Effect of Pelvic Floor and Hip Muscle Strengthening in the Treatment of Stress Urinary Incontinence: A Randomized Clinical Trial

Simone A A Marques; Simone R B da Silveira; Anice C Pássaro; Jorge M Haddad; Edmund C Baracat; Elizabeth A G Ferreira

doi:10.1016/j.jmpt.2019.01.007

Effect of Pelvic Floor and Hip Muscle Strengthening in the Treatment of Stress Urinary Incontinence: A Randomized Clinical Trial

J Manipulative Physiol Ther. 2020 Mar-Apr;43(3):247-256. doi: 10.1016/j.jmpt.2019.01.007. Epub 2020 Jul 21.

Authors

Simone A A Marques¹, Simone R B da Silveira², Anice C Pássaro¹, Jorge M Haddad³, Edmund C Baracat⁴, Elizabeth A G Ferreira⁵

Affiliations

¹ Department of Physical Therapy, Speech and Occupational Therapy, School of Medicine, University of São Paulo, São Paulo, Brazil.
² Department of Obstetrics and Gynecology, Urogynecology Section, University Hospital, University of São Paulo, São Paulo, Brazil.
³ Department of Obstetrics and Gynecology, Urogynecology Section, Clinical Hospital, University of São Paulo, São Paulo, Brazil.
⁴ Department of Obstetrics and Gynecology, Urogynecology Section, University Hospital, University of São Paulo, São Paulo, Brazil; Department of Obstetrics and Gynecology, Urogynecology Section, Clinical Hospital, University of São Paulo, São Paulo, Brazil.
⁵ Department of Physical Therapy, Speech and Occupational Therapy, School of Medicine, University of São Paulo, São Paulo, Brazil. Electronic address: elferreira@usp.br.

PMID: 32703614
DOI: 10.1016/j.jmpt.2019.01.007

Abstract

Objective: To investigate the effectiveness of strengthening the hip muscles in addition to strengthening the pelvic floor muscles (PFM) in the treatment of stress urinary incontinence.

Methods: This study used a prospective, assessor-blind, randomized clinical trial with parallel groups. We randomly allocated 47 individuals with stress urinary incontinence to 2 groups: 1 performing only pelvic floor strengthening exercises (PF, n = 21) and the other performing pelvic floor strengthening exercises plus exercises for the gluteus maximus and medius and hip adductor muscles (PFH, n = 22). Four individuals did not complete the study. Frequency of urine leakage was the primary outcome (3-day voiding diary and a follow-up voiding diary). Secondary outcomes were pelvic floor muscle strength (Ortiz scale, PERFECT scheme [Oxford Scale], and perineometry) and quality of life (QoL; International Consultation on Incontinence Questionnaire-Short Form and King's Health Questionnaire), which were evaluated by a blinded assessor before and after 20 sessions over 10 weeks.

Results: Regarding the daily frequency of urine loss evaluated by the follow-up voiding diary, an effect of group was observed (P < .001), with the PFH group showing a significant decrease in daily loss frequency, although no significant differences were found in the comparison between groups for the 3-day voiding diary, QoL, or functional assessment of the PFM.

Conclusion: Strengthening the PFM together with the hip synergic muscles showed better results for frequency of daily urine loss throughout the sessions, although there was no accompanying superiority in improvement of strength, perineometry, or QoL over the group that performed only PFM-strengthening exercises.

Keywords: Hip; Pelvic Floor; Physical Therapy Modalities; Rehabilitation; Urinary Incontinence, Stress; Women's Health.

Publication types

Randomized Controlled Trial
Research Support, Non-U.S. Gov't

MeSH terms

Adult
Exercise Therapy / methods*
Female
Humans
Middle Aged
Muscle Contraction / physiology*
Pelvic Floor / physiology*
Physical Therapy Modalities
Prospective Studies
Quality of Life / psychology
Surveys and Questionnaires
Treatment Outcome
Urinary Incontinence, Stress / physiopathology
Urinary Incontinence, Stress / therapy*