Diaphragmatic Breathing Exercises on Urinary Incontinence
Condition: Urinary Incontinence
MeSH terms: Urinary Incontinence; Enuresis
Study type: Interventional

Summary: 
      The main aim of this pilot study was to examine the effect of diaphragmatic breathing
      exercise on urinary incontinence treatment. The secondary purpose was to compare the effect
      of pelvic floor muscle exercises and diaphragmatic breathing exercises on urinary
      incontinence women.

      Design: Participants were randomized into two groups: pelvic floor muscle exercises (Group
      PFM n=20) and diaphragmatic breathing exercises (Group DB n=20). Exercise programs consisted
      of 1 set of contractions per day and each set included 30 repetitions for 6 weeks. Women were
      asked to complete forms of Incontinence Impact Questionnaire (IIQ-7) and the Urogenital
      Distress Inventory (UDI-6), Incontinence Quality of Life (I-QOL), and Overactive Bladder
      (OAB-V3) before starting the program and again at the end of the 6-week program. Changes from
      baseline were compared in both groups and between the two groups.
    

Detailed description: 
      Urinary incontinence (UI) is a chronic condition with involuntary urine loss. Urgency urinary
      incontinence (UUI) is a complaint of involuntary loss of urine associated with urgency;
      stress urinary incontinence (SUI) is a complaint of involuntary urine leaks out on effort or
      physical exertion including sporting activities, or on sneezing or coughing. In the mixed
      type of urinary incontinence (MUI) complaints coexist both in stress and urgency.

      Although urinary incontinence is not a life-threatening condition, the feeling of discomfort
      caused by constant wetness, irritation, and the fear of odor affects the daily and social
      activities of in patients.

      The abdominal-pelvic cavity contains most of the internal organs, is bounded by the diaphragm
      above, abdominal muscles anterior and lateral, thoracolumbar fascia and dorsal muscles in the
      back, and pelvic floor in the lower part. The respiratory diaphragm forms the roof of the
      abdomina-pelvic cavity and the pelvic floor forms the base. The diaphragm is the main
      respiratory muscle, connected to the pelvic floor via the transversalis fascia. The pelvic
      floor supports internal organs, as well as constrictor and continence mechanisms of the
      urethral, anal and vaginal orifices in females.

      Musculofascial support is provided by the pelvic floor forms a hammock onto which the urethra
      is compressed during increases in intra-abdominal pressure. When intraabdominal pressure
      increases, intra-abdominal contents downward momentum is arrested by stretch resistance of
      the pelvic floor structures. At this time, the proximal intraabdominal portion of the urethra
      is compressed against the underlying supporting layer, which consists of the endopelvic
      fascia, vagina, and pelvic floor.

      Pelvic floor muscle (PFM) exercises, defined by Arnold H. Kegel, aims to regain support to
      the urinary organs by actively functioning the pelvic floor muscles. Previous researches show
      that PFM exercises are an effective treatment for UI and improve the quality of life (Qol) of
      in women. It is currently used as the first choice in conservative treatment of incontinence.
      However, PFM exercises may be encountered with some difficulties in order to understanding
      and performing by patients.

      Talas et al. showed that the pelvic floor moves in the craniocaudal direction parallel to the
      diaphragm during respiration. In this study, they suggested that during expiration, the
      pelvic floor muscles contract together with the abdominal muscles, pushing the abdominal
      organs up, pushing the intra-abdominal pressure (IAP) to towards the diaphragm.

      In this study, the investigators hypothesized that the patients can improve pelvic floor
      function by performing DB exercises, indirectly via the facial and functional connection
      between the diaphragm and PFM, and incontinence could be reduced.
    

Intervention name(s): pelvic floor muscle exercises; diaphragmatic breathing exercises
Intervention type(s): Behavioral; Behavioral
Intervention description(s): During the first visit, the anatomy of the pelvic floor and the purpose of the program were explained. Exercises were taught in the supine position, as described by Kegel (1948), it was confirmed that the women learned to use the correct muscles with vaginal palpation. During the exercise, the participants were informed not to pull the abdomen inwards, not to tighten their legs and hip muscles, and not move their pelvis.; During the first visit, the anatomy of the diaphragm and abdominal wall and the purpose of the program were explained. Diaphragmatic breathing exercise was taught in supine position. The movement of the symphysis pubis was examined to confirm that the pelvic floors' movement was also involved breathing. Abdominal palpation was used to elicit unawareness of the diaphragmatic breathing and to assess whether contractions were performed correctly.
Allocation: Randomized
Intervention model: Parallel Assignment
Intervention model description: Participants were randomized into two groups: pelvic floor muscle exercises (Group PFM n=20) and diaphragmatic breathing exercises (Group DB n=20). Exercise programs consisted of 1 set of contractions per day and each set included 30 repetitions for 6 weeks. Women were asked to complete forms of Incontinence Impact Questionnaire (IIQ-7) and the Urogenital Distress Inventory (UDI-6), Incontinence Quality of Life (I-QOL), and Overactive Bladder (OAB-V3) before starting the program and again at the end of the 6-week program. Changes from baseline were compared in both groups and between the two groups.
Masking: None (Open Label)
Primary purpose: Supportive Care
Keywords: Diaphragmatic breathing exercise; Pelvic floor muscles exercises; Kegel exercise; Urinary incontinence; Physiotherapy