Neutral posture education during cough can reduce urine leakage in women with cough-related stress urinary incontinence

B Steenstrup; M Pelleray; J N Cornu; S Verdun; M Gilliaux

doi:10.1016/j.purol.2023.09.002

Neutral posture education during cough can reduce urine leakage in women with cough-related stress urinary incontinence

Prog Urol. 2023 Dec;33(17):1083-1091. doi: 10.1016/j.purol.2023.09.002. Epub 2023 Sep 26.

Authors

B Steenstrup¹, M Pelleray², J N Cornu³, S Verdun⁴, M Gilliaux⁵

Affiliations

¹ Rouen University Hospital, Department of Urology, Rouen, France; La Musse Clinical Research Department and Physiotherapy Training Institute (Fondation La Renaissance Sanitaire), Saint-Sébastien-de-Morsent, France. Electronic address: Benoit.Steenstrup@chu-rouen.fr.
² La Musse Clinical Research Department and Physiotherapy Training Institute (Fondation La Renaissance Sanitaire), Saint-Sébastien-de-Morsent, France.
³ Rouen University Hospital, Department of Urology, Rouen, France.
⁴ Lille Catholic hospitals, Biostatistics Department- Delegations for Clinical Research and Innovation, Lille Catholic University, Lille, France.
⁵ La Musse Clinical Research Department and Physiotherapy Training Institute (Fondation La Renaissance Sanitaire), Saint-Sébastien-de-Morsent, France; Clinical Research Department, Axinesis, Wavre, Belgium.

PMID: 37758607
DOI: 10.1016/j.purol.2023.09.002

Abstract

Background: Current literature highlights the difficulty in identifying an optimal educational technique for maintaining continence during cough.

Objective: To characterize the effects of an educational intervention focusing on neutral posture during cough in women with cough-induced urinary incontinence (UI).

Methods: This interventional study design included women with cough-induced UI. We recorded PFMs surface electromyographic (sEMG) peak activity, and assessed symptoms and quality of life (QoL) 6 weeks after the intervention. The effect of the experimental situation was estimated using a linear mixed model, sEMG measurements during coughing were indexed to each situation and adjusted to the resting value at, and a moderation analysis was used.

Results/findings: Eighteen participants were included. The measurement situations (control versus experimental) did not have a statistically significant impact on sEMG peak activity during coughing: mean effect [95% CI] 3.42 [-1.28; 7.66]. Six weeks post-intervention, participants reported statistically significant decrease in urinary symptoms (P=0.0246) and significant improvement in QoL (P=0.00776). This was also particularly marked on the dimension related to effort activities (P=0.00162).

Conclusion: This study suggests that a brief educational intervention focusing on neutral posture during cough, without voluntary pre-contraction of the PFMs, has no clinically significant influence on sEMG peak activity of the PFMs in women with cough-induced UI. However, this intervention can lead to a significant improvement in urinary symptoms and QoL at 6 weeks. These improvements seem to be independent of electromyographic PFMs peak activity recorded during cough. As such, our preliminary results pave the way for future research.

Level of evidence: NP4.

Keywords: Contrôle moteur postural; Cough; Femme; Incontinence urinaire à l’effort; Muscles du plancher pelvien; Pelvic floor muscles; Postural motor-control; Quality of life; Qualité de vie; Stress urinary incontinence; Toux; Women.

MeSH terms

Cough / etiology
Exercise Therapy / methods
Female
Humans
Pelvic Floor
Posture
Quality of Life
Urinary Incontinence*
Urinary Incontinence, Stress*