Indian Journal of Physiotherapy & Occupational Therapy-An International Journal

Open Access Open Access  Restricted Access Subscription Access
Open Access Open Access Open Access  Restricted Access Restricted Access Subscription Access

Abdominal Versus Pelvic Floor Muscles Exercises in Mild Stress Urinary Incontinence in Obese Egyptian Women


Affiliations
1 Department of Physical Therapy for Obstetrics and Gynecology, Faculty of Physical Therapy, Cairo University, Egypt
2 Department of Physical Therapy, College of Medical & Health Sciences, Ahlia University, Bahrain, Iran, Islamic Republic of
3 Department of Obstetrics & Gynecology, Faculty of Medicine, Al Azhar University, Cairo, Egypt
     

   Subscribe/Renew Journal


Objective

To compare the benefits of 12 weeks abdominal and pelvic floor muscles (PFM) strength training for mild stress urinary incontinence (SUI) in obese women.

Design

A randomized control trial with three months follow up.

Subjects

Thirty female obese patients with mild SUI.

Intervention

Abdominal exercises (Abd. ex's) group (n=15) received specific exercises for transversus abdominis and internal obliqus muscles. Whereas, pelvic floor exercises (PF ex's) group (n=15) received pelvic floor exercises. Main outcome measures Vaginal pressure, leak point pressure (LPP) and waist hip ratio (WHR) were measured for both groups at three intervals (baseline, 12 weeks of intervention and 3months follow up i.e. 24 weeks from the start of the study).

Results

Both abdominal and pelvic floor groups showed a significant increase in vaginal pressure after 12 weeks of intervention (P < 0.0001 and P < 0.021 respectively) and at follow up (P< 0.0001 and P < 0.009 respectively) compared to baseline. This effect was greater for Abd. ex's group at 12 weeks (P < 0.041) and at follow up (P < 0.022) when compared with PF ex's group. Also, both abdominal and pelvic floor groups showed a significant increase in LPP after 12 weeks of treatment (P < 0.001 and P < 0.008 respectively) and at follow up (P < 0.0001 and P < 0.007 respectively) compared to baseline; there were no significant differences between the two groups at these time points.

Conclusion

Overall, the results of this study suggest that 12 weeks of abdominal muscles strengthening training has superior effects compared to pelvic floor strength training for mild SUI in obese patients.


Keywords

Urinary Incontinence, Obesity, Pelvic Floor, Abdominal, Exercise
Subscription Login to verify subscription
User
Notifications
Font Size


  • Cammu H, Blockeel C, Amy J. Who will benefit from pelvic floor muscle training for stress urinary incontinence? Am J Obstet Gynecol. 2004; 191(4): 1152-1157.

  • Symonds I, Baker P, Kean L. Problem orientated obstetrics and gynecology. London: Arnold- Holdder Heading Group, 2002; 257.

  • Doughty D. Promoting continence: simple strategies with major impact. Ostomy Wound Manage. 2003; 49:46-52. 4. McGuire E, Gespedes R. Proper diagnosis: A must before surgery for stress incontinence. J Endo. Urol.1996; 10: 201- 205.

  • Frawley H, Galea M, Phillips B, Sherburn M, Bo K. Reliability of pelvic floor muscle strength assessment using different test positions and tools. Neurourol Urodyn. 2006; 25:236– 242.

  • Luber K. The Definition, Prevalence, and Risk Factors for Stress Urinary Incontinence. Rev Urol.2004; 6(Suppl 3): S3–S9.

  • Hannestad S, Rortveit G, Daltveit A, Hunskaar S. Are smoking and other lifestyle factors associated with female urinary incontinence? The Norwegian Epincont Study. BJOG.2003; 110: 247-254.

  • Hunskaar S. A systematic review of overweight and obesity as risk factors and targets for clinical intervention for urinary incontinence in women. Neurourol Urodyn. 2008; 27: 749- 757.

  • Cummings J, Rodning C. Urinary stress incontinence among obese women: review of pathophysiology therapy. Int Urogynecol J Pelvic Floor Dysfunct. 2000; 11(1):41-44.

  • Sapsford R, Hodges W. Contraction of the pelvic floor muscles during abdominal maneuvers. Arch Phys Med Rehabil. 2001; 82: 1081-1088.

  • Madill S, McLean L. Relationship between abdominal and pelvic floor muscle activation and inter-vaginal pressure during pelvic floor muscle contractions in healthy continent women. Neurourol Urodyn.2006; 25(7):722-730.

  • Richardson C, Jull G, Hodges P, Hides J. Therapeutic exercise for spinal segmental stabilization in low back pain. Edinburgh: Churchill Livingstone, 1999:75-84.

  • Power M. Embryological development of the levator ani muscle. Am J Obstet Gynecol. 1948; 55: 367-381.

  • Sapsford R, Hodges P, Richardson C, Cooper D, Markwell S, Jull G. Co-activation of the abdominal and pelvic floor muscles during voluntary exercises. Neurourol Urodyn.2001; 20; 31-42.

  • Sapsford R. The pelvic floor: A clinical model for function and rehabilitation. Physiother. 2001; 87(12): 620-630.

  • Neumann P, Gill V. Pelvic floor and abdominal muscle interaction: EMG activity and intra-abdominal pressure. Int Urogynecol J Pelvic Floor Dysfunct. 2002; 13(2): 125-32.

  • Dumoulin C, Lemieux M, Gravel D, Morin M. Physiotherapy for persistent postnatal stress urinary incontinence: a randomized controlled trial. Obstet Gynecol. 2004; 104 (3): 504-510.

  • Singh D. Female mate value at a Glance: Relationship of Waist-to-Hip Ratio to Health, Fedundity and Attraction. Neuro Endocrinol Lett. 2002; 23 (special issue):81-91.

  • Hung H, Hsiao S, Chih S, Lin H, Tsauo J. An alternative intervention for urinary incontinence: Retraining diaphragmatic, deep abdominal and pelvic floor muscle coordinated function. Man Ther. 2010; 15: 273–279.

  • Subak L, Wing R, West D, Franklin F, Villinghoff E, Creasman J, et al. weight loss to treat urinary incontinence in overweight and obese women. N Engl J Med. 2009; 360: 481-490.

  • DiNubile N. Strength training. Clin Sports Med. 1991; 10: 33–62.

  • Thompson J, O’Sullivan P, Briffa N, Neumann P. Altered muscle activation patterns in symptomatic women during pelvic floor muscle contraction and valsalva manouevre. Neurourol Urodyn. 2006; 25(3):268–76.

  • Critchley D. Instructing pelvic floor contraction facilitates transversus abdominis thickness increase during low abdominal hollowing. Physiother Res Int. 2002; 7 (2): 65-75.

  • Arab A, Chehrehrazi M. The response of the abdominal muscles to pelvic floor muscle contraction in women with and without stress urinary incontinence using ultrasound imaging. Neurourol Urodyn. 2011; 30(1): 117-120.

  • Bo K, Sherburn M, Allen T. Transabdominal ultrasound measurement of pelvic floor muscle activity when activated directly or via a transversus abdominis muscle contraction. Neurourol Urodyn. 2003; 22 (7): 654-658.

  • McIntosh L, Frahm J, Mallet V, Richardson D. Pelvic floor rehabilitation in the treatment of incontinence. J Reprod Med. 1993; 38(9):662-666.

  • Aukee P, Immonen P, Laaksonen D, Airaksinen O. The effect of home biofeedback training on stress incontinence. Acta Obstet Et gynaecol Scand. 2004; 83(10): 973-977.

  • Bo K. Pelvic floor muscle training is effective in the treatment of female stress urinary incontinence, but does it work? Int Uorgynecol J Pelvic Floor Dysfunct. 2004; 15 (2): 76-84.

  • Sampselle M, Miller J, Aims B, Antonakos C. Effect of pelvic muscle exercises on transient incontinence during pregnancy and after birth. Obstet Gynecol. 1998; 91(3): 406-412.

  • Bo K, Talseth T. Long term effect of pelvic floor muscle exercise 5 years after cessation of organized training. Obstet Gynecol. 1996; 87: 261-265.


Abstract Views: 437

PDF Views: 0




  • Abdominal Versus Pelvic Floor Muscles Exercises in Mild Stress Urinary Incontinence in Obese Egyptian Women

Abstract Views: 437  |  PDF Views: 0

Authors

Dalia M. Kamel
Department of Physical Therapy for Obstetrics and Gynecology, Faculty of Physical Therapy, Cairo University, Egypt
Ali A. Thabet
Department of Physical Therapy for Obstetrics and Gynecology, Faculty of Physical Therapy, Cairo University, Egypt
Sayed A. Tantawy
Department of Physical Therapy, College of Medical & Health Sciences, Ahlia University, Bahrain, Iran, Islamic Republic of
Mohamed M. Radwan
Department of Obstetrics & Gynecology, Faculty of Medicine, Al Azhar University, Cairo, Egypt

Abstract


Objective

To compare the benefits of 12 weeks abdominal and pelvic floor muscles (PFM) strength training for mild stress urinary incontinence (SUI) in obese women.

Design

A randomized control trial with three months follow up.

Subjects

Thirty female obese patients with mild SUI.

Intervention

Abdominal exercises (Abd. ex's) group (n=15) received specific exercises for transversus abdominis and internal obliqus muscles. Whereas, pelvic floor exercises (PF ex's) group (n=15) received pelvic floor exercises. Main outcome measures Vaginal pressure, leak point pressure (LPP) and waist hip ratio (WHR) were measured for both groups at three intervals (baseline, 12 weeks of intervention and 3months follow up i.e. 24 weeks from the start of the study).

Results

Both abdominal and pelvic floor groups showed a significant increase in vaginal pressure after 12 weeks of intervention (P < 0.0001 and P < 0.021 respectively) and at follow up (P< 0.0001 and P < 0.009 respectively) compared to baseline. This effect was greater for Abd. ex's group at 12 weeks (P < 0.041) and at follow up (P < 0.022) when compared with PF ex's group. Also, both abdominal and pelvic floor groups showed a significant increase in LPP after 12 weeks of treatment (P < 0.001 and P < 0.008 respectively) and at follow up (P < 0.0001 and P < 0.007 respectively) compared to baseline; there were no significant differences between the two groups at these time points.

Conclusion

Overall, the results of this study suggest that 12 weeks of abdominal muscles strengthening training has superior effects compared to pelvic floor strength training for mild SUI in obese patients.


Keywords


Urinary Incontinence, Obesity, Pelvic Floor, Abdominal, Exercise

References