Title: Impact of physiotherapy on sexual function of women with stress urinary incontinence and a comparison of electrical stimulation versus standard physiotherapy
Funder: Department of Health (England)

Abstract: Background Urinary incontinence (UI) is defined by the International Continence Society as the ‘complaint of involuntary leakage of urine on effort or exertion, or on sneezing or coughing’ . Epidemiological studies suggest that UI affects up to 41% of the female population. It is a health burden and impacts not only on social, psychological, occupational, domestic and physical health but also sexual well being. The proportion of women suffering from UI who have sexual dysfunction is significant and is reported to range from 26% to 83%. Pelvic Floor Muscle Training (PFMT) is now accepted as the first line treatment for UI however there is only limited evidence assessing the impact of physiotherapy on sexual function of women with UI and no evidence comparing treatment modalities. Aims This study aims to evaluate the effect of physiotherapy on the sexual function of women with urinary incontinence (UI). It also compares 2 different methods of pelvic floor muscle training: ‘electrical stimulation’ to ‘standard physiotherapy’ as a prospective parallel group randomised controlled trial (RCT). The clinical and cost effectiveness of these 2 interventions on the sexual function of women with urinary incontinence and the response to treatments over a 6-month period will be compared. Objectives 1. To evaluate the effect of physiotherapy on sexual function of women with UI. 2. To compare standard physiotherapy with electrical stimulation. 3. To evaluate the cost effectiveness of one treatment versus the other.?? Plan of Investigation 114 women (57 to each arm) with urinary incontinence and sexual problems will be recruited into the study and randomised to either standard therapy or electrical stimulation. Incontinence severity and screening for sexual problems related to Urinary Incontinence will be assessed using ePAQ (Electronic Pelvic Floor Assessment Questionnaire). Different aspects of sexual function will be assessed by the PISQ (Prolapse and Incontinence Sexual function Questionnaire) including physical, behaviour, emotive and partner related domains. Both of the treatments require visits at 4 weekly intervals for 4-6 visits depending on the patients’ response. Assessments will be made at baseline and on completion of treatment. The SF-36 domain scores and EQ-5D scores will also be calculated and compared. Potential Impact The study has the potential to alter the care delivered to this group of women with urinary incontinence (UI) and concurrent sexual problems Women who have ongoing urinary incontinence and sexual problems are usually referred for electrical stimulation even though there is no evidence of increased benefit over standard physiotherapy. If the use of standard physiotherapy is shown to be equally beneficial, patients can be treated at lower costs and a greater number of patients can be treated for the same amount of funds.


Research activity codes: 7.1 INDIVIDUAL CARE NEEDS;6.7 PHYSICAL
Health categories: REPRODUCTIVE HEALTH AND CHILDBIRTH;RENAL AND UROGENITAL