Education and women's pelvic floor muscle function
Urinary incontinence is a prevalent condition among women of all ages and has a considerably negative effect on quality of life. Despite this, most women lack knowledge regarding pelvic floor dysfunctions and treatment options. Many people who do research into clinical or educational interventions related to the pelvic floor specifically enroll women with incontinence in their studies.
However, a new study has been performed in an unselected group of women from the community, who were not required to have diagnosed incontinence to participate in the study. Why would the investigators do that?
Well, educational programs about the pelvic floor muscles can include information about pelvic floor muscle function, dysfunction and options for treatment. By drawing women in the community, such an educational program could facilitate the search for treatment, especially conservative options.
The educational intervention also included teaching of "the Knack", which is a strategy wherein women contract their pelvic floor muscles before and during activities that cause increased intra-abdominal pressure. The researchers wondered whether teaching the Knack to a general population of women from the community would improve their ability to contract their pelvic floor without further specific training of the pelvic floor muscles.
Among the women drawn from the community who participated in the study, almost none had urinary incontinence all the time but about half had it at some times.
The trial randomised 50 women to receive an education lecture weekly for 4 weeks (the experimental group) and 49 women to a control group that received no intervention. At the end of the 4-week period, the educational intervention hasn't made much difference to the ability to contract the pelvic floor muscles, or the severity of urinary incontinence. Most women reported no sexual activity, so the researchers couldn't really assess that.
However, the women's knowledge about the pelvic floor improved significantly. Women in the experimental group were about 1.5 times more likely to locate the pelvic floor muscles correctly, about twice as likely to know the functions of the pelvic floor muscles, about 3 times more likely to know the range of dysfunctions related to the pelvic floor muscles, and nearly 4 times more like to know the available treatment options.
So, even though many of the women may not've had much problem with their pelvic floor muscles during the study, they were better prepared to recognise any future dysfunction and seek appropriate help.
What does that mean for clinical practice?
Well there's a lot to consider. There wasn't any evidence of harm but the benefits would need to be weighed up against the cost. Education - although very effective for improving knowledge and understanding among the women - doesn't seem to be a substitute for specific pelvic floor muscle training.
Although not exclusively picked to have incontinence, many of the women did has at least some symptoms and the education didn't improve their signs and symptoms related to that. But at least they're more likely to recognise the problem, recognise that it is treatable, and seek an appropriate treatment option.
Want to read deeper into this topic? Have a look at the free full text version of this article published in Journal of Physiotherapy!
> From: Ferreira, J Physiother 64 (2018) 91-96. All rights reserved to the Australian Physiotherapy Association. Click here for the online summary.