Quality of life outcomes following 1 year encouragement of pelvic floor muscle exercise among urinary incontinence women living in the community
Main Article Content
Abstract
Background: Urinary incontinence (UI) is a silent problem affecting women’s health. This problem causes lower self-confidence to participate in various activities. Pelvic floor muscle exercise (PFE) is the first recommended for treatment of UI. Adherence to PEF is the key to success in maintaining continence. However, no studies have supported the effect of sustaining PFE continually on the symptoms of UI and the quality of life (QoL) in the long term.
Objectives: This study aimed to investigate the effect of the 1-year encouragement of PFE on UI symptoms and the quality of life among incontinence women living in the community.
Materials and methods: Thirty-four women with UI aged between 50-70 years were invited in this study. The women were interviewed for the UI variables including the ability to hold urine, the frequency and amount of UI, feeling urgency to urinate, the frequency of urination during the daytime and nighttime. Additionally, the King’s health questionnaire (KHQ- Thai version) was used to measure the quality of life. The UI variables and KHQ were measured at baseline, 3rd, 6th, 9th and 12th months of the intervention. PFE program was provided to participants after baseline measurement and encouraged to perform continually and consistency for 1 year. Descriptive statistics, one-way repeated ANOVA and Friedman test were used to analyze the data.
Results: At the end of program, 24 women (92.3%) had no problems with urinary control. In part of the frequency and the amount of stress UI, all of them were completely improves (100%). In terms of the symptoms associated with urged UI such as the feeling urgency to urinate, most of them had no hustle during urination (80.8%). The frequency of urination was reduced, all of them had less than 5 times urination during the day. The severity of symptoms associated with UI was significantly different compared to baseline. In addition, the KHQ score for all items was lower, indicating a higher QoL when compared to baseline.
Conclusion: Longterm promoting of PFE was effective for the improvement of UI and significantly increased the QoL among incontinence women living in communities.
Article Details
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
Personal views expressed by the contributors in their articles are not necessarily those of the Journal of Associated Medical Sciences, Faculty of Associated Medical Sciences, Chiang Mai University.
References
Abrams P, Andersson K-E, Birder L, Brubaker L, Cardozo L, Chapple C, et al. Fourth International Consultation on Incontinence Recommendations of the International Scientific Committee: evaluation and treatment of urinary incontinence, pelvic organ prolapse, and fecal incontinence Neurourol Urodyn. 2010; 29(1): 213-40. doi: 10.1002/nau.20870.
Haylen BT, de Ridder D, Freeman RM, Swift SE, Berghmans B, Lee J, et al. An International Urogynecological Association (IUGA)/International Continence Society (ICS) joint report on the terminology for female pelvic floor dysfunction. Int Urogynec J. 2010; 21(1): 5-26. doi: 10.1007/s00192-009-0976-9.
McClurg D, Campbell P, Pollock A, Hagen S, Elders A, Hill D, et al. Conservative interventions for urinary incontinence in women: an overview of Cochrane systematic reviews. Physiotherapy. 2017; 103(1): e26-e7. doi: doi.org/10.1016/j.physio.2017.11.185.
Komesu YM, Schrader RM, Ketai LH, Rogers RG, Dunivan GC. Epidemiology of mixed, stress, and urgency urinary incontinence in middle-aged/older women: the importance of incontinence history. Int Urogynec J. 2016; 27(5): 763-72. doi: 10.1007/s00192-015-2888-1.
Krhut J, Gärtner M, Mokris J, Horcicka L, Svabik K, Zachoval R, et al. Effect of severity of urinary incontinence on quality of life in women. Neurourol Urodyn. 2018; 37(6): 1925-30. doi: 10.1002/nau.23568.
Dumoulin C, Hunter KF, Moore K, Bradley CS, Burgio KL, Hagen S, et al. Conservative management for female urinary incontinence and pelvic organ prolapse review 2013: summary of the 5th International Consultation on Incontinence. Neurourol Urodyn. 2016; 35(1): 15-20. doi: 10.1002/nau.22677.
Borello-France DF, Zyczynski HM, Downey PA, Rause CR, Wister JA. Effect of pelvic-floor muscle exercise position on continence and quality-of-life outcomes in women with stress urinary incontinence. Phys Ther. 2006; 86(7): 974-86. doi: 10.1093/ptj/86.7.974.
Dumoulin C, Hay-Smith EJ, Mac Habée-Séguin G. Pelvic floor muscle training versus no treatment, or inactive control treatments, for urinary incontinence in women. Cochrane Database Syst Rev. 2014(5): CD005654. doi: 10.1002/14651858.CD005654.pub3.
Radziminska A, Straczynska A, Weber-Rajek M, Styczynska H, Strojek K, Piekorz Z. The impact of pelvic floor muscle training on the quality of life of women with urinary incontinence: a systematic literature review. Clin Interv Aging. 2018; 13: 957-65. doi: 10.2147/CIA.S160057.
Price N, Dawood R, Jackson SR. Pelvic floor exercise for urinary incontinence: a systematic literature review. Maturitas. 2010; 67(4): 309-15. doi:10.1016/j.maturitas.2010.08.004.tas.
Syan R, Brucker BM. Guideline of guidelines: urinary incontinence. BJU Int. 2016; 117(1): 20-33. doi: 10.1111/bju.13187.
Bø K, Hilde G. Does it work in the long term?—A systematic review on pelvic floor muscle training for female stress urinary incontinence. Neurourol Urodyn. 2013; 32(3): 215-23. doi: 10.1002/nau.22292.
Holley RL, Varner RE, Kerns DJ, Mestecky PJ. Long-term failure of pelvic floor musculature exercises in treatment of genuine stress incontinence. South Med J. 1995; 88(5): 547-9. doi: 10.1097/00007611-199505000-00008.
Venegas M, Carrasco B, Casas-Cordero R. Factors influencing long-term adherence to pelvic floor exercises in women with urinary incontinence. Neurourol Urodyn. 2018; 37(3): 1120-7. doi: 10.1002/nau.23432.
Chattrakulchai K, Manonai J, Silpakit C, Wattanayingcharoenchai R. Validation of the Thai version of the International Consultation on Incontinence Questionnaire-Female Lower Urinary Tract Symptoms (ICIQ-FLUTS). Int Urogynecol J. 2020; 31(12): 2603-10. doi: 10.1007/s00192-020-04422-1.
Kochakarn W, Pummangura N, Kijvikai K, Viseshsindh W, Sukying C, Lertsithichai P. Reliability of a Thai version of King's Health Questionnaire in Thai females with overactive bladder symptoms. J Med Assoc Thai. 2005; 88(11): 1526-34.
Hebbar S, Pandey H, Chawla A. Understanding King's Health Questionnaire (KHQ) in assessment of female urinary incontinence. Int J Res Med Sci. 2015; 3: 531-8. doi:10.5455/2320-6012.ijrms20150301.
Luginbuehl H, Baeyens J-P, Taeymans J, Maeder I-M, Kuhn A, Radlinger L. Pelvic floor muscle activation and strength components influencing female urinary continence and stress incontinence: a systematic review. Neurourol Urodyn. 2015; 34(6): 498-506. doi: 10.1002/nau.22612.
Wu C, Sun T, Guan X, Wang K. Predicting delay to treatment of urinary incontinence among urban community-dwelling women in China. Int J Nur Sci. 2015; 2(1): 34-8. doi: 10.1016/j.ijnss.2015.01.015.
Cacciari LP, Dumoulin C, Hay-Smith EJ. Pelvic floor muscle training versus no treatment, or inactive control treatments, for urinary incontinence in women: a Cochrane systematic review abridged republication. Braz J Phys Ther. 2019; 23(2): 93-107. doi: 10.1016/j.bjpt.2019.01.002.
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. 2015; 34(4): 300-8. doi: 10.1002/nau.22700.
Sherburn M, Bird M, Carey M, Bø K, Galea MP. Incontinence improves in older women after intensive pelvic floor muscle training: an assessor-blinded randomized controlled trial. Neurourol Urodyn. 2011; 30(3): 317-24. doi: 10.1002/nau.20968.
Sjöström M, Umefjord G, Stenlund H, Carlbring P, Andersson G, Samuelsson E. Internet-based treatment of stress urinary incontinence: 1- and 2-year results of a randomized controlled trial with a focus on pelvic floor muscle training. BJU Int. 2015; 116(6): 955-64. doi: 10.1111/bju.13091.
Wein AJ. Re: Incontinence improves in older women after intensive pelvic foor muscle training: an assessor-blinded randomized controlled trial. J Urol. 2012; 188(4): 1232-9.
Pereira VS, de Melo MV, Correia GN, Driusso P. Vaginal cone for postmenopausal women with stress urinary incontinence: randomized, controlled trial. Climacteric. 2012; 15(1): 45-51. doi: 10.3109/13697137.2011.593211.
Kenton K, Barber M, Wang L, Hsu Y, Rahn D, Whitcomb E, et al. Pelvic floor symptoms improve similarly after pessary and behavioral treatment for stress incontinence. Female Pelvic Med Reconstr Surg. 2012; 18(2): 118-21. doi: 10.1097/SPV.0b013e31824a021d.
McLean L, Varette K, Gentilcore-Saulnier E, Harvey MA, Baker K, Sauerbrei E. Pelvic floor muscle training in women with stress urinary incontinence causes hypertrophy of the urethral sphincters and reduces bladder neck mobility during coughing. Neurourol Urodyn. 2013; 32(8): 1096-102. doi: 10.1002/nau.22343.
Hersh L, Salzman B. Clinical management of urinary incontinence in women. Am Fam Physician. 2013; 87(9): 634-40.
Hu JS, Pierre EF. Urinary incontinence in women: evaluation and management. Am Fam Physician. 2019; 100(6): 339-48.
Hensangvilai K, Pirunsan U, Snow WM. Effects of pelvic floor exercises on the quality of life in incontinent women. J Assoc Med Sci. 2017; 50(2): 209-16. doi: 10.14456/jams.2017.20.
Paiva LL, Ferla L, Darski C, Catarino BM, Ramos JG. Pelvic floor muscle training in groups versus individual or home treatment of women with urinary incontinence: systematic review and meta-analysis. Int Urogynecol J. 2017; 28(3): 351-9. doi: 10.1007/s00192-016-3133-2.
Mesas AE, LóPez-GarcíA E, RodríGuez-Artalejo F. Self-reported sleep duration and falls in older adults. J Sleep Res. 2011; 20(1 pt 1): 21-7. doi: 10.1111/j.1365-2869.2010.00867.x.
Brown JS, Vittinghoff E, Wyman JF, Stone KL, Nevitt MC, Ensrud KE, et al. Urinary incontinence: does it increase risk for falls and fractures? Study of Osteoporotic Fractures Research Group. J Am Geriatr Soc. 2000; 48(7): 721-5. doi: 10.1111/j.1532-5415.2000.tb04744.x.