#346 Stress Urinary Incontinence: Pelvic floor exercises or pessary?

CLINICAL QUESTION

QUESTION CLINIQUE

How effective are pelvic floor exercises or pessaries for stress urinary incontinence?

BOTTOM LINE

RÉSULTAT FINAL

Pelvic floor exercises increase the proportion of women with symptom improvement (74% versus 11%) and patient satisfaction (71% versus 13%) compared to control over 1-6 months. Pessaries may reduce incontinence episodes compared to no treatment based on one small, 2-week study. Exercise may be slightly better than pessary at three months (example: more patients without bothersome symptoms) with less vaginal discharge at 12 months.

Reading Tools for Practice Article can earn you MainPro+ Credits

La lecture d'articles d'outils de pratique peut vous permettre de gagner des crédits MainPro+

Join Now S’inscrire maintenant

Already a CFPCLearn Member? Log in

Déjà abonné à CMFCApprendre? Ouvrir une session

EVIDENCE

DONNÉES PROBANTES

Results statistically different unless indicated. Focusing on systematic reviews from the last 10 years.
Pelvic floor exercises:
- Largest systematic review, 18 randomized controlled trials (RCTs), 26-133 women, compared to no treatment/control.¹ At 6-24 weeks:
  - Self-reported cure/improvement: 74% versus 11% (control), number needed to treat (NNT)=2.
  - Leakage (example baseline: 1-2 episodes/day):² Reduced by one episode/day over control.
  - Patient satisfaction: 71% versus 13% (control), NNT=2.
- Other systematic reviews and newer RCTs report similar.^3-9
Pessaries:
- Meta-analyses^10-11 did not combine RCTs.
- RCT, 55 women, pessary versus no treatment.¹² After two weeks:
  - Total incontinence episodes reduced: 32% versus 7.6% (control).
  - Satisfaction (scale 0-100, higher=better): 60 versus 5 (control).
  - Limitations: Industry funded; baseline incontinence episodes imbalanced: 36 versus 58 (control) in two weeks before trial.
- RCT, 446 women, pelvic floor exercises versus pessary:¹³
  - At 3 months:
    - Proportion without bothersome symptoms: 49% versus 33% (pessary), NNT=7.
    - Improved/much improved: Not different.
    - Satisfaction: 54% versus 50% (pessary), NNT=27.
    - Withdrawals due to adverse effects: No difference.
  - At 12 months:
    - No difference in above outcomes.
    - Vaginal discharge: 6% versus 16% (pessary), NNT=10.
  - Exercise plus pessary versus exercise alone: No difference.
  - Limitations: Pessary dropouts higher at 3 months, no different at 12 months.
- Limitations: RCTs unblinded and outcomes often subjective.^12,13

CONTEXT
CONTEXTE

Pelvic floor exercises considered first-line.¹⁴
- If supervised programs inaccessible, can provide written information¹⁵ or video¹⁶ to patients.
- At least 8 contractions three times daily recommended.¹⁴
Pessaries:
- Can last 5-10 years and be fitted in primary care.^17,18
  - ~10-40% women have unsuccessful first fittings.^13,19
- Cost:¹⁷ $50-150.

Nasir Ayub August 8, 2023

Excellent

Andrew chung August 9, 2023

good info

Abdul-Hamid Chehimi August 9, 2023

Pelvic floor exercise is the 1st line therapy for stress UI.

Latest Tools for Practice

Derniers outils pour la pratique

Allison Paige MD CCFP

#364 Facing the Evidence in Acne, Part II: Oral Antibiotics

How effective are oral antibiotics in treating acne of at least mild-moderate severity?

Read Lire 0.25 credits available Crédits disponibles

Bradley LeDrew PharmD candidate

#363 Making a difference in indifference? Medications for apathy in dementia

In patients with dementia, how safe and effective are stimulants, antidepressants, and antipsychotics for treating apathy?

Read Lire 0.25 credits available Crédits disponibles

Allison Paige MD CCFP

#362 Facing the Evidence in Acne, Part I: Oral contraceptives and spironolactone in females

How effective are combined oral contraceptives (COC) and spironolactone for treating acne of at least mild-moderate severity in females?

Read Lire 0.25 credits available Crédits disponibles

August 7, 2023

This content is certified for MainPro+ Credits, log in to access

Ce contenu est certifié pour les crédits MainPro+, Ouvrir une session

🔒 Complete Activity

🔒 Compléter l’activité

Author(s)

Auteur(s)

Samantha Moe PharmD
Anthony Train MBChB MSc CCFP

1. Dumoulin C, Cacciari LP, Hay-Smith EJC. Cochrane Database Syst Rev. 2018: CD005654.

2. Asklund I, Nyström E, Sjöström M, et al. Neurourol Urodyn. 2017; 36(5):1369-76.

3. Stenzelius K, Molander U, Odeberg J. Age Ageing. 2015; 5:736-44.

4. Moroni RM, Magnani PS, Haddad JM, et al. Rev Bras Ginecol Obstet. 2016; 38(2):97-111.

5. Nie XF, Ouyang YQ, Wang L, et al. Int J Gynaecol Obstet. 2017; 138(3):250-5.

6. Garcia-Sanchez E, Avila-Gandia V, Lopez-Roman J, et al. Int J Environ Res Public Health. 2019; 16(22).

7. Okayama H, Ninomiya S, Naito K, et al. Int Urogynecol J. 2019: 7:1093-99.

8. Al Belushi ZI, Al Kiyumi MH, AlMazuri AA, et al. Neurourol Urodyn. 2020; 39:5:1557-1566.

9. Kamali S, Ozengin N, Topcuoglu MA. Women Health. 2023; 63(6): 473-83.

10. Lipp A, Shaw C, Glavind K. Cochrane Database Syst Rev. 2014; CD001756.

11. Ayeleke Ro, Hay-Smith EJC, Omar MI. Cochrane Database Syst Rev. 2015: CD010551.

12. Cornu JN, Mouly S, Amarenco G, et al. Int Urogynecol J. 2012; 23(12): 1727-34.

13. Richter HE, Burgio KL, Brubaker L, et al. Obstet Gynecol. 2010; 115(3): 609-17.

14. National Institute for Health and Care Excellence. Urinary incontinence and pelvic organ prolapse in women: management. Available at: https://www.nice.org.uk/guidance/ng123/chapter/Recommendations#non-surgical-management-of-urinary-incontinence. Accessed May 5, 2023.

15. The Canadian Continence Foundation. Incontinence Treatments. Available at: https://www.canadiancontinence.ca/EN/treatment.php.

16. MDConversation. Pelvic Floor Muscle Training. Available at: https://www.youtube.com/watch?v=AuG7ZaKcH60. Accessed on July 2, 2023.

17. Ontario Health. Ont Health Technol Assess Ser. 2021; 21(3): 1-155.

18. Bordman R, Telner D, Jackson B, et al. Can Fam Physician. 2007; 53(3): 485-7.

Tools for Practice Outils pour la pratique