McIntosh L J, Frahm J D, Mallett V T, Richardson D A
Department of Obstetrics and Gynecology, Wayne State University/Hutzel Hospital, Detroit, Michigan 48201.
J Reprod Med. 1993 Sep;38(9):662-6.
This study assessed the effectiveness of a pelvic floor rehabilitation program in a clinical practice. A retrospective convenience sample of 48 women was evaluated pretreatment and posttreatment with follow-up interviews from six months to three years. This group consisted of 81% with stress urinary incontinence, 6% with unstable bladder and 10% with mixed incontinence. Fecal incontinence was present as well in 35% of the subjects. The patients were taught pelvic floor muscle exercises and instruction reinforced with electromyographic biofeedback. Neuromuscular electrical stimulation was used when clinically indicated. Two women did not continue the program beyond the first visit and were excluded. Sixty-two percent of patients with two or more visits demonstrated an improvement. Thirteen percent were completely dry, and 49% demonstrated a significant improvement. Patients with genuine stress urinary incontinence, unstable bladder and mixed incontinence showed a 66%, 33% and 50% improvement rate, respectively. Fecal incontinence was improved in 63% of women trained in pelvic floor muscle exercises. A significant decrease (P < .001) was found in the frequency of self-reported leakage at the six-month to three-year follow-up. The strength and duration of a pelvic muscle contraction was significantly greater between the first and last visit in all patients, regardless of the subjective improvement. A pelvic floor rehabilitation program was an effective alternative to surgical intervention in reducing the frequency of urinary leakage. Further studies are needed to identify factors predicting success and to determine the most cost-effective method of achieving pelvic floor rehabilitation.
本研究评估了盆底康复计划在临床实践中的有效性。对48名女性进行回顾性便利抽样，在治疗前和治疗后进行评估，并进行了6个月至3年的随访访谈。该组中81%为压力性尿失禁患者，6%为膀胱不稳定患者，10%为混合性尿失禁患者。35%的受试者还存在大便失禁。向患者教授盆底肌肉锻炼，并通过肌电图生物反馈加强指导。在临床指征明确时使用神经肌肉电刺激。两名女性在首次就诊后未继续该计划，被排除在外。进行了两次或更多次就诊的患者中有62%病情有所改善。13%的患者完全不再漏尿，49%的患者有显著改善。真性压力性尿失禁、膀胱不稳定和混合性尿失禁患者的改善率分别为66%、33%和50%。接受盆底肌肉锻炼训练的女性中，63%的大便失禁情况有所改善。在6个月至3年的随访中，自我报告的漏尿频率显著降低（P <.001）。无论主观改善情况如何，所有患者首次就诊和最后一次就诊时盆底肌肉收缩的强度和持续时间均显著增加。盆底康复计划是减少尿失禁频率的一种有效的手术干预替代方法。需要进一步研究以确定预测成功的因素，并确定实现盆底康复的最具成本效益的方法。
