Conservative treatments, a nonsurgical therapy, include improving the lifestyle, bladder training, pelvic floor muscle exercises, biofeedback, and the electrical stimulation of pelvic muscles [ 7 ]. They were first described in by the American gynecologist Anold Kegel. They are the most cost-effective treatment and differ from other therapies in that the patients can do them by themselves anytime, anywhere, while doing other work, and without regular hospital visits.
The patients simply need to be trained in how to contract their pelvic floor muscles. Most studies show that Kegel exercises steadily reinforce the pelvic muscles [ 8 ]. However, in practice the results of patients vary depending on whether they exercise their pelvic floor muscles after identifying them, how earnestly they exercise, and how much trust they place in the exercises themselves.
Hence, these study results need to be critically evaluated with respect to actual practice [ 9 ]. Also, several studies have reported systematic reviews on pelvic floor muscles exercises but have covered the female urinary incontinence with stress, urge, and mixed UI or have dealt with all nonsurgical treatment including drugs [ 8 , 10 — 12 ]. Therefore, the effects of Kegel exercises on urinary incontinence will be verified through a systematic review of the results of the randomized controlled trials RCTs in the literature, forming a basis for the suggestion that Kegel exercises are an economic intervention which can be understood and performed by both patients and nurses alike.
The search date was April Among the references searched, randomized control trials on female urinary incontinence patients undergoing Kegel exercises as the main intervention that report one or more major or secondary results were selected. Excluded were studies combining Kegel exercises with biofeedback or electrical stimulation therapy and those not published in either English or Korean.
After removing overlapping references from the primary search, papers were selected to match the inclusion and exclusion criteria. The first round of selection was based first on the title and abstract of each reference and the second on a more in-depth analysis. The reference selection process was first independently performed, and then a discussion was to be conducted in case of disagreement, and the third party intervention principle was applied if necessary.
However, no disagreement occurred. The methodological quality of selected studies was analyzed by two review authors independently using risk of bias RoB tool developed by Cochrane Collaboration.
Disagreements were resolved by discussion and consensus. Relevant data, such as the subject inclusion or exclusion criteria, baseline demographic and clinical characteristics of the study participants, treatment protocols, the follow-up period, and the outcome variables of each study, were consolidated using a standardized form.
The selected eleven studies were analyzed using Review Manager RevMan version 5. For all statistical comparisons, differences with a were considered significant. The -squared test was used to identify heterogeneity, and the chi-squared test was used to detect statistical heterogeneity. When heterogeneity was present , the data were analyzed using the random effect model.
In the absence of heterogeneity, a fixed effect model was applied. A total of candidate papers were obtained through electronic reference searches, and remained after excluding overlapping ones. After exclusion of papers according to the inclusion and exclusion criteria by titles and abstracts, 41 papers remained and from those 11 were finally selected, leaving a total of subjects. The detailed reference selection process is presented in the flow chart Figure 1.
Kegel exercises have been regularly studied from to by 11 selected references. They were most actively studied in Europe in the s and in Brazil since , not to mention two Korean studies, indicating a worldwide interest in Kegel exercises as a nursing intervention.
The general age of the subjects was 40s to 50s in seven papers and 60s and over in four papers. There were subjects in total, all of whom were middle-aged women of 40 and over exhibiting SUI and the studies themselves were relatively small scale, involving between 20 and 82 subjects each.
The Kegel exercises were mainly taught by professional physical therapists and varied by the number of contractions, five to six, and the number of times a day, 24 to Other variations involved elevation of the intensity of the contraction. Eight of the eleven selected studies satisfied all assessment items Figure 2 and three [ 16 — 18 ] were sufficient for appropriate random sequence generation but did not adequately describe allocation concealment.
The blinding of intervention and outcomes were unsatisfactory in five studies [ 15 — 19 ]. Although various difference scales were used to measure patient responses to treatment in the selected studies, whatever the scale was, the data was included in the formal comparisons as long as the trials stated the number of women who perceived that they have been cured or improved, as defined by the trials.
Subjective assessments of improvements in SUI were measured in four studies [ 18 — 21 ]. As the relative risk was Thus, there was a statistically significant difference between the Kegel exercise group and the control group and there was insubstantial heterogeneity , in the measured studies Figure 3 a. Urinary incontinence symptoms were measured by a questionnaire in three studies [ 16 , 22 , 23 ].
Three studies measured urinary incontinence episodes for 7 days [ 15 , 19 , 24 ] through patient self-reported urinary diaries. Kegel exercises reduced urinary incontinence episodes with a standardized mean difference SMD of 1.
The effect size of the two groups was statistically significant , , and there was no heterogeneity , Figure 3 c. Pad tests were conducted in five studies by two different methods. One used a 1-hour pad test, presenting results as mean urine loss volumes g , and another used a standardized bladder volume and the third used mean pad weight. Three studies measured mean urine loss volumes [ 22 , 23 , 25 ].
Kegel exercise groups had an MD of 3. One study [ 20 ] reported only the mean but found that women doing Kegel exercises reported a mean pad weight increase of 3. Pelvic floor muscle pressure was measured in five studies [ 16 , 17 , 20 , 22 , 23 ] by using perineometer.
Pelvic floor muscle pressures were improved after Kegel exercises with a standardized mean difference SMD of 1. This study was a meta-analysis of the effects of Kegel exercises on SUI as a nursing intervention through the systematic consideration of the characteristics and methods of Kegel exercises of a total of subjects over 11 RCT studies.
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Michael Garcia-Roig, M. The best way to find the pelvic floor muscles is to stop urinating midstream. The muscles that are tightened to cut off the flow of urine are the same ones that Kegel exercises strengthen.
Kegel exercises are all about tightening and relaxing these muscles. Tighten the pelvic floor muscles and hold them for six seconds then relax them for six seconds.
Repeat the Kegel exercises five or six times in a row. Avoid tightening your abdominal and thigh muscles at the same time. Learn how we develop our content. To learn more about Healthwise, visit Healthwise. Healthwise, Healthwise for every health decision, and the Healthwise logo are trademarks of Healthwise, Incorporated. Rebecca Robert, M. Kegel Exercises. Topic Overview Kegel exercises make your pelvic floor muscles stronger. Doctors often prescribe Kegels for: Stress incontinence. This means leaking urine when you laugh, cough, sneeze, jog, or lift something heavy.
Urge incontinence. This is a need to urinate that is so strong you can't reach the toilet in time. Pelvic floor weakness due to childbirth.
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