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Current Urology News |
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24 Feb 2006 |
PELVIC FLOOR EXERCISES
Pelvic floor exercises or kegals have been advocated in the treatment of urinary incontinence since 1950. Dr.Kegal taught his patients to forcefully contract the pelvic muscles to treat and prevent postpartum incontinence; PFEs are the simplest and prevent postpartum incontinence. PFEs are the simplest and least expensive method for pelvic floor rehabilitation.
Unfortunately, half of patients are unable to perform a proper contraction with simple instructions and up to one fourth will actually promote incontinence with their efforts. Indiscriminate recommendation of this therapy to all incontinent patients has created a negative bias that PFEs are just 'something to do' before pharmacologic or definite surgical treatment. It should also be acknowledged that Dr.Kegal routinely employed a perineometer with his patients in one of the first documented uses of bio feedback in medicine. This implies that Kegal exercises alone should not be considered the standard treatment for pelvic floor rehabilitation.
The first step beyond PFEs in cost and complexity is vaginal cones .Vaginal cones are a simple method of providing biofeedback in the home setting and are readily available for less than $ 50.The cone inserted into the vagina above the levator muscles , and biofeedback is produced when the patient feels the cone slipping down . She must tighten the pelvic muscles to retain the cone. When the patient is able to easily hold the lightest cone, a succession of heavier cones is used. This provides the patient biofeedback about improvement in strength. Six published series involving 189 patients demonstrate consistently good responses, with satisfaction rates of 40% to 70% among those complaints with therapy.
The primary problem with cones is also demonstrated in that there is a cumulative dropout rate of 27.5% that is remarkably similar throughout the different series. A substantial percentage of patients simply will not accept this form of therapy. There are many limitations in the use of cones. Many patients will not use any vaginal device, a substantial group will not even be able to retain the lightest cone, and some patients will retain the cones with use of thigh adductor muscles without proper levater contration.The cones are obviously not useful for the male incontinent patients. The most expensive of the basic methods of pelvic floor rehabilitation is home biofeedback.
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