(054) Improvement of Lower Urinary Tract Symptoms by Treating Pelvic Floor Muscle Increased Tone
Authors: Bardin M , Parizotto F , Araujo C , Hartman D , Teatin Juliato C 
Published: May 2023

Abstract

Introduction
Physical therapy is first line treatment for women diagnosed with urinary incontinence (UI). However, while pelvic floor muscle (PMF) strengthening for decreased PFM tone is well published, there is minimal data evaluating appropriate treatment strategies for PFMs increased tone on the improving of UI.

Objective
To retrospectively analyze the effectiveness of normalization of PFM tone on lower urinary tract symptoms (LUTS) of women with either stress urinary incontinence (SUI), overactive bladder (OAB), or urgency urinary incontinence (UUI).

Methods
Medical records of women who received physical therapy care from January 2017 till July 2021 for LUTS and who had increased PFM tone were included in this retrospective, cohort study. Exclusion criteria: previous pelvic surgeries or physiotherapy treatment for PFM dysfunction, neuromuscular diseases, lichen sclerosus et atrophicus, and missing data. Baseline and post-treatment assessments were carried out for: (i) LUTS trough voiding diaries (data on urinary frequency, episodes of SUI, urinary urgency and UUI, nocturia and enuresis) and Questionnaire for Urinary Incontinence Diagnosis (QUID), assessing LUTS with scores from 0-15 (no symptoms to maximum symptomatology); (ii.) PFM tone, via digital palpation using a 7-level grading score (Reissing Scale) from -3 (most decreased) to +3 (most increased PFM tone); (iii.) pain intensity - PFMs active trigger points (TP) were each rated from 0 (no pain) to 10 (worst possible pain) according to the Numerical Rate Scale (NRS); and (iv.) PFM power of contraction (PERFECT scheme). Treatment consisted of in-office physical therapy (including myofascial release, manual stretching of the vaginal walls and perineal massage) twice weekly during six weeks. Self-vaginal stretching and perineal massage was to be done daily by the women over the duration of care.

Results
Women (n=127) presenting LUTS and increased PFM tone were diagnosed with SUI (35%), OAB (21%), or mixed UI (44%). Mean age was 52 (±13.4). Women presenting normal PFM tone (0) after treatment showed a greater power of PFM contraction when compared to those who maintained tone (≥1) after treatment (2.7±0.9 vs. 2.2±0.6; p=.01; d=0.6) as well as a reduction in SUI episodes (0.1±0.31 vs. 1±1.5; p=.01; d=0.8). Women with improved SUI symptoms at the post-treatment assessment (QUID-SUI score ≤1) compared to those who maintained them (QUID-SUI score &gt;1), had decreased mean of pain intensity (0.88±1.77 vs. 2.59±2.78; p=.002; d=.73) as well as at any given PFM TP according to NRS (0.97±1.92 vs. 2.90± 3.26; p=.002; d=.72). With regard to symptoms of OAB, women who scored ≤1 on the QUID-OAB post-treatment compared to those who scored &gt;1 also showed significant decrease in pain intensity at all trigger points (0.85±1.76 vs. 2.16±2.52; p=.009; d=.60), with maximum pain intensity (0.94±2 .00 vs. 2.42±2.92; p=.010; d=.59), and experienced decreased tone in the right vaginal wall (0.05±0.22 vs. 0.41±0.73; p=.019; d=.67). A mild correlation between increased tone and SUI (p=0.04; r=0.32), episodes of urinary urgency (p=0.02; r=0.37), and nocturia (p=0.007; r=0.43) were shown.

Conclusions
These study findings points toward to the importance of focusing physiotherapeutic techniques to normalize PFM tone in women with LUTS and increased PFM tone.

Disclosure
No