EFFICACY OF PELVIC FLOOR MUSCLE TRAINING, POSTERIOR TIBIAL NERVE STIMULATION AND MAGNETIC STIMULATION FOR URINARY INCONTINENCE: A RANDOMIZED CONTROLLED TRIAL

Background: Urinary incontinence is a major health problem, particularly in women. Pelvic floor muscle training (PFMT) is a first–line conservative treatment for urinary incontinence in women. Another well-tolerated, non-invasive active treatment option is transcutaneous posterior tibial nerve stimulation (TPTNS) and functional magnetic stimulation (FMS). Due to the lack of randomized controlled trials (RCT), the ideal treatment for urinary incontinence is still elusive.

Purpose: The aim of this RCT was to compare effectiveness of PFMT versus FMS in women with stress urinary incontinence and the effectiveness of TPTNS versus FMS in women with overactive bladder syndrome. This is the first RCT that evaluates the efficacy of those two treatments in that way.

Methods: The sample included 130 female members of the Society of Urinary Incontinence Maribor. All the women were randomly allocated into four groups. Women with stress urinary incontinence were randomised into two groups (PFMT versus FMS) and so were the women with overactive bladder syndrome (TPTNS versus FMS). The treatment lasted twelve weeks in the form of two weekly sessions. The data were collected from a 3-day voiding diary, ICIQ-FLUTS (International Consultation on Incontinence Questionnaire Female Lower Urinary Tract Symptoms Module) and ICIQ-LUTSqol (International Consultation on Incontinence Questionnaire Lower Urinary Tract Symptoms Quality of Life Module).

Results: The participants of each group were comparable in age, BMI, educational level, physical activity, parity, prior gynaecological surgery and duration of urinary incontinence problem. Based on various inclusion and exclusion criteria, 39 participants were excluded from the sample. The PFMT group consisted of 21 participants and the FMS group of 20 participants with for stress urinary incontinence and 20 with overactive bladder, and the TPTNS group was composed of 30 participants. This RCT shows that all conservative therapies seem to be effective in the treatment of both types of urinary incontinence. The differences at the end of the treatment were not statistically significant (p < 0.05). All the groups show symptom improvement, better quality of life and the decreased number of voiding. In both groups of FMS, women need fewer pads, in the overactive bladder syndrome group (FMS and TPTNS) both techniques lessened urgency incontinence episodes. In the group treated with FMS, incontinence episodes were decreased in women with overactive bladder, while maximal voided volume increased only in the group treated with PFMT.

Conclusion(s): This study results indicate that PFMT and FMS are equally effective for treatment of stress urinary incontinence, and that FMS and TPTNS are equally effective for treatment of overactive bladder syndrome. Thus, there is need for more clinical trials that follow the quality criteria for randomized clinical trials, yielding more reliable scientific results.

Implications: The practical aspect of providing FMS and TPTNS in physiotherapy and a most important issue is that FMS and TPTNS is going to take its place beside other forms of non – invasive treatment for urinary incontinence in women.

Funding, acknowledgements: Our study was not founded.

Keywords: urinary incontinence, pelvic floor muscle training, functional magnetic stimulation, transcutaneous posterior tibial nerve stimulation

Topic: Pelvic, sexual and reproductive health

Did this work require ethics approval? Yes

Institution: University Medical Centre Maribor of Slovenia

Committee: Medical Ethical Committee

Ethics number: n. 28/17