Adult conservative management

TLDR: was included in the ICI 5 edition PFMT (24) vs PFMT + resistance device (28) 52 Women with SUI or MUI (stress predominant) PFMT: 5 quick and 5 slow (sustained), high-intensity contractions daily.

Abstract: was included in the ICI 5 edition PFMT (24) vs PFMT + resistance device (28) 52 Women with SUI or MUI (stress predominant) PFMT: As below without device PFMT +resistance; 5 quick and 5 slow (sustained), high-intensity contractions daily. Advised to hold contractions as long as possible, relaxing their PFM for an equivalent time before repeating the process. Intravaginal resistance: instructions to use the Pelvic-Toner Device concurrently whilst exercising. Two clinic visits and one phone call Reported cure (based on the Q11 of the ICIQFluts) PFMT 0/13 PFMT+resistance 1/15 Non-sign. difference btw groups (p=0.429) Improvement (post-Tx) PFMT 10/19 PFMT+resistance 11/21 Non-sign. difference btw groups 16 weeks of treatment, outcomes assessed at post-Tx and at 6 month follow-up Dropouts (at 6 month) PFMT 9/24 PFMT + resistance 15/28

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Newcastle University ePrints - eprint.ncl.ac.uk
Dumoulin C, Adewuyi T, Booth J, Bradley C, Burgio K, Hagen S, Hunter K,
Imamura M, Morin M, Morkved S, Thakar R, Wallace S, Williams K.
Adult conservative management.
In: Abrams P, Cardozo L, Wagg A, Wein A, ed. Incontinence: 6th International
Consultation on Incontinence, Tokyo, September 2016. Bristol, UK:
International Continence Society (ICS) and International Consultation on
Urological Diseases (ICUD), 2017, pp.1443-1628.
Copyright:
Copyright © ICS 2017. This book chapter may be downloaded for personal use only. Any other use
requires prior permission of the author and the publisher.
URL link to article:
https://www.ics.org/education/icspublications/icibooks/6thicibook
Date deposited:
31/10/2017
Embargo release date:
01 November 2018

1
Committee 12
ADULT CONSERVATIVE
MANAGEMENT
Chair
C. DUMOULIN (CANADA)
Members
T. ADEWUYI (UK)
J. BOOTH (UK)
C. BRADLEY (USA)
K. BURGIO (USA)
S. HAGEN (UK)
K. HUNTER (CANADA)
M. IMAMURA (UK)
M. MORIN (CANADA)
S. MORKVED (NORWAY)
R. THAKAR (UK)
S. WALLACE (UK)
K. WILLIAMS (UK)
The present chapter would not have been possible without the work of the previous editors, Katherine Moore
[2013], Jean hay Smith [2008] and don Wilson [2000, 2004]. They produced the remarkable framework for
the present review. In addition, we would like to acknowledge the indispensable contribution of Pauline
Campbell to the reviewing, analysis and reporting of POP section. Finally, this chapter would not have been
possible without the untiring dedication of Yvonne Ruella.

2
CONTENTS
INTRODUCTION 6
URINARY INCONTINENCE IN WOMEN 7
1. Lifestyle Modification Interventions .......... 7
1.1. Prevention ................................................... 8
1.2. Treatment ..................................................... 8
1.2.1 Weight Loss by Obese or Overweight
Women ......................................................... 8
1.2.2 Physical Activity ........................................ 10
1.2.3 Strenuous Physical Activity ..................... 10
1.2.4 Smoking ..................................................... 10
1.2.5 Dietary Modification (Elimination Diet) .... 11
1.2.6 Constipation .............................................. 14
1.3. Other LUTS ................................................ 14
1.4. Factors Affecting Outcome ...................... 14
2. Pelvic Floor Muscle Training (PFMT) ....... 14
2.1. Prevention and Treatment (Pregnant and
Postnatal Women Only) ............................ 14
2.1.1 Is PFMT Effective in the Prevention of UI in
Childbearing Women? .............................. 14
2.1.2 Is PFMT Effective in the Treatment of UI in
Childbearing Women? .............................. 15
2.1.3 Is PFMT Effective in the Mixed Prevention
and Treatment of UI in Childbearing
Women? ..................................................... 16
2.2. Prevention (Other Women) ....................... 22
2.3. Treatment (Other Women) ........................ 22
2.3.1 Is PFMT Better than No Treatment, a
Placebo, or a Control Group Treatment? 22
2.3.2 Is One Type of PFMT Programme Better
than Another?............................................ 23
2.3.3 Is PFMT Better than Other Treatments? .. 43
2.3.4 Does the Addition of PFMT to Other
Treatments Add Benefit? .......................... 48
3. Weighted Vaginal Cones (VC) .................. 52
3.1. Prevention ................................................. 52
3.2. Treatment ................................................... 52
3.2.1 Are VC Better than No Treatment, Placebo
or Control Treatments? ............................ 60
3.2.2 Are VC As Effective as Other Treatments?
60
3.2.3 Are VC Combined with PFMT Better than
PFMT Alone? ............................................. 60
3.3. Other Lower Urinary Tract Symptoms
(LUTS)......................................................... 61
3.4. Factors Affecting Outcome ....................... 61
4. Electrical Stimulation (EStim) ................... 61
4.1. Prevention .................................................. 62
4.2. Treatment ................................................... 68
4.2.1 Is EStim Better than No Active Treatment
(Placebo, Sham, Control or No Treatment)
for Treatment of UI? .................................. 68
4.2.2 Is One Type of EStim Better than Another
in the Treatment of UI? .............................. 68
4.2.3 Is EStim Better than Other Treatments for
UI? .............................................................. 70
4.2.4 Does the Addition of EStim to Other
Treatments Add Any Benefit in the
Treatment of UI? ........................................ 70
4.3. Other LUTS ................................................ 72
4.4. Factors Affecting Outcome ....................... 72
5. Posterior Tibial Nerve Stimulation (PTNS)
.................................................................... 73
5.1. Prevention .................................................. 77
5.2. Treatment ................................................... 77
5.2.1 Is PTNS Better than No Active Treatment
(Placebo, Sham, Control or No Treatment)
for Treatment of UI? .................................. 77
5.2.2 Is One Type of PTNS Better than Another in
the Treatment of UI? .................................. 77
5.2.3 Is PTNS Better than Other Treatments for
Treatment of UI? ........................................ 77
5.2.4 Does the Addition of PTNS to Other
Treatments Add Any Benefit in the
Treatment of UI? ........................................ 80
5.3. Other LUTS ................................................ 82
5.4. Factors Affecting Outcome ....................... 82
6. Magnetic Stimulation (MStim)................... 82
6.1. Prevention .................................................. 83
6.2. Treatment ................................................... 83
6.2.1 Is MStim Better Than no Active Treatment
(Placebo, Control or no Treatment)?........ 83

3
6.2.2 Is One Approach to MStim Better than
Another? .................................................... 85
6.2.3 Is MStim Better than Other Treatments? . 85
6.2.4 Does the Addition of MStim to Other
Treatments Add Any Benefit in the
Treatment of UI? ........................................ 85
6.3. Other LUTS ................................................ 85
6.4. Factors Affecting Outcome ...................... 85
7. Scheduled Voiding Regimens .................. 85
7.1. Prevention ................................................. 87
7.2. Treatment ................................................... 87
7.2.1 What Is the Most Appropriate Bladder
Training (BT) Protocol? ............................ 87
7.2.2 Is BT Better than No Treatment, Placebo or
Control Treatments? ................................. 89
7.2.3 Is BT Better than Other Treatments? ....... 89
7.2.4 Can Any Other Treatment Be Added to BT
to Add Benefit? ......................................... 90
7.2.5 Does the Addition of BT to Other Treatment
Add Benefit? .............................................. 90
7.2.6 Is Timed Voiding Effective at Treating UI?
91
7.3. Other LUTS ................................................ 91
7.4. Factors Affecting Outcome ...................... 92
8. Complementary and Alternative Medicines
.................................................................... 92
8.1. Prevention ................................................. 93
8.2. Treatment ................................................... 93
8.2.1 Acupuncture for Treatment of SUI ........... 93
8.2.2 Acupuncture for Treatment of OAB, UUI
and Mixed UI .............................................. 93
9. Future Research Directions ..................... 95
9.1. Summary .................................................... 95
9.2. Recommendations for practice ................ 95
9.2.1 Lifestyle Intervention ................................ 95
9.2.2 PFMT (Principal Recommendation) ......... 95
9.2.3 Cones ......................................................... 96
9.2.4 EStim .......................................................... 96
9.2.5 PTNS .......................................................... 96
9.2.6 Magnetic Stimulation ................................ 96
9.2.7 Bladder Training ........................................ 97
9.2.8 Complementary and Alternative Medicine
97
9.3. Future Research Direction ....................... 97
9.3.1 Lifestyle Modification Intervention ........... 97
9.3.2 PFMT in Antenatal and Postnatal women 97
9.3.3 PFMT in Women (Others) .......................... 97
9.3.4 Vaginal Cones ............................................ 98
9.3.5 EStim/PTNS/MStim .................................... 98
9.3.6 Scheduled Voiding Regimen .................... 98
PELVIC ORGAN PROLAPSE (POP) 98
1. Lifestyle Modification Intervention ........... 98
1.1. Prevention .................................................. 98
1.1.1 Quality of Data ........................................... 98
1.1.1.1 Association Between POP and
Occupation and Physical Activity........ 98
1.1.1.2 Association Between POP and Body
Weight .................................................... 99
1.1.1.3 Association Between POP and Smoking
............................................................... 99
1.1.1.4 Association Between POP and Bowel
Function .............................................. 105
1.1.1.5 Association Between POP and Nutrition
............................................................. 105
1.1.2 Results ..................................................... 105
1.1.2.1 Association Between POP and
Occupation and Physical Activity...... 105
1.1.2.2 Association Between POP and Body
Weight .................................................. 106
1.1.2.3 Association Between POP and Smoking
............................................................. 106
1.1.2.4 Association Between POP and Bowel
Function .............................................. 106
1.1.2.5 Association Between POP and Nutrition
............................................................. 107
1.2. Treatment ................................................. 107
2. Pelvic Floor Muscle Training .................. 108
2.1. Prevention ................................................ 108
2.2. Treatment ................................................. 109
2.2.1 PFMT Alone .............................................. 109
2.2.2 PFMT and Surgery ................................... 121
2.2.3 PFMT and Pessary ................................... 124
3. Pessaries .................................................. 126
3.1. Prevention of POP with Pessaries ......... 127
3.2. Treatment of POP with Pessaries ........... 127
3.2.1 Pessary Alone .......................................... 127

4
3.2.2 Pessary Versus no Treatment ................ 127
3.2.3 Pessary and PFMT .................................. 127
3.2.4 Pessary Versus Surgery ......................... 127
3.2.5 Comparison of One Pessary to Another 128
4. Recommendations .................................. 136
4.1. Recommendations for Practice .............. 136
4.1.1 Lifestyle Modification.............................. 136
4.1.2 Pelvic Floor Muscle Training (PFMT) ..... 136
4.1.3 Pessaries ................................................. 136
4.2. Future Research Directions ................... 136
4.2.1 Lifestyle Interventions ............................ 136
4.2.2 Pelvic Floor Muscle Training (PFMT) ..... 136
4.2.3 Pessarie for Prolapse ............................. 137
URINARY INCONTINENCE IN MEN 137
1. Lifestyle ................................................... 137
1.1. Weight Loss by Obese or Overweight Men
.................................................................. 137
1.2. Smoking ................................................... 138
1.3. Dietary Modification in Men .................... 138
2. Pelvic Floor Muscle Training (PFMT) ..... 154
2.1. Pre-Operative RP PFMT .......................... 154
2.2. Pre-Operative and/or Post-Operative RP
PFMT, Post RP Continence Status Not
Established Prior to Intervention ........... 154
2.2.1 Pre-Operative PFMT Instruction with Post-
Operative Home PFMT Versus Control .. 154
2.2.2 Pre-Operative PFMT Instruction Followed
by supervised Post-Operative PFMT
Versus Post-Operative PFMT ................. 155
2.2.3 Post-Operative PFMT Immediately Before
or After Catheter Removal (No Pre-
Operative Instruction) ............................. 155
2.3. Post-Operative RP PFMT for Incontinent
Men ........................................................... 156
2.3.1 PFMT with Digital Rectal Feedback (DRE)
After Radical Prostatectomy .................. 156
2.3.2 PFMT with BF After Radical Prostatectomy
157
2.3.3 PFMT Plus or minus BF with EStim or
MStim after Radical Prostatectomy ....... 157
2.3.4 PFMT Compared to or Plus Other
Interventions After Radical Prostatectomy
157
2.4. Pre-Operative TURP PFMT ..................... 158
2.5. Pre-Operative and/or Post-Operative TURP
PFMT ........................................................ 158
2.6. Post-Operative TURP PFMT for Incontinent
Men ........................................................... 158
2.7. Factors Affecting Outcome ..................... 158
2.8. PFMT for Other LUTS .............................. 159
2.8.1 PFMT for Post-Micturition Dribble (PMD)
159
3. Electrical Stimulation (EStim) ................. 159
3.1. Prevention of UI ....................................... 159
3.2. Treatment of UI ........................................ 159
3.2.1 Is EStim Better than No Treatment, Placebo
or Control Treatments? ........................... 159
3.2.2 Is One Approach to EStim Better Than
Another? .................................................. 159
3.2.3 Is EStim Better Than Other Treatments?159
3.2.4 Does the Addition of EStim to Other
Treatments Add Benefit? ........................ 159
3.3. Other LUTS .............................................. 159
3.4. Factors Affecting Outcome ..................... 159
4. Magnetic Stimulation (MStim)................. 159
4.1. Prevention of UI ....................................... 159
4.2. Treatment of UI ........................................ 159
4.2.1 Is MStim Better Than No Treatment,
Placebo or Control Treatment? .............. 159
4.2.2 Is One Approach to MStim Better Than
Another? .................................................. 159
4.2.3 Is MStim Better Than Other Treatments?
159
4.3. Other LUTS .............................................. 159
4.4. Factors Affecting Outcome ..................... 159
5. Penile Vibratory Stimulation (PVS) ........ 160
5.1. Prevention of UI ....................................... 160
5.2. Treatment of UI ........................................ 160
5.3. Other LUTS .............................................. 160
6. Scheduled Voiding Regimens ................ 160
6.1. Prevention of UI ....................................... 160
6.2. Treatment of UI ........................................ 160
6.2.1 Bladder Training ...................................... 160
6.2.2 Timed Voiding .......................................... 161
6.3. Other LUTS .............................................. 161
6.4. Factors Affecting Outcome ..................... 161