Pelvic floor muscle exercises in the treatment of urinary incontinence in women – a critical review and meta-analysis

Introduction
The occurrence of involuntary urine leakage significantly impairs the comfort of patients' life, negatively affects their social relations and deteriorate their health. Preventative treatment, including pelvic floor muscle training, is suggested in the early stages of diagnostic and therapeutic management. Pelvic floor muscle (PFM) exercises are a preventative treatment method for stress urinary incontinence. The aim of this systematic review and meta-analysis was to determine the treatment effectiveness of pelvic floor muscle training in women with stress urinary incontinence.

Material and methods
Electronic academic databases, PubMed and EbscoHost, were searched. A mean difference (MD) measure with 95% confidence interval (CI) was used to assess the effect size. The pooled effect size of the meta-analysis was calculated for the random effect model. The I2 test was used to assess heterogeneity. Furthermore, Physiotherapy Evidence Database Scale was used to evaluate the methodological quality of randomized control trials.

Results
A total of 7 articles, out of 135 identified papers, met the inclusion criteria. Meta-analysis revealed significant differences between the PFM training group and the group without active treatment in terms of total vaginal pressure (perineometry) (MD: -3.35; 95% CI: -4.48 to -2.21; p<0.001), urine loss (measured by 1-hour pad test) (MD: -3.35; 95% CI: -4.48 to -2.21; p<0.001), and pelvic floor muscle strength (MD: 1.67; 95% CI: 1.41 to 1.92; p<0.001).

Conclusions
PFM training is an effective form of treatment for stress urinary incontinence in women.