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

• Published in: Journal of manipulative and physiological therapeutics 2020-03, Vol.43 (3), p.247-256
• Main Authors: Marques, Simone A.A., Silveira, Simone R.B. da, Pássaro, Anice C., Haddad, Jorge M., Baracat, Edmund C., Ferreira, Elizabeth A.G.
• Format: Article
• Language: English
• Subjects: Adult; Exercise Therapy - methods; Female; Hip; Humans; Middle Aged; Muscle Contraction - physiology; Pelvic Floor; Pelvic Floor - physiology; Physical Therapy Modalities; Prospective Studies; Quality of Life - psychology; Rehabilitation; Surveys and Questionnaires; Treatment Outcome; Urinary Incontinence, Stress; Urinary Incontinence, Stress - physiopathology; Urinary Incontinence, Stress - therapy; Women's Health
• ISSN: 0161-4754; 1532-6586
• DOI: 10.1016/j.jmpt.2019.01.007

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. 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. 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. 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.