by the overactive bladder questionnaire (OAB-V8 questionnaire) and the power/endurance of pelvic floor muscles. Fifteen studies were identified as eligible. Both urine leakage (standardized mean difference (SMD) = 0.50, 95% CI [-0.78, -0.23], and neurogenic bladder symptoms, SMD = -2.24, 95% CI [-4.44, -0.03] significantly decreased by PFMT in people with MS. PFMT increased the overall endurance and power of pelvic floor muscles moderately and significantly, SMD = 1.25, 95% CI [0.69, 1.81], and SMD = 0.64, 95% CI [0.24, 1.05], respectively. Moderate to high-quality studies showed the overall efficacy of PFMT in decreasing urine leakage and neurogenic bladder symptoms and increasing endurance and power of pelvic floor muscles. MS patients with lower urinary tract symptoms could benefit from PFMT in the short term. [ABSTRACT FROM AUTHOR]

Abstract: The primary aims of this trial are: 1) to compare surgical outcomes following sacrospinous ligament fixation to uterosacral vaginal vault suspension in women undergoing vaginal surgery for apical or uterine pelvic organ prolapse and stress urinary incontinence and 2) to examine the effects of a structured perioperative program consisting of behavioral techniques and pelvic floor muscle training compared to usual care. This trial is performed through the Pelvic Floor Disorders Network (PFDN), which is funded by National Institute of Child Health and Human Development. Subjects will be enrolled from hospitals associated with seven PFDN clinical centers across the United States. A centralized biostatistical coordinating center will oversee data collection and analysis. Two approaches will be investigated simultaneously using a 2×2 randomized factorial design: a surgical intervention (sacrospinous ligament fixation versus uterosacral vaginal vault suspension) and a perioperative behavioral intervention (behavioral and pelvic floor muscle training versus usual care). Surgeons have standardized essential components of each surgical procedure and have met specific standards of expertise. Providers of the behavioral intervention have undergone standardized training. Anatomic, functional, and health-related quality of life outcomes will be assessed using validated measures by researchers blinded to all randomization assignments. Cost-effectiveness analysis will be performed using prospectively collected data on health care costs and resource utilization. The primary surgical endpoint is a composite outcome defined by anatomic recurrence, recurrence of bothersome vaginal prolapse symptoms and/or retreatment and will be assessed 2 years after the index surgery. Endpoints for the behavioral intervention include both short-term (6-month) improvement in urinary symptoms and long-term (2-year) improvement in anatomic outcomes and prolapse symptoms. This article describes the rationale and design of this randomized trial, focusing on several key design features of potential interest to researchers in the field of female pelvic floor disorders and others conducting randomized surgical trials. [Copyright &y& Elsevier]

and purpose: There is limited evidence from randomised controlled trials (RCTs) regarding the use of yoga and Pilates for the management of urinary incontinence (UI) in women. This study aims to investigate the preliminary effects of using Pilates and yoga to manage UI. An assessor-blinded, prospective, three-arm parallel-group randomised controlled pilot trial was conducted in three elderly care centres in Hong Kong. Thirty women aged 60 years or above were included in the study. Study centres were randomly assigned to each of the three interventions (yoga, Pilates and pelvic floor muscle training [PFMT; standard care control]). Study interventions were provided once a week for four weeks, followed by unsupervised CD-guided home exercises for eight weeks. Outcomes included the International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF), 1-h pad test, and feasibility measures such as adherence to the intervention programme, recruitment and retention rates and safety. Outcomes were assessed at baseline, 4 and 12 weeks. Statistical analysis was performed using two-way repeated measures analysis of covariance. All three interventions demonstrated a statistically significant effect on ICIQ-SF scores from baseline to weeks 4 and 12. Significant effects in UI were reported for yoga compared with Pilates (mean: −2.93, 95% CI −5.35, −0.51; p = 0.02). Yoga poses intended to address the pelvic floor and core muscles were found to have superior benefits over Pilates exercises in terms of improved continence measured with the ICIQ-SF. • Yoga provides superior benefits for improving incontinence compared with Pilates, as measured by the International Consultation on Incontinence Questionnaire-Short Form. • Yoga and Pilates are as effective as pelvic floor muscle training for decreasing the severity of stress urinary incontinence. • The findings of this study demonstrated that the use of yoga and Pilates to strengthen the pelvic floor is applicable and feasible in elderly women. [ABSTRACT FROM AUTHOR]

Abstract: Context: The ever-increasing number of radical prostatectomies entails an increasing number of patients suffering from postprostatectomy stress incontinence despite improved surgical techniques. We provide an overview of the current diagnosis and treatment of postprostatectomy stress incontinence. Objective: To review previous and recent literature on this subject and to assess the current standards of diagnosis and management of postprostatectomy incontinence. Evidence acquisition: The PubMed database was searched, and all articles published since 2000 were evaluated. Evidence synthesis: This review presents the current recommended diagnostic tools and available noninvasive and invasive treatment options. Conclusions: The European Association of Urology (EAU) recommends a two-stage assessment for diagnosis of postprostatectomy incontinence. Noninvasive therapy, pelvic floor-muscle training and biofeedback, is recommended in early postoperative and mild incontinence. Pharmacological treatment with duloxetine is especially effective in combination with physiotherapy, where it synergistically improves the continence rate. For surgical treatment, the insertion of an artificial urinary sphincter, AS-800, is still the gold standard. In recent years, several minimal invasive treatment options have been introduced with different rates of success, but they have not yet surpassed the results of the artificial sphincter. [Copyright &y& Elsevier]

Abstract: Objectives: The aim of this study was to assess efficacy and safety of association of duloxetine and rehabilitation compared with rehabilitation alone in men with SUI after radical retropubic prostatectomy (RRP), and to compare continence rate even after planned duloxetine suspension. Methods: After catheter removal, 112 patients were randomized to receive rehabilitation and duloxetine (group A) or rehabilitation alone (group B), for 16 wk. Inclusion criteria: postprostatectomy SUI with daily incontinent episodes frequency (IEF) of four or greater. After 16 wk both groups suspended duloxetine/placebo and continued rehabilitation. All patients completed incontinence quality of life (I-QoL) questionnaire and bladder diary. Wilcoxon test was used to analyse changes in IEF and in I-QoL score; Fisher exact test was used to compare continent patients between the groups. Results: Adverse events for duloxetine was 15.2%. 102 men completed the study. There was a significant decrease in pad use in group A. After 16 wk, 39 patients versus 27 were dry (p =0.007). At 20 wk, 4 wk after planned interruption of duloxetine, we observed a U-turn, 23 patients were completely dry in group A versus 38 in group B (p =0.008). Whereas, after 24 wk, 31 in group A versus 41 in group B were dry (p =0.08). The decrease in IEF and improvements in I-QoL scores were significantly greater in group A for the first 16 wk. Conclusions: The data suggest that combination therapy might provide another treatment option for SUI in men that might increase the percentage of early postsurgery continence. [Copyright &y& Elsevier]

Abstract: This study of Taiwanese women investigated effects of pelvic floor muscle training (PFMT) on urinary incontinence (UI) severity and on participants’ knowledge and attitudes regarding UI and PFMT. Of 114 participants in a 4-h PFMT program, 55 suffering from UI completed 2 questionnaires, 1 before and 1 after the program. Among them, 78% reported experiencing UI under increased abdominal pressure, and 82% had suffered the condition for more than 1 year. Participants achieved reductions in UI severity after PFMT; and the program produced a significant difference in their knowledge about, though not in their attitudes toward, both UI and PFMT. [Copyright &y& Elsevier]

Abstract: Stress urinary incontinence (SUI) is one common type of incontinence among women. It can have a serious impact on their quality of life. Many women are ashamed to talk about their problem and try to cope with their incontinence themselves. Those women who do seek treatment should initially undergo a basic evaluation to determine the type of incontinence which is present. In case of mild to moderate SUI, conservative treatment can be initiated. This includes lifestyle modifications and pelvic floor muscle training (PFMT). PFMT is effective, provided the patient is trained and able to perform a correct pelvic floor muscle contraction. PFMT is not invasive, but its efficacy depends on long-term compliance. In case of failure of conservative treatment and for women with severe SUI, surgery is today the only solution. There is a wide variety of surgical procedures available, of which the Burch colposuspension is best documented and is still considered the “gold standard”, because of well-known long-term follow-up. The tension-free tape procedures have become very popular the latest years, although more long-term follow-up data (up to 5–10 years) are needed. Only a scarcity of adequately performed randomised, controlled trials (RCTs) is available which evaluated the current treatments available for SUI. There is clearly a need for large, rigorous, prospective RCTs of high quality. Furthermore, there is a need for an efficacious and safe new pharmacological treatment for women with SUI. Duloxetine, a potent and balanced serotonin and noradrenaline reuptake inhibitor, is a promising candidate to fill this gap in the near future. [Copyright &y& Elsevier]

Objective: The purpose of this study was to determine which patient characteristics are predictive of outcome before pelvic floor muscle training for stress urinary incontinence. Study design: This was an observational study at a single-center outdoor patient clinic in Brussels, Belgium, that comprised 447 women, aged 26 to 80 years (mean, 52.7 years), who had urinary stress incontinence. All the women received individual pelvic floor muscle training under the guidance of the same physiotherapist. Twenty-two patient characteristics were considered for outcome measurements. Results: Forty-nine percent of the women considered their treatment to be successful; 51% of the women had experienced only some improvement, no change, or a worsening of their condition or had interrupted therapy. Three independent predictors of treatment failure were ≥2 leakages per day before treatment (P < .0001), the chronic use of psychotropic medication (P = .002), and a baseline positive stress test result at first cough (P = .042). The odds were only 15% for an individual patient to be treated successfully when these 3 predictors were present. Conclusion: Pelvic floor muscle training is beneficial in one half of the patients who are treated in this manner. Two or more leakages per day at baseline and the chronic use of psychotropic medication significantly predicted therapy failure. [ABSTRACT FROM AUTHOR]

Objectives: The aim of this article is to report evidence-based knowledge on short- and long-term effects, adverse effects, adherence, dropout and motivational problems of pelvic floor muscle (PFM) training for stress urinary incontinence (SUI).Methods: Randomised controlled trials (RCTs) retrieved from computerized search, Clinical Practice Guidelines (AHCPR, US), the Cochrane library, and International Consultation on Incontinence (ICI) consensus statements were used as sources of evidence.Results: Several RCTs have demonstrated that PFM training is more effective than no treatment for SUI. Subjective cure/improvement rates of PFM training reported in RCTs vary between 56 and 70%. Cure rates defined as <2 grams of leakage on different pad tests vary between 44 and 69%. Only one study has analysed data of long-term follow-up for as long as 10 years. Successful results were maintained in two thirds of the patients originally classified as successful.Conclusions: Pelvic floor muscle training has proved to be an effective treatment for female SUI in RCTs. It has no side effects, and is cost effective compared to surgery. There is a need for more physiotherapists specializing in this area, and better collaboration between urologists and physiotherapists to organize better health services for SUI patients and for planning of future high quality clinical trials. [Copyright &y& Elsevier]

Pelvic floor muscle training (PFMT) is recommended as part of supportive care for patients with prostate cancer. It can assist in reducing treatment-related symptoms such as urinary incontinence. This literature review aims to discuss recent innovative findings on the pathophysiology of the male continence mechanism and implications for PFMT in radical prostatectomy. CINAHL, Embase, Web of Science, Emcare and PsycINFO were searched until January 2020. Nurses providing supportive care for patients undergoing radical prostatectomy can engage in-clinic in the instruction and recommendation of pre- and postoperative PFMT and delivering guidance on home-based programs to promote motor learning. Optimal postoperative urinary incontinence outcomes are suggested to be promoted by preoperative PFMT. Training focused on the urethral and anterior pelvic floor muscle complex has been shown to facilitate mid urethral occlusion required for continence. Prescription of PFMT should be individualised, focusing on skill acquisition and motor learning, which is in line with recent knowledge developments in male pelvic floor anatomy. [ABSTRACT FROM AUTHOR]

Background: Vaginal birth is a risk factor for pubovisceral muscle tear, decreased urethral closure pressure, and urinary incontinence. The relationship between these 3 factors is complicated. Urinary continence relies on maintaining urethral closure pressure, particularly when low urethral closure pressure can usefully be augmented by a volitional pelvic muscle (Kegel) contraction just before and during stress events like a cough. However, it is unknown whether a torn pubovisceral muscle decreases the ability to increase urethral closure during an attempted pelvic muscle contraction.Objective: We tested the null hypothesis that a pubovisceral muscle tear does not affect the ability to increase urethral closure pressure during a volitional pelvic muscle contraction in the Evaluating Maternal Recovery from Labor and Delivery (EMRLD) study.Study Design: We studied 56 women 8 months after their first vaginal birth. All had at least 1 risk factor for pubovisceral muscle tear (eg, forceps and long second stage). A tear was assessed bilaterally by magnetic resonance imaging. Urethral closure pressure was measured both at rest and during an attempted volitional pelvic muscle contraction. A Student t test was used to compare urethral closure pressures. Multiple linear regression was used to estimate the effect of a magnetic resonance imaging-confirmed pubovisceral muscle tear on volitionally contracted urethral closure pressure after adjusting for resting urethral closure pressure.Results: The mean age was just a little more than 30 years, with the majority being white. By magnetic resonance imaging measure, unadjusted for other factors, the 21 women with tear had significantly lower urethral closure pressure during an attempted contraction compared with the 35 women without tear (65.9 vs 86.8 cm H2O, respectively, P = .004), leading us to reject the null hypothesis. No significant group difference was found in resting urethral closure pressure. After adjusting for resting urethral closure pressure, pubovisceral muscle tear was associated with lower urethral closure pressure (beta = -21.1, P = .001).Conclusion: In the first postpartum year, the presence of a pubovisceral muscle tear did not influence resting urethral closure. However, women with a pubovisceral muscle tear achieved a 25% lower urethral closure pressure during an attempted pelvic muscle contraction than those without a pubovisceral muscle tear. These women with pubovisceral muscle tear may not respond to classic behavioral interventions, such as squeeze when you sneeze or strengthen through repetitive pelvic muscle exercises. When a rapid rise to maximum urethral pressure is used as a conscious volitional maneuver, it appears to be reliant on the ability to recruit the intact pubovisceral muscle to simultaneously contract the urethral striated muscle. [ABSTRACT FROM AUTHOR]