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Paradoxical Findings in the Treatment of Predominant Stress and Urge Incontinence: A Pilot Study With Exercise and Electrical Stimulation

Firra, Joan PT, PhD1; Thompson, Mary PT, PhD, GCS2; Smith, Susan S. PT, PhD3

Journal of Women's Health Physical Therapy: September/December 2013 - Volume 37 - Issue 3 - p 113–123
doi: 10.1097/JWH.0000000000000003
Research Reports

Objective: To determine whether women with predominantly urge urinary incontinence (UI) would show greater gains from adding 12.5-Hz electrical stimulation to a progressive exercise program whereas those with predominantly stress UI would show similar gains from progressive exercise alone.

Study Design: Randomized block design with participants assigned to exercise alone, exercise with electrical stimulation, or control group, blocked on diagnosis (urge UI or stress UI).

Background: Further research needed to address exercise parameters, the role of electrical stimulation, and urinary incontinence type.

Methods and Measures: Sixty-four women, 38 with stress UI and 26 with urge UI, were randomized into groups; 42 completed the study. Outcome measures were quality of life, pelvic muscle strength, leaks, and urination frequency. Exercise group performed 6 pelvic floor and abdominal exercises progressed over 8 weeks. Electrical stimulation was added to the progressive exercises for the exercise with electrical stimulation group. Percent change in pretreatment and posttreatment outcome measures were calculated for each treatment group by diagnosis.

Results: For women with either stress UI or urge UI, controls worsened and treatment groups improved. For women with stress UI, the greatest gains (57.8%–119.8%) were made by the exercise with electrical stimulation group (P < .001). For women with urge UI, the greatest gains (78.7%-155.1%) were made by the exercise-alone group (P < .01).

Conclusions: Our exercise protocol appears to be of sufficient frequency, duration, intensity, and mode to be effective in improving outcomes and may inhibit the detrusor muscle in persons with urge UI. The addition of electrical stimulation appears most useful for muscle reeducation in women with weak pelvic floor muscles.

1Firra Therapeutics, Dallas, Texas.

2School of Physical Therapy, Texas Woman's University, Dallas.

3College of Nursing & Health Professions, Drexel University, Philadelphia, Pennsylvania.

This study was funded in part by the Texas Physical Therapy Foundation.

The authors declare no conflicts of interest.

Copyright © 2013 by the Section on Women's Health, American Physical Therapy Association.
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