Swedish investigators conducted a study(1) published in 2015 to compare two long-term, non-face-to-face treatment programs for treating stress urinary incontinence (SUI) using pelvic floor muscle training (PFMT). All participants in the study had actively sought treatment due to their severity of leakage and were recruited via an open access website. Two-hundred and fifty women were selected and their stress urinary incontinence (SUI) diagnosis confirmed based on a self-assessment questionnaire, 2-day bladder diary, and a urotherapist-fielded phone interview. The training regimen used in this study followed the guidelines of the UK’s National Institute for Health and Clinical Excellence (NICE) but was unsupervised by physicians. There was no face-to-face contact with women participants at any time during the study.
The women were separated into two groups, 124 women in an internet-based and 126 in a postal-based treatment group. Women in both treatment groups underwent at least 8 PFM contractions, 3 times per day for 3 months, and received information on SUI and lifestyle and training reports. The internet-based group additionally received individualized email support from a urotherapist during the treatment period. The internet-based program was designed with embedded on-line training to help educate women on lifestyle or behavioral changes to aid in avoidance of SUI episodes. Women in the postal group self-trained using materials received solely by mail. Results showed a significant improvement in both groups in symptoms and reduction of use of disposable incontinence products.
Results were gathered after 4 months, 1-year, and 2-years of starting treatment. Women participants were asked to evaluate their severity of SUI symptoms by filling out two Questionnaires, one on Incontinence Symptoms and the other on Quality of Life” (QoL) covering the effects and limitations of urinary leakage on work, travel, exercise, family life, sexuality, mood, energy, and sleep. Results after 4 months(2) showed a significant and clinically relevant improvement in SUI severity of symptoms and QoL and a reduction in use of disposable UI products in both groups. Improvements in both groups mainly occurred within these first 4 months and then remained steady throughout the 2-year follow-up period. Comparison of results grouped by age (<50 and ³50 years) and symptoms (slight, moderate, severe) showed significant improvement in severity symptom scores and QoL for all groups after 1 and 2-year follow-up periods. The only exception was the “slight-leakage” group which showed significant improvement in these areas after 1-year, but not after 2. Two thirds of participants reported that they were still satisfied with treatment results and did not want additional treatment after 2-year follow-up. Follow-up also showed that only a small percentage of women resorted to surgery, 3% after 1-year and 5.2% after 2-years.
In conclusion, this study shows that women suffering from SUI who actively sought treatment were able to be trained in PFMT exercises without any face-to-face interaction or physician involvement using treatments via internet and post. Although NICE and the ICS recommend supervised PFMT training, a 2012 American review(3)concluded that self-completed PFMT was as effective as supervised training in improving SUI symptoms, Quality of Life, and overall treatment success. Therefore, results from both treatment groups in the study discussed here support these findings as both groups showed improvement in SUI symptoms, QoL, and reduction in use of incontinence aids. This report presents a potential answer to self-managed SUI care using this non-face-to-face treatment.
Sjöström, M., Umefjord, G., Stenlund, H., Carlbring, P., Andersson, G. et al. (2015) “Internet-based treatment of stress urinary incontinence: 1- and 2-year results of a randomized controlled trial with a focus on pelvic floor muscle training”. BJU International, 116(6): 955-964.
Sjostrom M, Umefjord G, Stenlund H, Carlbring P, Andersson G, Samuelsson E. “Internet-based treatment of stress urinary incontinence: a randomised controlled study with focus on pelvic floor muscle training”. BJU International 2013; 112: 362–72.
Shamliyan T, Wyman J, Kane RL. “Nonsurgical Treatments for Urinary Incontinence in Adult Women: Diagnosis and Comparative Effectiveness”. [Internet] Rockville: Agency for Heathcare Research and Quality (US), 2012 (Comparative Effectiveness Review No. 36). Accessed November 2014