Pelvic floor muscle exercises: 5 years later.

OBJECTIVES

To determine the outcome of pelvic floor muscle exercises for genuine stress incontinence after 5 years.

METHODS

Questionnaires were sent to 48 women, mean age 57 years, with troublesome stress incontinence treated as outpatients by a skilled female physiotherapist to elucidate a self-assessment of therapy outcome and to determine patients' compliance concerning fulfillment of home exercises and attitude toward physiotherapy. Patients' self-assessment responses indicated cured, much improved, some improvement, or unchanged/worse and incidence of anti-incontinence surgery after physiotherapy.

RESULTS

The overall cure/much improvement rate for physiotherapy at the end of therapy was 54% and 5 years later it was 58% (confidence interval, 43 to 72); (P = 1.000, binomial test). Thirteen women (27%) underwent surgery. Seven unoperated women (15%) showed only some improvement or relapse and may have been undertreated. Severity of symptoms before therapy was an important factor in therapy outcome but not in therapy maintenance. Frequency of home practicing was comparable in those who had surgery afterward and those who had not. There was no clear linear relationship in long-term effect and frequency of home practicing. Severity of symptoms and behavioral changes bias this relationship. Physiotherapy was well tolerated, as 73% would still prefer it as first choice. Pelvic floor muscle exercises were recommended to friends or relatives by 77% of the patients.

CONCLUSIONS

Once a certain level of incontinence is established with pelvic floor muscle exercises, that level is maintained over 5 years.