Does menopause affect the results of pelvic floor physiotherapy in women with urinary incontinence?

Urinary incontinence is a common condition and current guidelines recommend conservative management (not drugs or surgery) as first line treatment1.

A trial of pelvic floor muscle training (PFMT) of at least 3 months should be offered2 as it has been reported women receiving regular supervision are more likely to comply and report improvement than women doing PFMT with little or no supervision3.

Oestrogen deficiency after menopause causes atrophic changes to the urogenital tract and is associated with urinary symptoms4Oestrogens increase urethral closure pressure, and improve cellular maturation in the urethra and vagina5.

.Nygaard et al’s study on the ‘Impact of menopausal status on the outcome of pelvic floor muscle training in women with urinary incontinence’, evaluated the effectiveness of PFMT in pre and post-menopausal women using a quality of life questionnaire (retrospective study)6.

Eighty-two women in the study were divided into 2 groups: pre and post menopausal, as confirmed by menstrual history. Reported UI symptoms (frequency, urgency, leakage) were similar in both groups with nocturia significantly higher in the post-menopausal group.

A period of supervised PFMT resulted in significant improvement in symptoms in both groups. Obesity (BMI higher in post-menopausal group) and HRT failed to reach statistical significance as confounding factors for improvement in menopausal women.

The authors state that ‘The similar outcomes point out that both groups were able to apply and benefit from motor learning strategies and adopt functional training to improve their urinary symptoms in similar ways, irrespective of hormonal status or HRT and BMI category’.

This study highlights that women of all ages can benefit from training of local PFM neuro-muscular control and learning reflex, guarding strategies for the PFMs.

 

  1. Thuroff JW et al (2011) EAU guidelines on urinary incontinence. Eur Urol 59(3):387-400
  2. National institute for health and care excellence (2006) Urinary incontinence: the management of urinary incontinence in women. Clinical guideline 40.
  3. Hay-Smith EJ et al (2011) Comparisons of approaches to pelvic floor muscle training for urinary incontinence in women. Cochrane database Syst Rev 12, CD 009508
  4. Robinsons D et al (2003) The role of oestrogens in female lower urinary tract dysfunction. Urology 62(4): 45-51
  5. Cardozo et al. Meta analysis of oestrogen therapy in the management of urogenital atrophy in post-menopausal women: second report of the hormones and urogenital therapy committee. Obstet Gynecol 92:722-727
  6. Nygaard CC et al. Impact of menopausal status on the outcome of pelvic floor physiotherapy in women with urinary incontinence. Int Urogynecol J (2013) 24:2071-2076