Voiding dysfunction in women without neurological medical history is a heterogeneous situation with investigation going on currently [1]. Usually, those women are visiting urologists complaining about incomplete bladder feeling, urinary retention and recurrent urinary tract infections (UTIs). In this study, we examined the efficacy of pelvic floor muscle training (PFMT) in women with non-neurogenic lower urinary tract dysfunction (LUTD).

This is an observational study including non-neurological women with LUTD, pooled from the urodynamics office of our department. All patients underwent a cystoscopy, a cystogram, an uroflow, a post void residual (PVR) estimation and a urodynamic study (UDS) at the baseline. Patients with urethral stricture and obstructive bladder neck have been excluded.The voiding pattern has been classified according to Blaivas-Groutz nomogram. Then, women were advised to a specific PFMT protocol for 6 months, executed in a physiotherapy center. After the end of treatment, all patients were re-evaluated with an uroflow, a PVR and a UDS. Clinical follow-up lasted for one year. The collected data were statistically analyzed with SPSS v22.0 with the appropriate methods for non-parametric samples.

Finally, 48 women with a mean age of 67.5y.o. completed the study. At the baseline, 20 (41.67%) reported a medical history of at least 3 UTIs in the last year and 12 (25%) at least one episode of urine retention at the same time. Moreover, 10 (20.83%) patients with a PVR larger than 100ml were advised to be self-catheterized upto three times daily.The mean maximum flow rate (Qmax) was 6.5ml/sec, while the mean total flow time has been measured at 21.5sec and the mean PVR was 120ml. The UDS revealed that 38 (79.17%) women were obstructive, 16 (42.1%) with a mild, 14 (36.84%) with a moderate and 8 (21.05%) with a severe obstruction. The rest 20.83% were non-obstructive and none of them had detrusor deficiency. After PFMT, the mean Qmax was 8.25ml/sec and the mean voiding time was 18.5sec, with no significant difference to the baseline (p= 0.16 and p= 0.27 respectively). The mean PVR has been measured at 60ml, significantly reduced (p= 0.02). More specifically, after PFMT, only 2 (4.17%) patients needed self-catheterization up to a maximum of twice daily.  Regarding to the UDS re-evaluation, 33 (68.75%) women remained obstructive, 22 (66.67%) of them has a mild, 8 (24.24%) a moderate and 3 (9.09%) a severe obstruction. No detrusor deficiency has been recorded, while the rest 15 (31.25%) were non-obstructive. After one year of follow-up, only 5 (10.42%) patients reported UTIs with no more than two episodes and there were no cases of retention.

The non-neurogenic lower urinary tract dysfunction in women may be a wide filed of research currently and in the future and a lot of data could be collected and evaluated in the basic research [2]. However, urologists have to find the way of treatment for those women complaining for LUTS and usually UTIs [3]. Pelvic floor muscle training seems to improve PVR and minimizes UTIs, although the urodynamic control is not significantly changed. Actually, conforming pelvic floor activity should permit a voiding with the minimum peripheral resistance.

A six-month course of pelvic floor muscle training could be beneficial for women with non-neurogenic LUTD, reducing PVR and UTIs episodes, despite not affecting significantly the urodynamic parameters.

Groutz A, Blaivas JG, Pies C, et al. Learned voiding dysfunction (non-neurogenic, neurogenic bladder) among adults. Neurourol Urodyn. 2001;20:259–268.
Panicker, J. N., Anding, R., Arlandis, S., et al.?Do we understand voiding dysfunction in women? Current understanding and future perspectives: ICI-RS 2017. Neurourology and Urodynamics, 37(S4), S75–S85.?doi:10.1002/nau.23709
Haylen BT, De Ridder D, Freeman RM, et al. An international urogynecological association (IUGA)/international continence society (ICS) joint report on the terminology for female pelvic floor dysfunction. Neurourol Urodyn. 2010;29:4–20.