Long-term effect of pelvic floor muscle exercise 5 years after cessation of organized training

Objective: To evaluate clinically and urodynamically the effect of pelvic floor muscle exercise on genuine stress incontinence 5 years after cessation of a structured training program. Methods: All 23 women who had participated in a 6-month intensive pelvic floor muscle exercise regimen participated in the follow-up study. Mean age was 50.7 years (range 30-70). The assessment included history by interview, use of subjective rating instruments (leakage index and social activity index), vaginal palpation, measurement of pelvic floor muscle strength by use of vaginal pressure measurement, cystometry, urethral pressure profiles during cough, and pad test with standardized bladder volume. Results: Three of 23 women had been treated surgically. Sixteen (70%) were exercising the pelvic floor muscles once a week or more. This included two of the women treated surgically. Of the 20 women not treated surgically, 70% were satisfied and did not want further treatment. Fifteen of 20 (75%) did not show any visible leakage during cough, and 11 had positive closure pressure during cough. There was a statistically significant increase in the scores of the leakage index and the pad test (P < .05) but not on the social activity index (P = .09). Pelvic floor muscle strength was reduced from a mean of 22 cm H2O (95% confidence interval [CI] 17-26.9) to 19.1 (95% CI 13.2-24.9) (P = .113) during the 5-year period. Conclusion: There was a significant increase in incontinence measured by pad test and leakage index 5 years after cessation of organized pelvic floor muscle exercise. However, 75% showed no leakage during stress test, and 70% were satisfied with the condition. Seventy percent were exercising the pelvic floor muscles at least once a week, and pelvic floor muscle strength was maintained.