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The Effect of Pelvic Floor Muscle Training on Incontinence JMHXXX10.1177/1557988318757242American Journal of Men’s HealthAydın Sayılan and Özbaş 757242research-article2018 Original Article American Journal of Men’s Health 2018, Vol. 12(4) 1007 –1015 The Effect of Pelvic Floor Muscle © The Author(s) 2018 Reprints and permissions: sagepub.com/journalsPermissions.nav Training On Incontinence Problems DOI:https://doi.org/10.1177/1557988318757242 10.1177/1557988318757242 After Radical Prostatectomy journals.sagepub.com/home/jmh Aylin Aydın Sayılan1 and Ayfer Özbaş2 Abstract The aim of the current study was to determine the effect of pelvic floor muscle exercises (PFME/Kegel) training administered to patients scheduled for robot-assisted radical prostatectomy on postprocedural incontinence problems. This study was a randomized controlled trial. Pelvic floor muscle exercises were applied to the procedure group three times a day for 6 months. No exercises were applied to the control group. Incontinence and quality-of-life assessments of the 60 patients in the experimental and control groups were performed on months 0 (10 days after removal of the urinary catheter), 1, 3, and 6 through face-to-face and telephone interviews. Total Incontinence Consultation on Incontinence-Short Form scores, which provide an objective criterion for the evaluation of individuals with incontinence problems, decreased over time. This decrease was statistically highly significant in the third and sixth months. Pelvic muscle floor exercises are suitable for patients experiencing incontinence after radical prostatectomy. Keywords urinary incontinence, prostatectomy, muscle stretching exercises. Received October 8, 2017; revised December 19, 2017; accepted January 3, 2018 Prostate cancer is one of the most common cancer types therefore involves noninvasive behavioral therapeutic in men, and the prevalence increases with age (Vidmar methods consisting of diet modification, bladder train- et al., 2017). Although radical prostatectomy (RP) is ing, pelvic floor muscle exercises (PFME), biofeed- considered the gold standard therapeutic option in back, and functional electrical stimulation. These patients with a life expectancy of more than 10 years methods are easily administered by health-care profes- for the treatment of organ-confined prostate cancer, sionals. In addition to being inexpensive and effective, post-RP complications are common (Sosnowski et al., they involve no side effects (Santa Mina et al., 2014). 2011). Incontinence that may be encountered after RP The aim of PFME, first defined by Arnold Kegel in is a surgical complication that significantly impairs 1948 as a behavioral therapeutic method for treating quality of life (Hsu, Liao, Lai, & Tsai, 2016). While the incontinence, is to enhance muscle volume and contrac- postoperative incontinence rate is 1% in patients under- tion strength in case of increased intra-abdominal going prostatectomy for benign reasons, a level of 2%−66% has been reported after RP (O’Callaghan 1Department of Nursing, Kırklareli University, Kofçaz, Kırklareli, et al., 2017). Turkey 2 Previous studies recommend that invasive methods Florence Nightingale Faculty of Nursing, Department of Surgical Diseases Nursing, İstanbul University, İstanbul, Turkey for treating incontinence should be delayed for approx- imately 1 year (Ficarra et al., 2013; Frawley, Dean, Corresponding Author: Slade, & Hay-Smith, 2017). Behavioral therapeutic Aylin Aydın Sayılan, Kirklareli University Department of Nursing, Kirklareli University,Kirklareli, Turkey. Kırklareli Üniversitesi Sağlık methods must always constitute the first step of treat- Yüksekokulu, Cumhuriyet Mahallesi Kofcaz Yolu Kayalı Yerleşkesi ment and must be primarily administered in eligible Merkezi Derslikler 2 No:39-L Merkez, Kırklareli, Türkiye. cases (Meyer, 2017). The treatment of incontinence E mail: [email protected] Creative Commons Non Commercial CC BY-NC: This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 License (http://www.creativecommons.org/licenses/by-nc/4.0/) which permits non-commercial use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access pages (https://us.sagepub.com/en-us/nam/open-access-at-sage). 1008 American Journal of Men’s Health 12(4) pressure (Newman, 2014). While the physiological day of arrival at the clinic), on the day of hospitalization, 1 effects of PFME become visible after 2 weeks, symptoms and 2 days after surgery, and on removal of the urinary cath- are reported to decrease between 6 and 8 weeks, and sig- eter at 10 days postoperatively. nificant improvement is observed by the sixth month (Chang, Lam, & Patel, 2016). Inclusion criteria. Inclusion criteria were a diagnosis of Previous studies have described incontinence prob- stable localized prostate cancer (stage T1 and T2 and lems that may occur postprocedurally in patients under- Gleason score 2–4) as defined by the relevant guidelines going RP and have emphasized the positive effect PFME use of the bilateral nerve sparing technique, absence of on these (Filocamo et al., 2005; MacDonald, Fink, urinary incontinence before surgery, BMI < 30, an ele- Huckabay, Monga, & Wilt, 2007; Overgård, Angelsen, mentary school level of education such as to permit com- Lydersen, & Mørkved, 2008; Ribeiro et al., 2010; pletion of the study forms, age 30–75 years, and voluntary Tienforti et al., 2012; Lombraña, Izquierdo, Gómez, & participation in the study. Alcaraz, 2013). The purpose of this study was therefore to determine the effect on postprocedural incontinence Instruments problems (PFME/Kegel) training administered to patients scheduled for robot-assisted RP. Personal information form. This form contained 11 ques- tions designed to collect information about subjects’ sociodemographic characteristics and relevant medical Methods histories. Participants and Procedure Incontinence Diagnosis Questionnaire. This form contained The study was conducted from April 1, 2014, to January 14 questions designed to collect information about num- 1, 2015, in the Dr. Sadi Konuk Training and Research bers of episodes of incontinence, and their frequency and Hospital Urology Clinic, Istanbul, Turkey. A standard type. perioperative physiotherapy program, consisting of PFME and general physical activity, was applied. The Incontinence Assessment Scale—International Consultation training began in the preoperative period and involved on Incontinence Questionnaire Short-Form (ICIQ-SF). The both supervised and unsupervised contractions of the first three of the four questions in the ICIQ-SF are pelvic floor muscles in a range of functional positions. intended to elicit data concerning the frequency, level, Continuous feedback regarding contraction techniques and impact of urinary incontinence. The total possible was given with the assistance of verbal and tactile point- score ranges from 0 to 21, higher scores indicating ers and real-time transabdominal ultrasound imaging. greater severity of urinary incontinence. In the final Transabdominal ultrasonography was performed question, participants indicate those activities during approximately 1 cm above the urinary bladder and indi- which urine leakage occurs from a range of alternatives, cated sufficient pelvic floor muscle strength and including coughing or sneezing, and during physical contraction. activity or exercise. No assistance was provided by the This experimental study was conducted to evaluate the authors or any medical personnel during completion of effect of a 6-month Kegel exercise program (three ses- the questionnaire. sions daily) on reducing incontinence after RP. The target population consisted of individuals diagnosed with local- Pelvic Floor Muscle Exercise Guide. This was prepared by ized prostate cancer. one of the authors and contained PFME techniques and The sample size was calculated before the procedure rules for application. using Russ G-Power analysis software. Significance was set at an alpha level of 0.05, with a statistical power of .95 Data Collection (1 − ß). A sample size of 64 was determined total for groups sufficient to establish a 37% difference. Participants were Subjects undergoing preoperative PFME training informed about the study and gave written informed con- received one to four sessions before RP, each approxi- sent to take part. Sixty patients, 30 in the experimental mately 1 hr in duration. Detailed histories were taken, group and 30 in the control group (Figure 1), met the inclu- and comorbidity was evaluated during the first session. sion criteria and were evaluated at months 0 (10 days after Anatomically exact models and diagrams were used to urinary catheter removal), 1, 3, and 6 (Tienforti et al., 2012). outline the architecture and functions of the bladder, ure- The training was given 1 week before hospitalization (the thra, and pelvic floor muscles. Subjects were instructed Aydın Sayılan and Özbaş 1009 how to activate the pelvic floor muscles in various func- for quantitative and descriptive data (mean, standard tional positions, such as lying down and standing upright. deviation, median, frequency, level, minimum and Feedback was given to subjects through transabdominal maximum). Pearson’s χ2 test, Fisher’s exact test, the ultrasound imaging. Superior displacement of the blad- Fisher-Freeman-Halton test, and Yates’ continuity cor- der base exceeding 1 cm was regarded as indicating suc- rection test (Yates-corrected χ2) were applied
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