Sharma Kiran, Gupta Meena, Parasher Raju K, Chawla Jasmine Kaur
Physiotherapy, Amity Institute of Health Allied Sciences, Noida, IND.
Physical Medicine and Rehabilitation, Venkateshwar Hospital, New Delhi, IND.
Cureus. 2023 Dec 15;15(12):e50551. doi: 10.7759/cureus.50551. eCollection 2023 Dec.
Background and objective Stress urinary incontinence (SUI) is a prevalent condition affecting women of various age groups, significantly impacting their quality of life. To address this multifaceted issue, a comprehensive approach that goes beyond traditional pelvic floor exercises is needed. Dynamic neuromuscular stabilization (DNS) exercises, targeting the integrated spinal stabilization system, offer a promising alternative. Thus, this study aimed to compare the effectiveness of DNS exercises and Kegel exercises in managing SUI among women. Methods This single-blinded, pilot study involved 24 women aged 18-40 years with mild to moderate SUI. Participants were divided into DNS and Kegel exercise groups. Outcome measures included perineometer readings, electromyography (EMG) data, and the Urogenital Distress Inventory-6 (UDI-6). Statistical analysis compared baseline and 12-week data within and between groups, and rank-biserial correlation coefficient (r) as a measure of effect size in our study was calculated. Results At 12 weeks, the DNS group showed significant improvement in pelvic floor muscle strength compared to Kegel exercises (p = 0.005). Both groups had significantly enhanced pelvic floor muscle strength (p < 0.05). A significant change occurred for EMG average, EMG peak, and EMG maximum voluntary contraction (MVC) at 12 weeks (average p = 0.005; peak p = 0.001; MVC p = 0.009), with significant improvements in both groups (p < 0.05). For UDI-6, a significant difference emerged between the two groups at 12 weeks (p < 0.05), with significant improvements in both groups individually from baseline to 12 weeks (p < 0.05). The effect size "r" for all variables indicated a medium to large effect size, underscoring the substantial and significant impact of DNS exercises in managing SUI among women compared to Kegel exercises. Conclusion This study suggests that DNS exercises, emphasizing the coordinated activation of the diaphragm, abdominals, multifidus, and pelvic floor, may provide a more effective approach for managing SUI in women compared to traditional Kegel exercises.
背景与目的 压力性尿失禁（SUI）是一种普遍存在的疾病，影响着各个年龄段的女性，严重影响她们的生活质量。为解决这一复杂问题，需要一种超越传统盆底肌锻炼的综合方法。针对整合脊柱稳定系统的动态神经肌肉稳定（DNS）锻炼提供了一种有前景的替代方案。因此，本研究旨在比较DNS锻炼和凯格尔运动在女性压力性尿失禁管理中的有效性。方法 这项单盲试点研究纳入了24名年龄在18至40岁之间、患有轻度至中度压力性尿失禁的女性。参与者被分为DNS锻炼组和凯格尔运动组。结果指标包括会阴张力计读数、肌电图（EMG）数据以及泌尿生殖系统困扰量表-6（UDI-6）。统计分析比较了组内和组间的基线数据与12周的数据，并计算了等级双列相关系数（r）作为本研究中效应大小的度量。结果 在12周时，与凯格尔运动相比，DNS组的盆底肌力量有显著改善（p = 0.005）。两组的盆底肌力量均有显著增强（p < 0.05）。12周时，EMG平均值、EMG峰值和EMG最大自主收缩（MVC）发生了显著变化（平均值p = 0.005；峰值p = 0.001；MVC p = 0.009），两组均有显著改善（p < 0.05）。对于UDI-6，两组在12周时出现显著差异（p < 0.05），两组从基线到12周均有显著改善（p < 0.05）。所有变量的效应大小“r”表明为中等到大的效应大小，强调了与凯格尔运动相比，DNS锻炼在女性压力性尿失禁管理中的实质性和显著影响。结论 本研究表明，强调膈肌、腹部、多裂肌和盆底肌协调激活的DNS锻炼，与传统的凯格尔运动相比，可能为女性压力性尿失禁的管理提供一种更有效的方法。
