PELVIC MUSCLE EXERCISES - WHEN DO THEY WORK

Objective: To identify urodynamic indices that can predict the outcome of pelvic muscle exercises in women with genuine stress urinary incontinence. Methods: Thirty-six women with genuine stress urinary incontinence were evaluated during a 6-month period. Urodynamic studies were performed before and 3 months after completion of a program of Kegel pelvic muscle exercises. Subjective symptoms and objective loss of urine as well as pad count were used to evaluate the outcome of the exercise program. A receiver-operating characteristic curve was used to assess the prognostic value of the pressure transmission ratio between the abdomen and urethra. Results: Twenty patients (56%) were cured or substantially improved 3 months after completing the pelvic muscle training, whereas 16 were unchanged. The urethral closure pressure significantly increased in the subjects cured or improved. After successful training, significant changes were noted in the pressure transmission ratio between the abdomen and urethra on cough. Six of seven subjects with mild incontinence responded favorably, whereas 13 of 15 with severe incontinence did not improve after the training. The pressure transmission ratio plotted on a receiver-operating characteristic curve was found to have optimal predictive value at the 80% level. Conclusion: Kegel pelvic muscle exercises give a better outcome in women with mild stress urinary incontinence and/or with a pressure transmission ratio between the abdomen and urethra of 80% or more.