Assessment of efficacy of home available reminders to aid in the adherence and effectiveness of home-based pelvic floor muscle training in the management of stress urinary incontinence

ABSTRACT

Background: Strengthening exercises for pelvic floor muscles (SEPFM) are considered the first approach in the treatment of stress urinary incontinence (SUI). UI has a devastating effect on women's quality of life in the physical, social, sexual and psychological spheres. Women restrict or diminish their activity and social participation, with serious implications. In SUI, there is an association between physical exertion and urinary loss. Increased intra-abdominal pressure triggered by physical exertion leads to increased intra-vesical pressure and, if it exceeds intraurethral pressure, in the absence of contraction of the detrusor muscle, the resulting urinary leakage is referred to as SUI. Aim of the study To identify the protocol and/or most effective training parameters in the treatment of female SUI. Materials and methods: 100 patients with stress urinary incontinence attending the out-patient department were thoroughly evaluated and randomized into 2 groups of 50 patients each, both groups were taught Kegels exercises and instructions to perform them at home. The experimental group (A) received additional strategies to enhance the efficacy of PFME in the form of reminder bindis to be placed in areas of the home frequented by the patient like the kitchen and its appliances. Patients in the control group (B) did not receive any additional reminders. Both groups were asked to maintain an T. Srikala Prasad, Jessima Subahani, B. Amirtha. Assessment of efficacy of home available reminders to aid in the adherence and effectiveness of home-based pelvic floor muscle training in the management of stress urinary incontinence. IAIM, 2019; 6(9) 7-12. Page 8 exercise diary and allowed to continue their routine medications for comorbidities if any. They were reviewed on Day 15, Day 30 and physiotherapy sessions are given. Later on Day 90 the patients of both groups were reviewed and evaluated with a questionnaire for improvement in symptoms and adherence to PFME. Results: Among the total 100 patients who were trained to do PFME, 23 (14 from group A and 9 from group B) were completely dry by 90 days, 51 (29 from group A and 22 from group B) patients had reduction in the leak and 26 (7 from group A and 19 from group B) patients showed no improvement. Assessment from the exercise diary showed good adherence and symptom relief in most patients in the trial group. Conclusions: Adherence to PFME was better in the trial group in whom indigenous reminders were used which in turn translated into clinical improvement. In this time and era as PFMT is the first management modality in patients with stress and mixed incontinence implementation of such strategies to improve adherence to treatment is suggested especially in tertiary care setups.