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Can pelvic floor muscle training be a solution for leaky bladder woes in women?

The Bottom Line

  • Globally, hundreds of millions of people deal with issues related to urinary incontinence, a.k.a. involuntary loss of bladder control. 
  • Older adult women are particularly vulnerable to developing urinary incontinence.
  • Urinary incontinence can cause a decline in the physical, mental, and social health of individuals. 
  • Pelvic floor muscle training can either cure or improve urinary incontinence in women with different forms of the condition. 
  • Consider trying pelvic floor muscle training, but first, talk to a health professional (e.g., physiotherapist, general practitioner, or specialist nurse) about your interest in this strategy and exercises you can do safely at home.

Do you ever involuntarily lose control of your bladder right after getting the urge to urinate or when engaging in routine activities like bending down to pick up a dropped TV remote, going for a light evening walk, or simply laughing at a funny joke a friend has made? If you do, know that you are not alone. These stressful experiences that leave you feeling embarrassed are par for the course in folks with urinary incontinence and affect hundreds of millions of people worldwide (1-3). What’s more, this condition is extremely common in older adults and is two times more prevalent in older women than older men (1).


Urinary incontinence takes a significant toll on your physical, mental, and social health. In everyday life, these negative impacts can manifest as increases in urinary tract infections and pressure ulcers, decreases in physical activity, poor perceptions of yourself, and lower levels of social interaction that lead to social isolation (2;4-6). Fortunately, a variety of treatments exist to help folks with this condition cope or achieve success in beating it. For those not wanting to add another medication to the medicine cabinet or looking to supplement an existing management plan, a non-drug option such as pelvic floor muscle training might be of interest (2). This form of training relies on exercises that work to enhance aspects of your pelvic floor muscles, such as muscle endurance, power, and strength (2;7). An example of these exercises includes squeezing and relaxing the pelvic floor muscles (2).


But do these exercises work? A systematic review, looking specifically at the impact of this strategy on women, has this query covered (2).


What the research tells us

Although more long-term research is needed on pelvic floor muscle training, the currently available evidence is positive. The authors of the review concluded that this form of training could be suggested as a primary treatment option for women with urinary incontinence.


Let’s delve into the details!


First, we have women with stress urinary incontinence—involves unintentionally leaking urine during times where you are exerting yourself. The review found that when these women engaged in pelvic floor muscle training, they were eight times more likely to state that they had been cured than women not receiving any treatment or receiving another treatment that did not involve activity (e.g., motivational telephone calls, placebo medications, etc.). Second, when combining outcomes like patient-reported cure and improvement of urinary incontinence, women doing pelvic floor exercises were six times more likely to state that they had experienced one of these two benefits. Third, the evidence also showed a potential for symptom improvement due to pelvic floor muscle training.


When it comes to women with any type of urinary incontinence (i.e., stress incontinence, urgency incontinence [unintentionally leaking urine during or immediately following a sudden urge to urinate], or both) engaging in pelvic floor muscle training, similar results were brought to light. More specifically, these women were five times more likely to report that they had been cured than women not receiving treatment or receiving a non-pelvic floor training treatment. The women doing muscle training were also two times more likely to report that they had experienced either a cure or improvement in urinary incontinence when these two outcomes were looked at together.


What’s more, women with urinary incontinence—regardless of type—may see a reduction in the number of leakage episodes experienced over one day and a decrease in the amount of urine lost with pelvic floor muscle training. And last but not least, safety. Based on studies that did report on negative side effects from engaging in pelvic floor muscle training, such events were uncommon, and when they did occur, they were not serious (e.g., pain, discomfort while exercising, temporary worsening of symptoms, etc.) (2). All in all, pelvic floor muscle training appears to be a generally safe and solid addition to your bladder control management plan. Even better, it can be done at home with little to no equipment and with guidance from online videos, mobile apps, or instructions provided by a health professional (e.g., physiotherapist, general practitioner, or specialist nurse). If you do decide to use an online resource, remember to make sure that it's evidence-based and comes from a trustworthy source. Consult with a health professional (e.g., physiotherapist, general practitioner, or specialist nurse) before commencing as they may direct you to a specific in-person or online program, exercises to do on your own, or offer such services themselves.


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References

  1. World Health Organization. Evidence profile: Urinary incontinence. [Internet] 2017. [cited March 2021]. Available from https://www.who.int/ageing/health-systems/icope/evidence-centre/ICOPE-evidence-profile-urinary-incont.pdf 
  2. Dumoulin C, Cacciari LP, Hay-Smith EJC. Pelvic floor muscle training versus no treatment, or inactive control treatments, for urinary incontinence in women. Cochrane Database Syst Rev. 2018; 10:CD005654. doi: 10.1002/14651858.CD005654.pub4.
  3. Milsom I, Altman D, Cartwright R, et al. Epidemiology of urinary incontinence (UI) and other lower urinary tract symptoms (LUTS), pelvic organ prolapse (POP) and anal incontinence (AI). In: Abrams P, Cardozo L, Khoury S, Wein A editor(s). Incontinence: 5th International Consultation on Incontinence. Recommendations of the International Scientific Committee: evaluation and treatment of urinary incontinence, pelvic organ prolapse and faecal incontinence; 2012 Feb 23-25; Paris. Belgium: International Consultation on Urological Diseases (ICUD), 2013:15-107. 
  4. Resnick NM, Yalla SV, Laurino E. The pathophysiology of urinary incontinence among institutionalized elderly persons. N Engl J Med. 1989; 320(1):1-7
  5. Papanicolaou S, Hunskaar S, Lose G, et al. Assessment of bothersomeness and impact on quality of life of urinary incontinence in women in France, Germany, Spain and the UK. BJU International. 2005; 96(6):831-838.
  6. Fantl J, Newman DK, Colling J. Urinary incontinence in adults: acute and chronic management: 1996 update. AHCPR clinical practice guidelines No. 2. Rockville (MD): Agency for Health Care Policy and Research (AHCPR), Public Health Service, US Department of Health and Human Services; 1996 Mar. AHCPR Report No.: 96-0682.
  7. Bø K, Frawley H, Haylen BT, et al. An International Urogynecological Association (IUGA)/International Continence Society (ICS) joint report on the terminology for the conservative and nonpharmacological management of female pelvic floor dysfunction. Neurourol Urodyn. 2017; 28(2):191-213.  

DISCLAIMER: These summaries are provided for informational purposes only. They are not a substitute for advice from your own health care professional. The summaries may be reproduced for not-for-profit educational purposes only. Any other uses must be approved by the McMaster Optimal Aging Portal (info@mcmasteroptimalaging.org).

Many of our Blog Posts were written before the COVID-19 pandemic and thus do not necessarily reflect the latest public health recommendations. While the content of these blogs identify activities that support optimal aging, it is important to defer to the most current public health recommendations such as social distancing and frequent hand washing. Some of the activities suggested within these blogs may need to be modified or avoided altogether to comply with current social distancing recommendations. To view the latest updates from the Public Health Agency of Canada, please visit their website.

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