EFFECT OF PILATES RING EXERCISES ON PELVIC FLOOR MUSCLE IN FEMALE WITH STRESS URINARY INCONTINENCE - RCT

R. Joshi^1,2, M. Rathi²

¹Dr. D. Y. Patil College of Physiotherapy, Dr. D. Y. Patil Vidyapeeth, Community Physiotherapy & Rehabilitation, Pune, India, ²Dr. D. Y. Patil College of Physiotherapy, Community Physiotherapy & Rehabilitation, Pune, India

Background: The Urinary incontinence (UI) is defined by International Continence Society as “Involuntary loss of urine which is unhygienic and social embarrassment and negative self-perception”. 27% of Indian female are suffering with this problem. Stress UI is defined as the involuntary loss of urine occurring during physical exertion due to increased abdominal pressure causes intra-vesical pressure that exceeds the maximum urethral pressure causes descent of the bladder and causes involuntary leakage of urine, PFM activation will keep the bladder and the urethra within the intra-abdominal cavity to maintain continence. As developing nation females are highly involved in domestic work and with each pregnancy the strength of core muscle get comprised hence there is strong need to find solution to enhance and objectify core muscle activation and without hesitation female should able to continue pelvic floor exercises.

Purpose: India is country where female are less vocal about their sexual health issues. Physical therapy has become a popular non-invasive mode of treatment in cases of musculoskeletal problems. Previous studies reported low back pain can be due to inefficient co-contraction of the trunk and pelvic floor musculature resulting in lumbar instability hence PFM weakness also considered as cause of lower back pain. Dual contraction of core muscles and pelvic floor muscle helps to maintain lumbo-pelvic stability and maintain urethral pressure by detrusor contraction whenever there is increased abdominal pressure. Thus this study recommends use of Pilates exercises with ring can helps to increase core muscle strength and prevent stress urinary incontinence.

Methods: Randomized control trial was performed in tertiary health care center where females were screened for SUI. Females were explained about the study and written informed consent was taken in vernacular language they usually speak in their region. After screening 256 females with back pain 52 female participants were included in the study. They were randomly divided into two groups using chit method into Group A (EG) and Group B (CG).For the Pre-post assessment vaginal pressure was measured by pressure manometer, core strength and severity of incontinence was assessed by using PAD test and Frequency chart (7 days).

Results: Between group analyses was performed with independent t tests and the Mann Whitney test was applied to find the significance. The core strength and the PFM strength showed highly significant change with P value <0.05 with moderate significance was seen in PFM strength and severity of the SUI in the group A compare to group B.
Experimental group showed increase in PFM on pressure manometry and core muscle strength onpressure biofeedback was significant (p<0.0001) in comparison to control group. Severity of incontinence was assessed with pad test and quality of life assessed IICQ was seen with moderately significant in group A in comparison to group B.

Conclusions: Study concludes that core muscle strengthening can be performed with Pilates ring to improve pelvic floor muscle strength.

Implications: Core muscle training and Pelvic floor muscle training will helps to minimize stress urinary incontinence and may improve sexual health with quality of life

Funding acknowledgements: Nill

Keywords:
Stress urinary incontinence
Pilates ring exercises
Pelvic floor muscles

Topics:
Pelvic, sexual and reproductive health
Community based rehabilitation

Did this work require ethics approval? Yes

Institution: Dr D Y Patil College of Physiotherapy,Pune

Committee: Institutional Ethical Committee of Dr D Y Patil college of Physiotherapy,Pune

Ethics number: DYPCPT/IEC/27/2021