IAGS
39:785-791, 1991
Pelvic Muscle Exercise for Stress Urinarv Incontinence in Elderlv Women J
J
Thelma I. Wells, PhD, RN,* Carol A. Brink, MPH, RN,* Ananias C. Diokno, MD,t Robert Wolfe PhD,$ and Grace L. Gillis, MA tj
Purpose: To compare pelvic muscle exercise to pharmacologic treatment of stress urina y incontinence, the most common cause of urine leakage reported by communityliving elderly women. Subjects: Convenience sample of 157 community-living women, aged 55 to 90 years, after completion of a comprehensive diagnostic evaluation. Methods: Eighty-two subjects were randomly assigned to the exercise protocol (with a 34% attrition rate). Pelvic muscle exercises were taught and monitored for 6 months. Phenylpropanolamine hydrochloride was given to the other group in a dose of 50 mg a day, increasing to
50 mg twice a day.
S
The literature contains 19 studies of women 55 years of age and older treated with PME as the only therapy but with varying methodologic or no treatment, or weight contrasted to or combination PME and faradism or PME and interfarential therapy.25Four studies focused on PME in an exclusively older sample.'*-*' Overall interpretation of findings is limited, especially in earlier studies, by inadequate reporting, small sample size, and unrevealing design characteristics. In general, the treatment was found to be effective; rates of cure or improvement were usually greater than 60%. The outcome of PME was not as successful as surgery in two studies. It was no better than weight loss only in a study flawed by a failure to randomize and by inadequate reporting. In one study, intensive hospital training was found to be better than home instruction; the addition of faradism or interfarential therapy yielded no significant benefit.25Both use of a resistive d e v i ~ e ' ~and , ' ~ biofeedback approaches'4f20have uncertain effects with conflicting findings. Given the limited studies on PME in older women and the overall limitation of PME research, further study is needed. Pharmacologic treatment of stress urinary incontinence has used primarily alpha-adrenergic agonists, either alone or in combination with estrogenz6 The mechanism of action is stimulation of alpha-adrenergic receptors located in the urethra, thereby increasing
tress urinary incontinence is the most common cause of urinary leakage reported by community living older While surgery is a frequent treatment, it is costly, has risk, and is not useful for many older women who are either physically ineligible or fearful of hospitalization and operations. Alternative treatment includes pelvic muscle exercise and pharmacologic therapies. Pelvic muscle exercise (PME), also known as Kegel or post-partum exercise, has been a treatment for stress urine loss for at least a ~ e n t u r yThe . ~ theory underlying this treatment is that, through a learned program of muscle reeducation, the pubococcygeous muscle, which by proximity exerts a closing force on the urethra, will increase in strength and size with a corresponding increase in urethral resistance.6
From the *University of Rochester, School of Nursing, Rochester, New York; tWilliam Beaumont Hospital, Royal Oak, Michigan, the University of Michigan Medical School, and $The University of Michigan School of Public Health; and the §Department of Internal Medicine, the University of Michigan Hospital, Ann Arbor, Michigan. The study was funded by the National Institute on Aging (ROlAG03542). Portions of this paper w a e presented at the Gerontological Society of America Annual Scientific Meeting, Washington, DC, November 21, 1987. Address correspondence and reprint requests to Dr. T. J . Wells, University of Rochester, School of Nursing, 601 Elmwood Avenue, Box HWH, Rochester, NY 14642.
39:785-791, 1991
Pelvic Muscle Exercise for Stress Urinarv Incontinence in Elderlv Women J
J
Thelma I. Wells, PhD, RN,* Carol A. Brink, MPH, RN,* Ananias C. Diokno, MD,t Robert Wolfe PhD,$ and Grace L. Gillis, MA tj
Purpose: To compare pelvic muscle exercise to pharmacologic treatment of stress urina y incontinence, the most common cause of urine leakage reported by communityliving elderly women. Subjects: Convenience sample of 157 community-living women, aged 55 to 90 years, after completion of a comprehensive diagnostic evaluation. Methods: Eighty-two subjects were randomly assigned to the exercise protocol (with a 34% attrition rate). Pelvic muscle exercises were taught and monitored for 6 months. Phenylpropanolamine hydrochloride was given to the other group in a dose of 50 mg a day, increasing to
50 mg twice a day.
S
The literature contains 19 studies of women 55 years of age and older treated with PME as the only therapy but with varying methodologic or no treatment, or weight contrasted to or combination PME and faradism or PME and interfarential therapy.25Four studies focused on PME in an exclusively older sample.'*-*' Overall interpretation of findings is limited, especially in earlier studies, by inadequate reporting, small sample size, and unrevealing design characteristics. In general, the treatment was found to be effective; rates of cure or improvement were usually greater than 60%. The outcome of PME was not as successful as surgery in two studies. It was no better than weight loss only in a study flawed by a failure to randomize and by inadequate reporting. In one study, intensive hospital training was found to be better than home instruction; the addition of faradism or interfarential therapy yielded no significant benefit.25Both use of a resistive d e v i ~ e ' ~and , ' ~ biofeedback approaches'4f20have uncertain effects with conflicting findings. Given the limited studies on PME in older women and the overall limitation of PME research, further study is needed. Pharmacologic treatment of stress urinary incontinence has used primarily alpha-adrenergic agonists, either alone or in combination with estrogenz6 The mechanism of action is stimulation of alpha-adrenergic receptors located in the urethra, thereby increasing
tress urinary incontinence is the most common cause of urinary leakage reported by community living older While surgery is a frequent treatment, it is costly, has risk, and is not useful for many older women who are either physically ineligible or fearful of hospitalization and operations. Alternative treatment includes pelvic muscle exercise and pharmacologic therapies. Pelvic muscle exercise (PME), also known as Kegel or post-partum exercise, has been a treatment for stress urine loss for at least a ~ e n t u r yThe . ~ theory underlying this treatment is that, through a learned program of muscle reeducation, the pubococcygeous muscle, which by proximity exerts a closing force on the urethra, will increase in strength and size with a corresponding increase in urethral resistance.6
From the *University of Rochester, School of Nursing, Rochester, New York; tWilliam Beaumont Hospital, Royal Oak, Michigan, the University of Michigan Medical School, and $The University of Michigan School of Public Health; and the §Department of Internal Medicine, the University of Michigan Hospital, Ann Arbor, Michigan. The study was funded by the National Institute on Aging (ROlAG03542). Portions of this paper w a e presented at the Gerontological Society of America Annual Scientific Meeting, Washington, DC, November 21, 1987. Address correspondence and reprint requests to Dr. T. J . Wells, University of Rochester, School of Nursing, 601 Elmwood Avenue, Box HWH, Rochester, NY 14642.
