Physical therapies for prevention of urinary and faecal incontinence in adults
Abstract
Background
Physical therapies, particularly pelvic floor muscle training, have been recommended for prevention of incontinence associated with childbearing, and prostate surgery.
Objectives
To assess the effectiveness of physical therapies in preventing incontinence in adults.
Search methods
The Cochrane Incontinence Group trials register was searched to September 2001. Trials were also sought from the Reference Lists of relevant articles and from experts in the field.
Selection criteria
Randomised and quasi‐randomised trials in adults without incontinence symptoms that compared a physical therapy with no treatment, or any other treatment to prevent incontinence.
Data collection and analysis
Two reviewers independently assessed eligibility, trial quality and extracted data. Data were processed as described in the Cochrane Collaboration Handbook.
Main results
Two trials in men (155 men) and 13 trials in women (4661 women) were included. As most trials recruited regardless of continence status, and there was much heterogeneity, only a qualitative synthesis was undertaken. Three of seven trials in childbearing women reported less urinary incontinence after pelvic floor muscle training compared to control treatment three months postpartum. Two trials selected women at higher risk of postnatal incontinence. The third used an intensive training programme. Four trials did not find any difference between the groups at the primary endpoint. Two trials compared pre‐prostate surgery pelvic floor muscle training with control treatment, and no difference in the occurrence of postoperative urinary incontinence was reported between the groups.
Authors' conclusions
There is insufficient evidence to determine whether physical therapies can prevent incontinence in childbearing women, or men following prostate surgery. Further, better quality research is needed.
Plain language summary
There is not enough evidence on whether pelvic floor exercises can prevent incontinence after childbirth or prostate surgery, but the evidence is most promising for women at high risk after childbirth.
Inability to control the bladder or bowel (incontinence) can be severely distressing and socially limiting. Control of the bladder and bowel is maintained by a complex system including muscles. Ageing can affect this, as can damage during childbirth, or from prostate or other surgery. One way of trying to increase control is exercising the muscles in the pelvic floor (the area holding up the bladder and bowel). However, the review found that there is not enough evidence from trials to determine whether or not pelvic floor exercises help to prevent incontinence, although intense exercising for women at high risk after childbirth appears most likely to be helpful.
