Study design, materials and methods
A prospective study was conducted in a tertiary urogynecology center which included women with urinary incontinence who referred for pelvic floor training program from 2011 to 2018. All women presented with urinary incontinence underwent a medical consultation by gynecologist using a standard consultation form. They completed a validated Urinary distress inventory short form (UDI-6) and Incontinence impact questionnaire questionnaires (IIQ-7) in Chinese1 by herself in the first and last session of pelvic floor training program. The program was led by specialized continent advisor which consisted of a teaching session on life style, drinking and voiding habit and pelvic floor exercise with bladder retraining, followed by 2-3 sessions of individual tutorial on pelvic floor training. Urodynamic study was arranged for them which were investigated using Laborie Urodynamics, Aquarius system, (Laborie, Canada) in a standard protocol. Treatment outcome was assessed by using the UDI-6 and IIQ-7 scores before and after the training program.
An analysis was carried to assess the change of UDI-6 and IIQ-7 scores before and after the pelvic floor training program and also any associated factors. Statistical analysis using student T test and one-way ANOVA were performed with SPSS 22.0 software (SPSS, Inc, Chicago, IL). Ethics approval and informed consent was obtained.
Results
Total of 1256 women were referred for pelvic floor training program, 376 did not attend the program, 237 being unable to answer the questionnaires, 200 women either did not complete the program or with the questionnaires being incomplete, leaving 443 women who were included for analysis. The mean age of the women was 60.7 years old (SD 11.9) with median parity of 2 (1-3), and mean BMI of 24.7 kg/m2 (SD:4.0). The mean follow up time was 9.2 (4.7) months. Two hundred and sixty-six women (60.0%) were post-menopausal and 237/443 (53.5%) were sexually inactive. All of them reported urinary symptoms with 354/443 (79.9%) of them reported stress urinary incontinence, 259/443 (58.5%) with urge urinary incontinence and 137/443 (30.9%) were having other urinary problems. Total of 274 women had urodynamic study, 106/274 (38.7%) were diagnosed with urodynamic stress incontinence and 37/274 (13.5%) were with detrusor overactivity. 14/274 (5.1%) of them had both urodynamic stress incontinence and detrusor overactivity and 107/274 (39.1%) had no abnormality detected. Both of the UDI-6 and IIQ-7 scores were reported to be improved after the training program with the mean UDI-6 scores from 38.9 (19.2) to 29.3 (17.9); the mean IIQ-7 score was from 26.8 (23.2) to 19.4 (21.9). The mean difference of the UDI-6 was 9.5 (17.2) and IIQ -7 was 7.3 (19.9). Age, vaginal parity, body mass index, history of smoking, history of diabetic Mellitus, sexual activity and urodynamic diagnosis were not associated with mean difference of UDI-6 or IIQ-7 but only the compliance of pelvic floor exercise and menopausal status were significantly associated. (Table 1)
Interpretation of results
Women presented with urinary incontinence reported improvement after the pelvic floor training program with mean improvement of UDI-6 score of 38.9 and IIQ-7 score of 29.3. Menopausal women had significantly more improvement than pre-menopausal women and compliance of pelvic floor exercise is also associated with better improvement in IIQ-7 scores.