Physiotherapist-guided pelvic floor muscle training better for urinary incontinence
Friday, 6 June 2008 - Urinary incontinence after radical prostatectomy (RP) is a common problem and may lead to reduced quality of life. Overgard et al. (2008) assessed the effects of guided pelvic floor muscle training on continence status and perceived problems with urinary function after RP.
The authors conducted a randomised controlled trial at St. Olavs Hospital/Trondheim University Hospital in Norway between September 2005 and December 2007. All men with clinically localised prostate cancer who underwent surgery with open RP were invited to participate, until 85 participants were included. Dropout rate was 6%. Two intervention groups (A and B) received instructions in correct pelvic floor muscle contractions and were encouraged to train the pelvic floor muscles. Group A was offered additional follow-up training instructions by a physiotherapist throughout the 1-year period. Primary outcome was continence (0 pads) status, and secondary outcomes were perceived problems with urinary function 6 weeks and 3, 6, and 12 months postoperatively.
No statistically significant difference in continence status between groups was found at 3 months; 46% were continent in group A versus 43% in group B (p=0.73). In group A, 97% reported no or only mild problems with urinary function compared to 78% in group B (p=0.010). After 6 months there was a clinically relevant difference in continence status between groups: 79% were continent in group A and 58% in group B (p=0.061). Twelve months postsurgery the difference was clinically and statistically significant (p=0.028) in favour of group A; 92% were continent in group A and 72% in group B.
In conclusion, continence rates were similar 3 months after RP in groups performing intensive pelvic floor muscle training with or without follow-up instructions by a physiotherapist. However, in the following period up to 1 year, the group receiving physiotherapist-guided training reduced urinary incontinence significantly more compared to patients training on their own.
Overgard, M., Angelsen, A., Lydersen, S., & Morkved, S. (2008). Does Physiotherapist-Guided Pelvic Floor Muscle Training Reduce Urinary Incontinence After Radical Prostatectomy? A Randomised Controlled Trial. Eur Urol, doi:10.1016/j.eururo.2008.04.021.