The effectiveness of pelvic  oor exercises on symptoms

in females with stress urinary incontinence

Nitesh Malhotra

* and Aksh Chahal

Ph.D Scholar, Department of Physiotherapy, Shri Jagdishprasad Jhabarmal Tibrewala University, Churela,

Rajasthan 333001

Department of Physiotherapy, Shri Jagdishprasad Jhabarmal Tibrewala University, Churela, Rajasthan

333001 India

ABSTRACT

The aim of the present investigation is to depict the interventions of pelvic  oor exercises in urinary incontinence. The

present study deals with the employment of pelvic  oor exercises in subjects of varying age group from 30-60 years.

Tools employed for the study are B-SAQ validation, the Bladder Control Self-Assessment Questionnaire (B-SAQ) and

1 Hr pad test which was working as outcome measure. The study was designed to investigate the effect of pelvic  oor

exercises on symptoms and botherness caused by urinary incontinence and achieving continence level was marked

through pad test. Results con rmed that there was a signi cant improvement in the symptoms scores of experimental

group in which pelvic  oor muscles were employed in contrast with the control group. Pelvic  oor muscles should be

done under the supervision of physiotherapist as geriatric population needs some external support in order to complete

the pelvic  oor exercise protocol.

681

Medical

Communication

Biosci. Biotech. Res. Comm. 11(4): 681-686 (2018)

INTRODUCTION

Urinary incontinence is commonest problem in old age

affecting social, psychological and physical daily activi-

ties. The most prevalent urinary incontinence amongst

females is Stress urinary incontinence especially at

the age between 30-60 years. Generally it is believed

these reduced in muscle strength of urethra and muscle

around the sphincter is responsible for causing inconti-

nence. The intension of doing pelvic  oor exercises is

to increase maximal urethral pressure and also increase

in re ex contractions sphincteric unit which can sus-

tain the rise in the intraabdominal pressure. Pelvic  oor

muscle training exercises is the recognized and preferred

ARTICLE INFORMATION:

Corresponding Authors: malhotra.nitesh@gmail.com,

aksh.chahal@gmail.com

Received 12

Aug, 2018

Accepted after revision 21

Nov, 2018

BBRC Print ISSN: 0974-6455

Online ISSN: 2321-4007 CODEN: USA BBRCBA

Thomson Reuters ISI ESC / Clarivate Analytics USA

Mono of Clarivate Analytics and Crossref Indexed

Journal Mono of CR

NAAS Journal Score 2018: 4.31 SJIF 2017: 4.196

Online Contents Available at: http//www.bbrc.in/

DOI: 10.21786/bbrc/11.4/19

Nitesh Malhotra and Aksh Chahal

682 THE EFFECTIVENESS OF PELVIC FLOOR EXERCISES ON SYMPTOMS IN FEMALES BIOSCIENCE BIOTECHNOLOGY RESEARCH COMMUNICATIONS

conservative treatment for urinary incontinence, (Saps-

ford et al. 2001, Ferreira et al. 2004, Sinclair et al. 2011,

Kılıcin et al. 2016 and Aarthi et al., 2018).

Exercises for pelvic  oor were introduced in 1948 by

Kegel, till date many randomized controlled studies and

systematic reviews have supported the ef cacy of these

exercises, (Cavkaytar et al. 2014). Many researchers

have reported that more than 68.4% of the women suf-

fered from SUI while 41.2% of the women reported with

mixed urinary incontinence, both showed improvement

after 8 weeks of Kegel’s exercises. The incidence of uri-

nary incontinence in female subjects in a Turkish com-

munity was determined and stress urinary incontinence

was found to be higher i.e. 33.7 % than any other type

of incontinences in females of different age groups. This

was explained through observational studies, based on

questionnaires, where it was found that out of total of

192 subjects having incontinence, 45.5% had stress uri-

nary incontinence (SUI), 19.8 % had urge urinary incon-

tinence and 34.6% had mixed incontinence (Bhanupriya

et al. 2015 and Kılıcin et al. 2016).

In the previous studies as explained with different

outcome measures and exercise protocols including

other intervention to enhance the muscle contraction

like biofeedback, duration and number of contraction

per day can also be a cause for difference in results

output. Therefore pelvic  oor exercises are accepted as

an ef cient intervention for SUI, many queries related

to protocol adapted are still not yet explained. Other

adjunct treatment like interferential therapies did not

prove bene cial over pelvic  oor exercises in SUI as

recently reported by Aarthi et al. 2018).

For application of a competent treatment concern

should be not only towards the pathology but also

towards the social, socio-economical status and emo-

tional aspect. Earlier surgical intervention was usually

considered as foremost choice of treatment, last few

years inclination towards conservative treatment has

increased. As per the opinion from The International

Continence Society, conservative treatment should be

the  rst choice in incontinent patients (Dumoulin et al.

2016).

Researchers also employed different type of exer-

cises protocol for primiparous women and their sexual

ef cacy by employing 8 weeks of pelvic  oor exercises

and found improvement in the outcome measure and

strength of pelvic  oor muscles (Luginbuehl et al. 2015,

Malhotra et al 2018). Aforementioned studies employed

for Pelvic  oor exercises combination with additional

treatment but there is limited study on the age group 30

– 60 years of ages. Therefore, there is need to determine

that whether the stress urinary incontinence can alone

be treated with PFMT on different age groups. The aim

of the study is to evaluate the effectiveness of pelvic

 oor muscle exercise in female subjects with different

age groups having stress urinary incontinence

MATERIAL AND METHODS

The 42 female subjects between the ages of 30-60 were

included in the study and were divided into two groups,

Control (Group A) & Experimental (Group B) and. The

study was performed at RLJT Hospital & Research Cen-

tre, Jhunjhunu. The group allocation was done blinded

through randomly and data acquisition, data reduction,

data analysis was been blinded, the demographic data

of name, age, height weight and BMI were recorded

subjects present with stress urinary incontinence based

on patients history ,both parous and nulliparous , pre

and post menopausal and hemodynamicaly stable and

physically  t for therapeutic exercises these subjects

who were included in study, subjects having any his-

tory of organ prolapse ,suffering from vaginal or urinary

tract infection, tumors or infectious disease or under

some kind of medications affecting incontinence were

excluded. Total study period was for 8 weeks, readings

were taken at baseline, on 4

week and 8

week of the

study. Experimental groups were asked to come are to

come every weekends and perform the exercise and fol-

low up while control group B were only explained the

exercises. Also both groups were asked to follow up on

and 8

weeks.

B-SAQ validation, the Bladder Control Self-Assess-

ment Questionnaire (B-SAQ) and 1 Hr pad test was

employed as outcome measure, following the method of

Sahai et al (2014). The B-SAQ contained 8- questions

that assessed the symptoms such as number of times a

patient is required to void, dif culty in holding urine,

nocturia and urine leaks, for which there were associ-

ated scores. Responses to both were scored on a 4-point

Likert scale. Total of both the score can give a signi cant

illustration of patients to seek help or medical advice.

1 hour pad test: the test was performed on all the

female subjects, where they were given pre-weighed

pads and were asked to wear the same, few subjects

were requested to wear two pads due to increased symp-

toms of incontinence. All subjects were asked to drink

500 ml of plain water at room temperature in 15 min-

utes of span, following which they asked to conduct

certain activities like simple walking, climbing up and

down a  ight of stairs, standing up-down from sitting

(10 times), cough vigorously (10 times), on spot jog for

1 minute, pick up objects with bending (5 times) and

washing hands in running water (1 minute). All patients

were strictly asked not to void their bladder for 1 hour

and later the pads were weighed, for which the calcula-

tions were done on the basis of pad weight in grams i.e.

Nitesh Malhotra and Aksh Chahal

BIOSCIENCE BIOTECHNOLOGY RESEARCH COMMUNICATIONS THE EFFECTIVENESS OF PELVIC FLOOR EXERCISES ON SYMPTOMS IN FEMALES 683

1-10 gms signi ed mild incontinence, 11 to 50 gms sig-

ni ed moderate and more than 50 gms indicated severe

incontinence respectively.

Patients were explained about the anatomy and phys-

iology of pelvic  oor muscle a group class was conducted

for both the groups on another day was an live demon-

stration video to explain how to perform the exercises in

the protocol, also exercises in three different position i.e.

Lying, sitting and standing an muscle contraction and

stopping while passing the urine For experimental group

the patients were explained and asked to perform correct

pelvic  oor muscle exercise in three different positions:

Lying down supine with one pillow below the hips, sit-

ting on chair and standing with legs both slightly kept

apart. Patients were asked to perform exercises in lying

position for  rst two weeks 10- 15 repetition. Contract-

ing the muscle with a hold of 2-4 seconds of hold in

each contraction without holding breath they were also

asked to perform 2-3 sets per , with minimum of 20-30

contractions in a day. At 3

and 4

week there was an

addition of sitting position, number of set remained the

same, by increasing the number of repetition to 30-40

in each set and 60-120 contractions over all through-

out the day. Remaining 4 weeks, the protocol was added

with an additional position of standing and keeping the

number of sets as constant, the contraction per set was

increased to 50-60 per set and minimal number of con-

tractions per day ranged from 150 to 180. Telephonic

and message reminders were sent on phone to encour-

age the subjects twice a week and queries were noted

down and answered either on telephone or during the

follow up visits.

RESULTS AND DISCUSSION

The data analysis was done with help of SPSS software

version 19 was applied , To isolate the variable that dif-

fer from the others Turkey test was applied for multiple

comparison analyze the mean and standard deviation

within group and ANOVAs test were applied to calcu-

late the difference between groups. Forty subjects were

included in the study having a mean age of 46.05±6.04

and were divided in experimental and 41.15±7.12 in

control group. The mean height in respective groups

were 162±6.69 cm and 58.55±5.09 cm, mean weight was

64±6.50 and 67.3±5.54 in kg, The mean BMI was also

calculated as 25.23±2.44 and 24.63±2.13 respectively

for experimental and control group.

Amongst the 42 participant in the study, 2 women

could not complete the study there was no signi cant

difference seen in Group A (Control) before treatment

and after treatment, but there was a statistical difference

seen amongst Group B (Experimental Group) subjects at

4th week and 8

week of treatment.

As shown in  gure I, the pad test demonstrates the

signi cant improvement at 4

and 8

week for patient

who was engaged in exercises and with regular follow-

ups Group B, there was an improvement seen in the pad

test performed for women in control group (Group A)

but was not statistically signi cant.

Explaining through  gure 1 & table 2 there was no

signi cant difference found in between baseline data

and 4

week and at end of 8

week in Group A (Control

group), similarly when compared within intergroups as

explained through table 3, there was a signi cant dif-

FIGURE 1. Illustrates about the mean and standard deviation difference in the score in Pad test

Nitesh Malhotra and Aksh Chahal

684 THE EFFECTIVENESS OF PELVIC FLOOR EXERCISES ON SYMPTOMS IN FEMALES BIOSCIENCE BIOTECHNOLOGY RESEARCH COMMUNICATIONS

Table 1. Illustrates the mean and standard deviations

in demographic data.

Characteristics Group A Group B

Age (Mean ± SD) 41.15±7.12 46.05±6.04

Height (In cm) (Mean ± SD) 158.55±5.09 162±6.69

Weight(In kg) (Mean ± SD) 67.3±5.54 64±6.50

BMI (Mean ± SD) 24.63±2.13 25.23±2.44

FIGURE 2. Explains about the mean and standard deviation difference in the symptom score in

B-SAQ

Table 2. As explained in the above table comparison illustrates the

pad test day 1 proved to be statistically signi cant for 4th week

and 8th week

Statistics Control group Experimental group

Day 1 Median (Q1,Q3) 17(15, 18) 19(13, 23)

week Median (Q1,Q3) 11(9,13) 8(7,9) ,@

week Median (Q1,Q3) 5(3,27) 1(0,1.75) ,,#

Q1:  rst quartile, Q3: third quartile

. Statistically signi cant (p <0.001) reductions at 4th week and 8th week compared

to Day 1 in patients with Experimental group

. Statistically signi cant (p <0.001) reduction from week 4th to 8th week in patients

with Experimental group

@. Statistically signi cant (p <0.001) differences in mean pad test scores between

Control group & Experimental group regimes at 4th week

#. Statistically signi cant (p <0.001) differences in mean pad test scores between

conventional and advance physiotherapy regimes at 8th week

ference seen in pad test results for experimental groups,

bringing the P at signi cant value of <0.001.

Explaining through  gure 2 the result signi es that

symptoms score of B-SAQ were signi cantly improved

from day 1 4

week and at 8

for group B week but

there no signi cant improvement in the scores for con-

trol group,  gure 3 explains about the bothers score in

B-SAQ in shows neither the experimental group nor the

control group brings a signi cant change.

The pelvic  oor muscles constitute the core muscles

of the pelvis; the study was designed to investigate the

effect of pelvic  oor exercises on symptoms and bother-

Nitesh Malhotra and Aksh Chahal

BIOSCIENCE BIOTECHNOLOGY RESEARCH COMMUNICATIONS THE EFFECTIVENESS OF PELVIC FLOOR EXERCISES ON SYMPTOMS IN FEMALES 685

FIGURE 3. Explains about the mean and standard deviation difference in the bother score in

B-SAQ

ness caused by urinary incontinence and achieving con-

tinence level were marked through pad test. There was

a signi cant improvement in the symptoms scores of

experimental group in contrast with the control group.

The bother score when compared in both the groups at

baseline and 4

week there was no statistical signi -

cant difference seen. The present study showed a signi -

cant decrease in symptoms and levels of incontinence,

also there was an improvement reduction in frequency,

urgency and nocturia in experimental group when

compared to the control group in a 12 weeks protocol.

Supervised protocol for pelvic  oor exercises proved

to be a most effective method for improvement in the

symptoms in urinary incontinence. In a study by Sha-

ron et al. (2010), it has been explained that this sever-

ity impacted the quality of life it was found that 30

% of female subjects and 18% of male subjects were

reported with micturition dribbling and severity from

mild to moderate, also female were more affected than

men associated with other variable representing increase

in the micturition dribble .this study showed that the

increase in symptoms were disturbing quality of life. A

signi cant improvement was seen in quality of life and

self esteem frequency of urination and amount of urine,

(Johromi et al. 2014).

In a study performed by Ali et al. (2011) the effect of

Kegels exercises on women aged between 25-54 years

suffering from urinary incontinence was carried out, it

was found that the average score before administering

the exercises was 53.15 and after the treatment there was

a signi cant improvement to 73.82, bringing the signi -

cant level to p=0.0001. A study performed by another

researcher on 30 patients affected with urinary inconti-

nence in Imam Reza and Gharazi hospital at Sirjan city

Iran with a aim to investigate the effect of kegels exer-

cises on incontinent female subject for 3 month showed

Table 3. Illustrates the mean and standard deviation questionnaire

at different time interval for both control and experimental group

Source of Variation DF SS MS F P

Between Subjects 19 59.500 3.132

Between Treatments 5 1254.367 250.873 230.716 <0.001

Residual 95 103.300 1.087

Total 119 1417.167 11.909

Nitesh Malhotra and Aksh Chahal

686 THE EFFECTIVENESS OF PELVIC FLOOR EXERCISES ON SYMPTOMS IN FEMALES BIOSCIENCE BIOTECHNOLOGY RESEARCH COMMUNICATIONS

a signi cant improvement in reduction frequency of uri-

nation and was lessened by 30 % concluded that kegels

exercises can become a suitable method to treat urinary

incontinence, (Baba et al. 2006). Through the present

study we explain that it is better to do pelvic  oor exer-

cises under supervision of a physiotherapist, learning of

the correct technique of exercises to strengthen the mus-

cle for required results, 2 months of exercises protocol

results in the improving the strength and symptoms.

Limitation of the study : Considering small sample

size dif cult to draw and  rm conclusion Explaining

and recognizing the correct pelvic  oor muscle and

skilled exercises learned by patient as treatment can

result in positive effect but if not can result in negative

effect increasing frequency of urination and dribbling.

CONCLUSION

Pelvic  oor muscle exercises can be considered as an

empowerment methods for improvement in the symp-

toms and bother score also improving on pelvic  oor

muscle strength. So it is recommended that these types

of exercising protocol can be utilized in improving the

strength and quality of life in patient suffering from

incontinence

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