Incontinence in Older Women: When to Expect Meaningful Leakage Reduction from Pelvic Floor Muscle Training.

INTRODUCTION AND HYPOTHESIS: Perceived benefits are crucial for maintaining adherence to pelvic floor muscle training (PFMT). However, the timeline for expected responses and the factors influencing PFMT effectiveness remain unclear. Our study aimed to (1) determine when older women with urinary incontinence (UI) can expect a clinically important reduction in leakage from PFMT, and (2) identify factors associated with the time needed to achieve this reduction.

METHODS

This is a pooled analysis from a randomized controlled trial supporting the non-inferiority of group-based versus individual PFMT. Participants included 362 older women with stress or mixed UI following a structured 12-week PFMT program, delivered in group sessions or individually. Primary Outcomes: Time to achieve minimal (50%) and incremental (70%) clinically important differences in weekly incontinence episodes were assessed using Kaplan-Meier estimates.

SECONDARY OUTCOMES: Factors that potentially influenced treatment response, including age, body mass index, parity, comorbidities, UI duration, severity and type, pelvic floor strength, and PFMT delivery mode were analysed using ordinal logistic regression.

RESULTS

A total of 328 (91%) women provided usable leakage report data. Median minimal and incremental clinically important differences were achieved by the 4th and 6th weeks of treatment. Improvements continued until the last treatment session. Age, UI duration, severity, pelvic floor strength, and group-based intervention were related to later treatment response.

CONCLUSIONS

In older women with stress or mixed urinary incontinence, a clinically significant reduction in leakage can be achieved by the 4th week of PFMT. Early PFMT intervention and post-treatment exercise adherence favours optimal outcomes.

TRIAL REGISTRATION: NCT02039830.