Unsupervised behavioral and pelvic floor muscle training programs for storage lower urinary tract symptoms in women: a s
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REVIEW ARTICLE
Unsupervised behavioral and pelvic floor muscle training programs for storage lower urinary tract symptoms in women: a systematic review Chen Wu 1 & Diane K. Newman 2 & Mary H. Palmer 1 Received: 19 May 2020 / Accepted: 13 August 2020 # The International Urogynecological Association 2020
Abstract Introduction and hypothesis This study synthesized the effects of unsupervised behavioral and pelvic floor muscle training (BPFMT) programs on outcomes relevant to women’s storage lower urinary tract symptoms (LUTS) and pelvic floor muscle strength (PFMS). Methods PubMed, CINAHL, Web of Science, and PsycINFO were searched since their inception to August 6, 2019. Randomized controlled trials (RCTs) and quasi-experimental articles that enrolled community women aged 18 years and older and reported storage LUTS outcomes including symptoms, severity, impact, self-reported symptom improvement, and PFMS were screened and extracted. Risk of bias was evaluated, and a narrative synthesis approach was used to synthesize evidence. Results Ten RCTs and three pretest-posttest articles were retrieved. Half of the RCTs had some concerns of bias; the remaining RCTs had high risk of bias. Three pretest-posttest articles had at least some risk of bias. Ten articles aimed to treat urinary incontinence (UI) primarily in middle-aged women, two aimed to prevent UI, and one aimed to improve PFMS in young continent women. Two months post-intervention, UI treatment effectiveness was observed, and cumulative effectiveness was evident in: (1) reduction in the number of incontinent episodes, (2) reduction in the International Consultation on Incontinence Questionnaire-Urinary Incontinence-Short Form and International Consultation on Incontinence Questionnaire-Lower Urinary Tract Symptoms Quality of Life scores, (3) increased patients’ global impression of improvement, and (4) improvement of PFMS. Conclusions Unsupervised B-PFMT programs improve outcomes relevant to UI and PFMS in midlife community women who have UI. Their effects on UI prevention and other storage LUTS remain unclear. Keywords Lower urinary tract symptoms . Urinary incontinence . Women . Pelvic floor . Exercise
Introduction
Electronic supplementary material The online version of this article (https://doi.org/10.1007/s00192-020-04498-9) contains supplementary material, which is available to authorized users. * Mary H. Palmer [email protected] 1
School of Nursing, University of North Carolina at Chapel Hill, CB 7460, Chapel Hill, NC, USA
2
Division of Urology, Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
Approximately 2.3 billion of the adult world population experience lower urinary tract symptoms (LUTS), and of those, 1.7 billion are women with storage LUTS [1]. Storage LUTS, i.e., stress urinary incontinence (SUI), urgency urinary incontinence (UUI) and mixed urinary incontinence (MUI), urinary urgency, urinary frequency, and nocturia, have a detrimental impact on women’s health-related quality of li
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