Pelvic physiotherapy in genuine stress incontinence

In a prospective cohort study, the effect of pelvic physiotherapy on genuine stress incontinence, factors that influence therapy outcome, and patients' attitudes toward physiotherapy were studied. The study group consisted of 52 ambulatory and mentally fit Caucasian women (mean age, 53 years), suffering from genuine stress incontinence and who had no contraindications for surgery. They had physiotherapy twice weekly for ten weeks. The aim of physiotherapy was strengthening the pelvic floor muscles under control of digital vaginal palpation. Therapy outcome was assessed by a questionnaire and by the patients' self-monitoring urinary diary recording pad changes (52) and number of leakage episodes (35) before treatment and at end of therapy. The questionnaire also served to determine how patients appreciated physiotherapy. Physiotherapy had a low cure rate (+/- 25%) but a high improvement rate causing a decreased demand for surgery. At follow-up (mean 14 months) its beneficial effect was maintained. To date, only 10 patients (19%) have undergone surgery. Severity of symptoms was the only limiting factor. We conclude that every woman with urinary stress incontinence is a potential candidate for physiotherapy but surgical treatment as an option must remain open. Overall, physiotherapy was well accepted since episodes of urinary incontinence were less frequent and therefore bearable; however, changes in patients' behavior play a role.