Single blind, randomised controlled trial of pelvic floor exercises, electrical stimulation, vaginal cones, and no treatment in management of genuine stress incontinence in women

BMJ 1999;318:487-493 ( 20 February )

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Single blind, randomised controlled trial of pelvic floor exercises, electrical stimulation, vaginal cones, and no treatment in management of genuine stress incontinence in women

Kari Bø, professor, ^a Trygve Talseth, consultant urologist, ^b Ingar Holme, professor of biostatistics. ^c

^a Norwegian Centre for Physiotherapy Research and Norwegian University of Sport and Physical Education, PO Box 4014, Ullevål Stadion, 0806 Oslo, Norway, ^b National Hospital of Norway, Oslo, ^c Norwegian University of Sport and Physical Education, Oslo

Correspondence to: Professor Bø karib{at}brage.idrettshs.no

Objective: To compare the effect of pelvic floor exercises,electrical stimulation, vaginal cones, and no treatment for genuinestressincontinence.
Design: Stratified, single blind, randomised controlledtrial.
Setting: Multicentre.
Participants: 107 women with clinically and urodynamicallyproved genuine stress incontinence. Mean (range) age was 49.5(24-70) years, and mean (range) duration of symptoms 10.8 (1-45)years.
Interventions: Pelvic floor exercise (n=25) comprised 8-12contractions 3 times a day and exercise in groups with skilledphysical therapists once a week. The electrical stimulation group(n=25) used vaginal intermittent stimulation with the MS 106 Twinat 50 Hz 30 minutes a day. The vaginal cones group (n=27) usedcones for 20 minutes a day. The untreated control group (n=30)was offered the use of a continence guard. Muscle strength wasmeasured by vaginal squeeze pressure once amonth.
Main outcome measures: Pad test with standardised bladder volume,and self report ofseverity.
Results: Improvement in muscle strength was significantlygreater (P=0.03) after pelvic floor exercises (11.0 cm H₂O (95%confidence interval 7.7 to 14.3) before v 19.2 cm H₂O (15.3 to23.1) after) than either electrical stimulation (14.8 cm H₂O (10.9to 18.7) v 18.6 cm H₂O (13.3 to 23.9)) or vaginal cones (11.8cm H₂O (8.5 to 15.1) v 15.4 cm H₂O (11.1 to 19.7)). Reductionin leakage on pad test was greater in the exercise group ( $-$ 30.2g; $-$ 43.3 to 16.9) than in the electrical stimulation group ( $-$ 7.4g; $-$ 20.9 to 6.1) and the vaginal cones group ( $-$ 14.7 g; $-$ 27.6 to $-$ 1.8). On completion of the trial one participant in the controlgroup, 14 in the pelvic floor exercise group, three in the electricalstimulation group, and two in the vaginal cones group no longerconsidered themselves as having aproblem.
Conclusion: Training of the pelvic floor muscles is superiorto electrical stimulation and vaginal cones in the treatment ofgenuine stressincontinence.

Key messages

Training to increase the strength of pelvic floor muscles was superior to electrical stimulation and vaginal cones in treatment of genuine stress incontinence
Adverse effects were reported with use of electrical stimulation and vaginal cones but not with exercises
Patients' tolerance for electrical stimulation and vaginal cones was low
Pelvic floor exercise should be first choice of treatment for genuine stress incontinence

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Conservative management of genuine stress incontinence in women: Vik Khullar, Stefano Salvatore, John Bidmead, Kate Anders, Linda Cardozo, Kari Bø, Ingar Holme, and Trygve Talseth
BMJ 1999 319: 190. [Extract] [Full Text]

A health planner's delight?
BMJ 1999 318: 0. [Full Text] [PDF]

A health planner's delight?
BMJ 1999 318: 0. [Full Text] [PDF]

Exercise is the answer for stress incontinence
BMJ 1999 318: 0. [Full Text]

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