Lower urinary tract symptoms and pelvic floor muscle exercise adherence after 15 years

Pelvic floor muscle training effectively treats female stress urinary incontinence. However, data on long-term efficacy and adherence are sparse. Our aims were to assess current lower urinary tract symptoms and exercise adherence 15 years after ending organized training.

Originally, 52 women with urodynamic stress urinary incontinence were randomly assigned to home or intensive exercise. After 6 months, 60% in the intensive group were almost or completely continent, compared with 17% in the home group. Fifteen years later, all original study subjects were invited to complete a postal questionnaire assessing urinary symptoms (using validated outcome tools) and current pelvic floor muscle training.

Response rate was 90.4%. There were no differences in any urinary outcomes or satisfaction between the 2 study groups as a whole or when restricted to those without intervening stress urinary incontinence surgery. One half of both groups had stress urinary incontinence surgery during the 15-year follow-up period. Twenty-eight percent performed pelvic floor muscle training at least weekly; this rate did not differ by original group assignment or operated status. More operated women reported severe incontinence (P = .03) and leakage that interfered with daily life (P = .04) than did nonoperated women. There were no other differences between operated and nonoperated women.

The marked benefit of intensive pelvic floor muscle training seen short-term was not maintained 15 years later. Long-term adherence to training is low. Urinary symptoms were equally common in both operated and nonoperated women. Further studies are needed to understand factors associated with long-term effectiveness of stress urinary incontinence treatments.