Saturday, April 19, 2014

Does It Work in the Long Term?—A Systematic Review on Pelvic Floor Muscle Training for Female Stress Urinary Incontinence

BØ K and Hilde G: Neurol and Urodynam 32:215-223 (2013)

Ann Dunbar PT, DPT, MS, WCS
April 9, 2014

Primary Aim:  To present long-term results of pelvic floor muscle training (PFMT) with or without biofeedback on stress urinary incontinence (SUI) and mixed urinary incontinence (MUI) with predominant SUI symptoms (including both RCTs and pre- and post-evaluation studies)

Study Design:  Systematic Review


  • Inclusion criteria: Pre-and post-test design, non-RCT and RCT’s using PFMT with or without biofeedback to treat SUI and SUI predominant MUI
  • Authors completed a computerized search on PubMed
    1. Pelvic floor AND (training OR exercise OR physical  activity)AND (urinary incontinence  OR stress urinary incontinence) AND (follow-up OR long-term)
    2. Limits: humans, female, clinical trial, English, only adult subjects

Proof of concept: differential effects of Valsalva and straining maneuvers on the pelvic floor

Talasz H, Kremser C, Kofler M, Kalchschmid E, Lechleitner M, Rudisch A:  Eur J Obstet Gynec and Repord Biology 164(2012) 227-233

Ann Dunbar PT, DPT, MS, WCS
April 9, 2014

Introduction: History of Valsalva Maneuver (VM): 

  • Named after physician (Antonio Maria Valsalva 1666-1723) whose main interest was in studying the ear. He described use of forceful inflation of air from the oro-nasopharyngeal cavity into Eustachian tubes and then into middle ear with closed mouth and nostrils. Over time, VM became widely used  in medicine including otorhinology, internal medicine (see article for details), and OB/GYN (to assess urinary incontinence, pelvic organ prolapse, to aid diagnosis of intrinsic sphincter deficiency in urodynamic testing, to demonstrate maximum impact of IAP on pelvic organ descent.
  • More recently, an article published in 2006, reported on current understanding of VM which demonstrated variance from its original definition thus presenting confusion between 2 different maneuvers.