Parkkinen A et al. (2004) Physiotherapy for female stress urinary incontinence: individual therapy at the outpatient clinic versus home-based pelvic floor training: a 5-year follow-up study. Neurourol Urodynam 23: 643–648

Conservative therapy is widely considered an appropriate first-line treatment for women with stress urinary incontinence, although few randomized controlled trials have been conducted in this area. A new study from Finland has compared clinic-based and home-based programs designed to improve the function of the pelvic floor muscles.

The 5-year study included 33 women with stress urinary incontinence. Those who lived more than 40 km from the hospital were allocated to home-based treatment (n = 17), which consisted of active pelvic floor muscle exercises and training with a vaginal ball. The remaining patients (n = 16) carried out a similar program and also received weekly electrical stimulation treatment at the outpatient clinic. All patients were instructed how to identify their pelvic floor muscles and were taught with biofeedback how to contract them.

Response to treatment was assessed using the urinary incontinence severity score (UISS) questionnaire, a 1-hour pad test and by measuring pelvic floor muscle strength. Both groups showed significant improvements at 4 months, 12 months and 5 years. The overall rate of cure or improvement in symptoms was 64%, with no significant difference between the groups.

In summary, home-based therapy was as effective as a clinic-based approach in the long-term treatment of these patients. The authors note that electrical stimulation treatment is useful in women who are unable to carry out pelvic floor muscle exercises. They also recommend that thorough instruction, motivation and follow-up are provided.