Efficacy of pelvic floor muscle training in women with overactive bladder syndrome: a systematic review
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Introduction and hypothesis
Our objective was to evaluate the effectiveness of pelvic floor muscle training (PFMT) in reducing overactive bladder (OAB) symptoms in women.
Searches were performed at MEDLINE, PubMed, Physiotherapy Evidence Database (PEDro), Scielo, and Central Cochrane Library PubMed until January 2017. Controlled trials were researched by two independent reviewers. Eligible studies were restricted to random and controlled clinical trials that investigated the effectiveness of PFMT in decreasing OAB symptoms. Qualitative methodology was evaluated using the PEDro scale. Data was analyzed and interpreted qualitatively.
The final search retrieved eight studies (n = 1161 women with urgency symptoms), which were published between 2002 and 2016. The methodological scores varied between 4 and 7 in the PEDro scale. PFMT, with the objective of controlling urgent micturition, demonstrated improvements in quality of life in women with OAB. Most data in this revision came from small- to moderate-sized trials, with different and inconsistent outcome measures, which could have impacted the end results.
The literature regarding the effectiveness of PFMT in OAB remains heterogeneous and inconclusive.
KeywordsOveractive detrusor Urinary bladder Urinary incontinence Urge Urinary bladder Overactive Exercise and exercise therapy
PFMT + BT: pelvic floor muscle training and combined pelvic floor rehabilitation
Descritores em Ciências da Saúde, Health Science descriptors
Functional electrical stimulation
International classification of functioning, disability and health
International Continence Society
Incontinence Quality of Life Questionnaire
Incontinence Severity Index
King’s Health Questionnaire
Medical Subject Headings of the National Library of Medicine
Mixed urinary incontinence
Pelvic floor muscle(s)
Pelvic floor muscle training
Physiotherapy Evidence Database
Patient’s Perception of Intensity of Urgency Scale
Randomized controlled trials
Short-Form Health Survey
Stress urinary incontinence
Urgency urinary incontinence
Compliance with ethical standards
Conflicts of interest
- 4.Staski D, Kelleher C, Avery K, Bosch R, Cotterill N, Coyne K, et al. Initial assessment of urinary and faecal incontinence in adult male and female patients. In: Abrams P, Cardozo L, Khoury S, Wein A, editors. Incontinence. 4th International Consultation on Incontinence (2008), International Continence Society. 4th ed. Paris: Health Publications Ltd; 2009. p. 331–412.Google Scholar
- 6.Milson Md, Altman D, Cartwright R, Lapitan MC, Nelson R, Sillén U, et al. Epidemiology of Urinary Incontinence (UI) and other Lower Urinary Tract Symptoms (LUTS), Pelvic Organ Prolapse (POP) and Anal Incontinence (AI). In: Abrams P, et al. editors. (2012) Incontinence. 5th International Consultation on Incontinence, International Continence Society, 2013. J et al (2010) An International Urogynecological Association (IUGA)/International Continence Society (ICS) joint report on the terminology for female pelvic floor dysfunction. 5th ed. Paris: Health Publications Ltd; 2012. p. 15–108.Google Scholar
- 8.Dumoulin C, Hay-Smith J, Habée-Séguin GM, Mercier J. Pelvic floor muscle training versus no treatment, or inactive control treatments, for urinary incontinence in women: a short version Cochrane systematic review with meta-analysis. Neurourol Urodyn. 2014;34(4):300–8. https://doi.org/10.1002/nau.22700.CrossRefPubMedGoogle Scholar
- 12.Dumoulin C, Hay-Smith J. Pelvic floor muscle training versus no treatment, or inactive control treatments, for urinary incontinence in women. Cochrane Database Syst Rev. CD005654. 2010. https://doi.org/10.1002/14651858.CD005654.pub2.
- 13.Sand PK, Goldberg RP, Dmochowski RR, McIlwain M, Dahl NV. The impact of the overactive bladder syndrome on sexual function: a preliminary report from the multicenter assessment of transdermal therapy in overactive bladder with oxybutynin trial. Am J Obstet Gynecol. 2006;195(6):1730–5. https://doi.org/10.1016/j.ajog.2006.08.013.CrossRefPubMedGoogle Scholar
- 19.Arruda MR, Castro RA, Sousa GC, Sartori MG, Baracat EC, Girão MJ. Prospective randomized comparison of oxybutynin, functional electrostimulation, and pelvic floor training for treatment of detrusor overactivity in women. Int Urogynecol J. 2008;19(8):1055–61. https://doi.org/10.1007/s00192-008-0586-y.CrossRefGoogle Scholar
- 22.Voorham CJ, Wachter SD, Van de Bos TWL, Putter H, Nijeholt GAL, Voorham PJ. The effect of EMG biofeedback assisted pelvic floor muscle therapy on symptoms of the overactive bladder syndrome in women: a randomized controlled trial. Neurourol Urodyn. 2016;36(7):1796–803. https://doi.org/10.1002/nau.23180.CrossRefPubMedGoogle Scholar
- 24.Van Tulder M, Furlan A, Bombardier C, Bouter L, the Editorial Board of the Cochrane Collaboration Back Review Group. Updated method guidelines for systematic reviews in the Cochrane collaboration back review group. Spine. 2003;28(12):1290–9. https://doi.org/10.1097/01.BRS.0000065484.95996.AF.PubMedGoogle Scholar
- 25.Wang AC, Wang YY, Chen MC. Single-blind, randomized trial of pelvic floor muscle training, biofeedback-assisted pelvic floor muscle training, and electrical stimulation in the management of overactive bladder. Urology. 2004;63(1):61–6. https://doi.org/10.1016/j.urology.2003.08.047.CrossRefPubMedGoogle Scholar
- 27.World Health Organization / PAHO. CIF international classification of functioning, disability and health. 1st ed. São Paulo: EdUSP; 2003. p. 37–8.Google Scholar
- 28.Hay Smith J, Berghmans B, Burgio K, Dumoulin C, Hagen S, Moore K, et al. Adult conservative management. In: Abrams P, Cardozo L, Khoury S, Wein A, editors. Incontinence, 4th international consultation on incontinence. 4th ed. Paris: Health Publications Ltd; 2009. p. 1027–120.Google Scholar
- 29.Bø K, Berghmans B, Morkved S, Van Kampen M. Evidence-based physical therapy for the pelvic floor: bridging science and clinical practice. 2nd ed. Edinburgh: Churchill Livingstone; 2015. p. 111–30.Google Scholar
- 31.Salvatore S, Delancey J, Igawa Y, Koelbl H, Laterza RM, Serati M, et al. Pathophysiology of urinary incontinence, fecal incontinence and pelvic organ prolapse. In: Abrams P, Cardozo L, Wagg A, Wein A, editors. Incontinence. 6th International Consultation on Incontinence (2016), International Continence Society, 6th ed. Paris: Health Publications Ltd; 2017. p. 365–66.Google Scholar