An intensive programme for pelvic floor muscle exercises: short- and long-term effects on those with stress urinary incontinence

Abstract

腹圧性尿失禁に罹患する女性患者123名を, 骨盤底筋体操の強化訓練法で8週間治療し, 12ヵ月以上にわたり経過観察した.15名は65歳以上(高齢者群)であり, 108名は64歳以下(成人群)であった.体操終了時と平均28ヵ月後の治療成績を前向きに検討し, 更に治療成績の予測因子を調査した.腟収縮力は両群で改善したが, 失禁量と尿失禁に基因する困窮度は, 成人群のみで有意に改善した.高齢者群と成人群での短期成績は各20%と40%であった.平均28ヵ月後の長期成績は27%と40%であり, 6名はこの間に手術を受け尿禁制となっていた.短期及び長期治療成績は, それぞれ両群間で統計的に有意差を認めなかった

Pelvic floor muscle exercises for the treatment of stress urinary incontinence were reported 45 years ago. However, few studies have been made on the long-term outcome and clinical effects in elderly people. We put 123 incontinent women on an intensive exercise programme for 8 weeks and followed them for more than 12 months; 15 patients were over 65 years old and 108 under 65 years old. Self-reported success rates, i.e., cure or a reduction of > 50% of the original severity, were prospectively assessed in the 2 groups immediately and a mean of 28 months (12-52) after the training. Predictive parameters for an immediate and a long-term success were assessed. The intensive programme depended on patients being motivated, patient education, correct muscle contractions, and the keeping of treatment diaries for 8 weeks. Urine loss evaluated objectively and bothersome scores in 6 activities assessed subjectively improved only in the younger adult group. However, vaginal contractile strength increased in both groups. The immediate success rate was 20% and 40% for the elderly and the adults, respectively. Twenty eight months later, the success rate was 27% for the aged and 40% for the adults with 6 patients becoming continent by surgery. Both the short- and long-term success rates were similar in the 2 groups (p < 0.05). 95% of the patients stated that the intensive training was valuable and that they would recommend the training to friends suffering from stress incontinence. Contractile strength of the vagina can be used to predict the immediate treatment outcome, but there are no parameters for predicting the long-term success. In conclusion, the intensive programme of pelvic floor muscle exercises is an effective treatment option for not only for the young adults but also for elderly people suffering from stress incontinence.