Effects of treatment of urinary incontinence in women: Exercise or electrical stimulation or both
The effectiveness of electrical stimulation for treatment of urge incontinence versus stress incontinence is still uncertain because of research design flaws. The purposes of this study were to determine (a) whether exercise with electrical stimulation was an effective treatment for women with incontinence, and (b) whether treatment effectiveness varied between women with urge incontinence, versus women with stress incontinence. Sixty three women were assigned to either stress incontinence (n = 41) or urge incontinence (n = 22) for the study, 34 completing in the stress group and 13 in the urge group, (n = 47). Participants were randomized into 3 treatment groups, exercise with electrical stimulation, exercise alone, and no treatment. Forty women were Caucasian, 1 was African-American, aged 23 and 78, with Body Mass Index (BMI) between 17.7 and 50 and had at least 3 leaks in a 3 day period. Variables included manual muscle testing, pelvic floor strength in centimeters water pressure, contraction time, participants' self-reported incontinence leaks over 3 days, frequency of urination over 3 days, and quality of life as measured by the York Incontinence Perception Scale (YIPS). Participants completed an IRB permission form, the Medical, Epidemiological, and Social Aspects of Aging (MESA) questionnaire to determine type of incontinence, stress or urge, and the YIPS on the 1st visit and received an educational session and were randomized on the 2 nd visit. Those randomized into the treatment groups received treatment consisting of 15 sessions of treatment on a 2x a week basis. Participants who were randomized as “controls” and returned in 8 weeks for re-measurement of the same variables as on the first two visits and were then offered treatment. The 2 treatment groups were also remeasured at the end of 16 sessions. The 2 treatment groups performed 3 trunk muscle exercises and 3 pelvic floor muscle exercises, and performed them independently on a daily basis. Those in the exercise with electrical stimulation group additionally received 30 minutes of electrical stimulation with the Liberty stimulator at 12.5 Hz on each visit. Two dependent variables were eliminated as the manual muscle test correlated with perineometer scores and the endurance factor for seconds held for pelvic floor contraction was capped at 10. Leaks were eliminated at pre-treatment for lack of homogeneity. Therefore, further analysis for the remaining 3 variables was within and between treatment groups for only the stress incontinence group (n = 34). Significance for pelvic floor strength (P = .002) and the YIPS scores ( P = .001) was demonstrated for stress incontinence in both exercise with electrical stimulation and exercise alone groups. No changes were noted in the control group in either the pelvic floor strength (P = .505) or YIPS (P = 1.00). The decrease in visits to the bathroom (frequency) was not significant for the whole group, but 14 of 17 with frequency, experienced improvement. Analysis of the urge incontinence either within or between groups would have been meaningless because of the low numbers in that diagnostic group. This study demonstrated effective treatment with 6 simple exercises, increasing pelvic floor muscle strength and self-perception in control of incontinence in 34 stress incontinent women. Application of electrical stimulation in addition to exercise gave no additional benefit to women with stress incontinence. The study continues until a sufficient number of participants will allow statistical analysis to determine if electrical added to the exercise program makes a significant difference for urge incontinence.