Effect of Home-Based Pelvic Floor Muscle Rehabilitation on Severity, Frequency, and Volume of Urinary Leakage among Women with Incontinence

Abstract

Abstract : Introduction: Urinary incontinence (UI) is a prevalent condition affecting women's Quality of Life (QoL) worldwide. Physiotherapy, particularly Home-Based Pelvic Floor Muscle Rehabilitation (HB-PFMR), has shown promise in managing UI symptoms. Aim: This study aimed to assess the effectiveness of HB-PFMR in reducing the severity, frequency, and volume of urinary leakage among women with UI in the Kingdom of Bahrain. Further objectives are to investigate the HB-PFMR's effect on the QoL among women with UI. Method: The study employed a quasi-experimental design with pre-test and post-test assessments to evaluate the impact of the intervention on the targeted outcomes. A convenient sample of 62 women with UI who met the inclusion criteria were randomly assigned to the study group receiving HB-PFMR (n=32) and the control group receiving the routine Kegel exercise (n=30). Initially participants of both groups were assessed for the type of UI by using 3-Incontinence questionnaire (3IQ), severity by using the incontinence severity index (ISI), frequency and volume of urinary leakage by using International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form (ICIQ-UI SF), and QoL by using King's Health Questionnaire (KHQ). The study group underwent HB-PFMR, consisting of five different Kegel exercises and five functional approach exercises performed daily, which were selected based on established physiotherapy guidelines and evidence from previous studies demonstrating their efficacy in improving pelvic floor muscle strength and function. In contrast, the control group performed routine Kegel exercises twice daily, with 25 repetitions per session. Both groups participated twice weekly and had live training sessions for over a month. Women were monitored through log sheets and daily communication. Both groups were reassessed for UI severity, frequency, volume, and QoL after the intervention using the same validated tools employed at baseline. Data were analyzed using statistical methods, including paired t-tests and ANOVA, to compare pre-test and post-test outcomes within and between groups, ensuring the reliability and validity of the results. Results: Overall, the study group demonstrated significant improvements in managing UI. A substantial reduction in the severity of urinary leakage was noted, decreasing from 34.4% at baseline to just 3.1% post-study. Moreover, a significant improvement was observed in the frequency of urinary leakage among women who practiced HB-PFMR. The percentage of women reporting no urinary incontinence increased from 0% at baseline to 53.1% after the intervention, whereas no improvement was observed in the control group. The study group also experienced a reduction in leakage volume from 18.8% reporting large amounts of leakage pre-intervention to 0% post-intervention. Additionally, 56.2% of the study group reported no bladder problems post-intervention, compared to only 13.3% in the control group (p=0.003). Conclusion: It is concluded that HB-PFMR is an effective non-pharmacological intervention in reducing the severity, frequency, and volume of urinary leakage among women with UI and their overall QoL. This study highlights the need for integrating physiotherapy interventions like HB-PFMR into standard care as an evidence-based practice for women with UI, potentially improving healthcare strategies and decision-making in the Kingdom of Bahrain. Keywords: Women's Health, Quality of Life, Pelvic Floor Disorder, Exercise Training, Urinary incontinence.