Effectiveness of Pelvic Floor Muscle Training as Adjunctive Therapy for UI Still Unknown


There is not enough good evidence showing that pelvic floor muscle training benefits patients already receiving active treatment for urinary incontinence, finds a new Cochrane analysis.

More research is needed to determine whether adding pelvic floor muscle training (PFMT) to active treatment is beneficial to patients, according to an analysis of 11 previous trials by the Cochrane Incontinence Group.

The review included looking at women with stress urinary incontinence, urgency urinary incontinence, or mixed urinary incontinence. The reviewers compared pelvic floor muscle training in conjunction with another active treatment in 494 women with the same active treatment alone in 490 women.

In general, the reviewers found that there was insufficient evidence to evaluate the benefits or potential adverse effects associated with adding pelvic floor muscle training to another active treatment. Still, the authors urged caution in placing much value in the review because the review mostly included small, single trials.

“None of the trials in this review were large enough to provide reliable evidence,” the Cochrane authors concluded. “Also, none of the included trials reported data on adverse events associated with the PFMT regimen, thereby making it very difficult to evaluate the safety of PFMT.”

The review found that most of the trials did not report the primary outcomes of cure or improvement in the incontinence and also failed to report the effect of the patient’s quality of life. Most of the trials also measured outcomes in different ways, which affected the ability to effectively compare the evidence, leading the Cochrane authors to rate the quality of evidence as moderate to low.

One trial investigating women with stress urinary incontinence, urgency urinary incontinence, or mixed urinary incontinence found that a higher proportion of women who received a combination of PFMT and applied heat- and steam-generating sheets reported cure compared with those who received sheet treatment alone (19 [51%] of 37 vs 8 [22%] 37 with a risk ratio (RR) of 2.38; 95% confidence interval, 1.19 to 4.73).

Another trial found that more women reported a cure or improvement of incontinence when PFMT was added to vaginal cones than when vaginal cones was the sole treatment. However, this finding was not statistically significant, with a 95% confidence interval of 0.94 to 1.71. (More on vaginal cones for urinary incontinence here.)

Furthermore, there were no statistically significant differences between women with any of the 3 types of incontinence who received PFMT added to bladder training and those who received only bladder training.

Pertinent Points:
- There is little evidence about the effectiveness of adding pelvic floor muscle training to another treatment when seeking to cure or improve incontinence in women, according to a Cochrane review of 11 studies.
- The reviewers found that none of the trials reviewed were large enough to provide reliable evidence of the potential benefit or harm of adding pelvic floor muscle training.



Ayeleke RO, Hay-Smith EJC, Omar MI. Pelvic floor muscle training added to another active treatment versus the same active treatment alone for urinary incontinence in women.

Cochrane Database Syst Rev.

2013;11:CD010551. DOI: 10.1002/14651858.CD010551.pub2.

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