Department of Physiotherapy, University College of Northern Denmark, Aalborg, Denmark.
Department of Elderly and Disability, Aalborg Municipality, Aalborg, Denmark.
J Bodyw Mov Ther. 2021 Oct;28:34-41. doi: 10.1016/j.jbmt.2021.07.032. Epub 2021 Aug 8.
Pelvic floor exercises combined with patient education has shown to be a promising intervention for women suffering from urinary incontinence. This pilot study investigated the effect of patient education combined with group or individualised pelvic floor exercises, or individualised pelvic floor exercises with ultrasonography guidance.
Thirty-three elderly women with urinary incontinency completed a block-randomised, assessor-blinded study combining patient education with 12-weeks of pelvic floor exercises either group-based or individual with or without ultrasonography guidance. Urinary incontinence symptoms were assessed using the Incontinence Impact Questionnaire-7 (IQ-7) and Urogenital Distress Inventory-6 (UDI-6). Furthermore, daily fluid intake and number of bathroom visits were recorded. Pelvic floor muscle strength was assessed using a manual squeeze test (Oxford Scale, 6-point).
An increase in pelvic floor strength was observed after 12 weeks for both the individual (P = 0.038) and the individual ultrasonography-guided (P = 0.01) exercise groups. However, only the latter group maintained an increased strength at the 24-week follow-up (P = 0.008). Across all groups, the intervention led to a decrease in bathroom visits (P = 0.002) that was maintained at the 24-week follow-up (P < 0.001). The interventions led to a decrease in UDI-6 both after the 12-week intervention (P = 0.009) and at the 24-week follow-up (P = 0.032).
These findings indicate that pelvic floor exercises together with patient education can reduce urogenital distress and bathroom visits without change in fluid intake. Furthermore, when pelvic floor exercises were conducted individually, pelvic floor strength increased, but pelvic floor strength was maintained over time only for individualised pelvic floor exercises with ultrasonography guidance.
盆底肌锻炼结合患者教育已被证明是治疗尿失禁女性的一种很有前途的干预手段。本初步研究调查了结合患者教育的盆底肌锻炼的效果，包括基于群体或个体化的盆底肌锻炼，或个体化的盆底肌锻炼结合超声引导。
33 名患有尿失禁的老年女性完成了一项块随机、评估者盲法研究，将患者教育与 12 周的盆底肌锻炼相结合，这些锻炼可以基于群体或个体化进行，也可以结合或不结合超声引导。尿失禁症状采用失禁影响问卷-7（IQ-7）和尿生殖窘迫问卷-6（UDI-6）进行评估。此外，还记录了每日液体摄入量和去洗手间的次数。盆底肌力量采用手动挤压测试（牛津量表，6 分制）进行评估。
12 周后，个体（P=0.038）和个体超声引导（P=0.01）锻炼组的盆底肌力量均有增加。然而，只有后者组在 24 周随访时保持了增加的力量（P=0.008）。所有组别的干预都导致去洗手间的次数减少（P=0.002），这种减少在 24 周随访时仍然存在（P<0.001）。干预后 12 周（P=0.009）和 24 周随访时（P=0.032），UDI-6 也均有下降。
这些发现表明，盆底肌锻炼结合患者教育可以减少尿生殖窘迫和去洗手间的次数，而不改变液体摄入量。此外，当个体化进行盆底肌锻炼时，盆底肌力量会增加，但只有个体化的盆底肌锻炼结合超声引导才能维持盆底肌力量随时间的变化。
