TDNet Discover

Background: Stress urinary incontinence (SUI) is defined as the involuntary loss of urine, and often occurs during activity, sneezing, and laughing. It is 1 of the 5 different types of urinary incontinence (UI) and commonly affects parous females. The exact mechanism of injury is unknown, but it is believed that injury may occur due to compression, stretching, or tearing of nerve, muscle, or tissue. The pelvic floor provides support to the pelvic organs and female urethra and allows the ability to contract and relax the sphincter involved with urination. Currently, pelvic floor muscle therapy (PFMT) is suggested as the first line treatment to decrease symptoms. Purpose: To determine if PFMT is beneficial in treating UI in parous women by performing an evidence-based review of current literature. Methods: An evidence-based literature review was completed to address the efficacy of PFMT in treating SUI in parous females. EBSCO, Cochrane, and PubMed databases were searched for relevant articles using the terms “postpartum and physical therapy of urinary incontinence”, “urinary incontinence AND PFMT AND postpartum”, “pelvic floor therapy and urinary incontinence treatment.” Limits included peer reviewed articles that were published in the last 10 years, and classified as a meta-analysis, randomized controlled trial, or systematic review, with access to full text. Study population had to include pregnant females, those who have previously given birth, over the age of 18, and had symptoms of urinary incontinence during pregnancy or after birth. Men, and women under 18 were excluded from the study. After review of relevance, data extraction, and quality assessment, 5 total studies were selected by the 3 independent researchers. iii Results: Three randomized controlled trials, and 2 systematic reviews were selected for this review. The study population was females who had SUI during their current pregnancy, or as a result of a previous pregnancy. Four of the articles discovered PFMT was beneficial in the shortterm treatment of UI, and found lack of evidence to support use in long term treatment. One systematic review found there was no evidence PFMT led to a decrease in UI. Conclusion: PFMT is recommended as a first line therapy for UI in postpartum women and there is no evidence to support changing these guidelines currently. Review of the literature reveals lower incidence of urinary incontinence in the intervention group that performed PFMT compared to the control group. However, UI in pregnant and PP women is a difficult population to study due to the variation in pregnancy, patients, symptoms with increased parity, and lack of standard protocol between each study. More research must be conducted with better research methods to determine the long-term effects of PFMT, effect on variation of parity, when is the most appropriate time to start therapy, and which specific regimen of exercises is most beneficial to decrease UI in these patients.