Bladder-neck effective, integrative pelvic floor rehabilitation program: follow-up investigation

To evaluate the effectiveness of a pelvic floor rehabilitation program consisting of pelvic floor (PF) and transverse abdominal muscle (TrA) pre-contraction, coordination training and sustained submaximal contractions employing a validated pelvic floor questionnaire.

Fifty-five consecutive women with stress urinary incontinence (n=9), overactive bladder (n=9) or mixed symptoms (n=37) were invited to participate. The German version of the Australian pelvic floor questionnaire was completed by all women before and after treatment, and additional validated improvement and satisfaction scales assessed patient-centered outcome. Individual treatment programs were selected according to the dysfunction evaluated by vaginal palpation and perineal ultrasound. Bladder-neck effective pelvic floor contraction was ensured using perineal ultrasound. Co-contraction of TrA was incorporated. Active integration of the pelvic floor contraction into daily life and individual incontinence triggering activities was practiced (duration, submaximal contraction, maintenance, pre-contraction before breathing, getting up and urgency).

Of 46 women with stress urinary incontinence symptoms, 67% and of 46 women with OAB symptoms 78% were improved or cured. Bladder, bowel and sexual function domain scales improved significantly after 1-6 sessions (median 2). Pre-contraction of PF and TrA was routinely performed by 39 of 55 women (71%) resulting in less incontinence.

The bladder-neck effective, integrative pelvic floor rehabilitation program is highly effective for SUI and OAB. Although PF strengthening with maximal contractions was omitted, these results are comparable with strength programs in the literature. Due to the integration of submaximal PF contractions into daily life and individual incontinence situations, life-long strength training might be unnecessary, and this has to be studied further.