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 Table of Contents  
ORIGINAL ARTICLE
Year : 2020  |  Volume : 15  |  Issue : 1  |  Page : 36-39

Comparative study of effect of vaginal cones as a biofeedback device and pelvic floor exercises in rural females with urinary incontinence


Department of Community Health Physiotherapy, Ravi Nair Physiotherapy College, Datta Meghe Institute of Medical Sciences (Deemed to be University), Wardha, Maharashtra, India

Date of Submission15-Nov-2019
Date of Decision20-Nov-2019
Date of Acceptance10-Dec-2019
Date of Web Publication13-Oct-2020

Correspondence Address:
Dr. Pooja Kasatwar
Department of Community Health Physiotherapy, Ravi Nair Physiotherapy College, Sawangi Meghe, Wardha, Maharashtra
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jdmimsu.jdmimsu_181_19

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  Abstract 


Background: The international continence society defines urinary incontinence (UI) as a situation in which involuntary urine loss is a hygienic or social issue and can be demonstrated objectively. Due to culture of silence, Indian females with urinary issues are quietly suffering from symptoms even when their symptoms trigger great discomfort and hamper regular activities. In India, there are limited research dealing with the effect of UI among rural females. Aim: The aim of the study was to determine the effect of vaginal cones and perineometer as a biofeedback device in rural females with UI. Objective: The objective of the study was to compare the effect of vaginal cones along with perineometer as a biofeedback device versus pelvic floor exercise in rural females with UI. Procedure: A comparative study included 45 participants aged 45–70 years as per the inclusion criteria which were divided into two groups: Group A was treated with vaginal cones and perineometer, whereas Group B was given Kegel exercises. Pre- and postreadings of questionnaire for female UI diagnosis and perineometer were taken. Results: The analysis of the result showed a significant improvement in Group A as compared to Group B. Conclusion: The present study concluded that a combined effect of vaginal cones and perineometer with biofeedback device showed a more significant result than pelvic floor muscle strength training (Kegel exercise).

Keywords: Biofeedback, pelvic floor muscles, questionnaire for female urinary incontinence diagnosis, stress urinary incontinence, vaginal weighted cones


How to cite this article:
Kasatwar P, Bele A, Dhankar S, Naqvi W. Comparative study of effect of vaginal cones as a biofeedback device and pelvic floor exercises in rural females with urinary incontinence. J Datta Meghe Inst Med Sci Univ 2020;15:36-9

How to cite this URL:
Kasatwar P, Bele A, Dhankar S, Naqvi W. Comparative study of effect of vaginal cones as a biofeedback device and pelvic floor exercises in rural females with urinary incontinence. J Datta Meghe Inst Med Sci Univ [serial online] 2020 [cited 2020 Oct 28];15:36-9. Available from: http://www.journaldmims.com/text.asp?2020/15/1/36/297971




  Introduction Top


The international continence society defines urinary incontinence (UI) as a situation in which involuntary urine loss is a hygienic or social issue and can be demonstrated objectively. UI is a highly awkward condition. In females, UI is more prevalent than in males, affecting females of all ages.[1] UI can seriously affect quality of life, limit social engagement, affect self-image, and lead to depression and other health problems.[2]

Genuine stress incontinence is demonstrated to be involuntary urine loss when the intravesical pressure exceeds that of the urethra without no contraction of the detrusor. Inherently weak connective tissue, vaginal delivery, obesity, hard work, and old age are risk variables for genuine stress incontinence.[1] Stress UI (SUI) can be distinguished between three stages that include Phase I – happens only during a major effort such as sneezing, vomiting, or laughing causing in increased intra-abdominal stress, Phase II – symptoms arise during gentle exercise such as walking, lifting or jogging, leading to a slight increase in intra-abdominal pressure, and Phase III – with minimal physical exertion symptoms can be observed and intra-abdominal stress increases.[3]

S. I. Perry studied on the incidence of incontinence in the general population and analyzed 11 trials that were performed with a mixed population of women of different ages, and a variety of causes of incontinence indicate that the incidence is comparatively low in early adulthood, has a peak around menopause, and then continuously increases between 60 and 80 years of age.[4] It tends to peak in females between the ages of 45–55 years.[5] A woman spends nearly one-third of life in menopause with the increasing life expectancy. The average age of menopause in developing countries is 44–45 years. There are different rural and urban lifestyles. The average age of menopause in rural populations is somewhat lesser than in urban populations. Menopausal symptoms in rural and urban areas have been observed to be different.[6] Menopause typically occurs a little earlier in Indian females, with an estimated age varying from 40 to 49 years.[7] The average age of menopause in the Western world is 50 years and the average age of menopause in Indian females is 45 years.[8] The prevalence of incontinence in postmenopause is 15% to 56%. The documented prevalence of SUI in India is approximately 46%.[9] Due to increased life expectancy and increasing population of menopausal females, menopausal health demands preference in the Indian situation in both metropolitan and rural regions. Large attempts are needed to teach and help to educate females about the signs of menopause, including rural females. This will help to recognize symptoms soon, reduce pain, and allow them to seek adequate treatment.[6] UI, especially in postmenopausal women, is a common clinical problem.[10]

Due to culture of silence, Indian females with urinary issues are quietly suffering from symptoms even when their symptoms trigger great discomfort and hamper regular activities. In India, there are limited research dealing with the effect of UI among rural females [Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6], [Table 7] and [Graph 1], [Graph 2], [Graph 3].[11]
Table 1: Distribution of participants according to their age in years

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Table 2: Comparison of perineometer score in Group A pre and post

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Table 3: Comparison of perineometer score in Group B pre and post

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Table 4: Comparison of mean difference in perineometer score in two groups

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Table 5: Comparison of Questionnaire for female Urinary Incontinence Diagnosis score in Group A pre and post

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Table 6: Comparison of Questionnaire for female Urinary Incontinence Diagnosis Score in group B pre and post

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Table 7: Comparison of mean difference in Questionnaire for female Urinary Incontinence Diagnosis Score in two groups

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  Materials and Methods Top


A randomized controlled trial was conducted at the Department of Community Health Physiotherapy, Ravi Nair Physiotherapy College, Sawangi (M), Wardha. Institutional ethical committee clearance was obtained (Ref. no. DMIMS (DU)/IEC/2018-19/7202) from Datta Meghe Institute of Medical Science. Participants were selected from Acharya Vinoba Bhave Rural Hospital and nearby rural areas. Inclusion criteria were rural females with SUI, age: 45–70 years, postmenopausal women, and participants those are willing to participate.

Materials

  1. Questionnaire for female UI diagnosis (QUID): It is a tool which is used for confirmatory diagnosis of SUI and urge incontinence
  2. Vaginal weighted cones: Vaginal cones are weighted devices designed to increase the strength of pelvic floor muscles (PFMs)
  3. Perineometer: Perineometer is one of the valid devices used to quantify PFM strength
  4. Written consent form and assessment form.


Methodology

Written informed consent was obtained from all the participants. A total of 45 participants were selected and were divided into two groups: Group A (experimental group, n = 23) and Group B (control group, n = 22).

  • Participants were provided with the QUID
  • After conformation of symptoms of SUI on the QUID, all the selected 45 participants were assessed using perineometer
  • Participants were instructed to lie down in the lithotomy position
  • Perineometer cable was attached to the vaginal probe
  • Select probe which fit perfectly (small, medium, and large), and the participants were instructed to hold the probe tightly, i.e. (to contract the PFM) for 10 s and then relaxed. Repeat the same procedure for three times and note down the best of three readings of PFM before treatment for both the groups.


Group A: weighted vaginal cones and perineometer with biofeedback display

  • Participants were asked to hold the perineometer probe as tightly as possible for 15 seconds and then relax for 10 seconds. Twenty repetition for 15 days
  • Each time the participants contracted the PFM, the perineometer readings were shown to participants to motivate them and to contract the PFM as tightly as possible to create maximum PFM contraction
  • 10 min relax time was given after completion of this session
  • The highest Vaginal weight cone (VWC) the participants is able to bear was use for training
  • Participants were asked to walk 15 min a day with the cone for 15 days
  • Participants were assessed after 15 days on QUID and perineometer.


Group B: Kegel exercises

These exercises include hold relax technique, transverse abdominis, contraction, hip adductor strengthening, and bridges.

  • Procedure of treatment was carried out for 15 days with 20 repetitions per exercise with 15 s hold. Exercise was done under supervision once a day
  • Participants were assessed after 15 days using QUID and perineometer.



  Results Top


A total of 45 participants were taken and they were allotted into two groups with 22 in each. One participant was allotted by a lottery method. Statistical analysis was done using descriptive and inferential statistics using Student's paired and unpaired t- test, and software used in the analysis was SPSS 22.0 version (Chicago, Illinois, USA)and P < 0.05 is considered as the level of significance.

Discussion

This study showed a significant improvement in UI in postmenopausal women when assessed on QUID and perineometer. Participants of Group A showed statistically significant improvement which was treated with vaginal cone and perineometer with biofeedback display and Group B participants were treated with PFM strength training (Kegel exercise).

Gandhe S et al. demonstrated the use of perineometer as a strength assessment and endurance training device for stress incontinency in elderly women.[12] Our study utilized vaginal cones and perineometer with biofeedback display to improve the strength of PFM and found a significant improvement.

Gameiro et al. mentioned comparative effect of VWC and assisted PFM training (APFMT) in the treatment of UI in women and found no difference between the groups treated with VWC and APFMT.[13] A study conducted on vaginal cone for postmenopausal women with SUI by Pereira et al. also found similar positive results for treatment with the vaginal cone and PFM training for urinary leakage.[14]

In the present study, we compared the effect of vaginal cones and perineometer with biofeedback display and Kegel exercises and found a significant improvement in the group treated with vaginal cones and perineometer.[15]


  Conclusion Top


The present study concluded that a combined effect of vaginal cones and perineometer with biofeedback device showed a more significant result than PFM strength training (Kegel exercise).

Financial support and sponsorship

The source of funding was provided by R and D office, research house, Datta Meghe Institute of Medical Sciences with ref no. DMIMS (DU)/R and D/2018-19 issued on April 17, 2018.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Bø K, Talseth T, Holme I. Single blind, randomised controlled trial of pelvic floor exercises, electrical stimulation, vaginal cones, and no treatment in management of genuine stress incontinence in women. BMJ 1999;318:487-93.  Back to cited text no. 1
    
2.
Glazer HI, Laine CD. Pelvic floor muscle biofeedback in the treatment of urinary incontinence: a literature review. Appl Psychophysiol Biofeedback 2006;31:187-201.  Back to cited text no. 2
    
3.
Bradway C. Treating Women's Incontinence: A Review of the Literature and Recommendations for Practice. The Internet Journal of Advanced Nursing Practice. 1997;2:8.  Back to cited text no. 3
    
4.
Nitti VW. The prevalence of urinary incontinence. Rev Urol 2001;3 Suppl 1:S2-6.  Back to cited text no. 4
    
5.
Perry SI. Prevalence of urinary incontinence: A review of the literature. In: Laycock J, Haslam J, editors. Therapeutic Management of Incontinence and Pelvic Pain. London: Springer; 2002. p. 3-5. Available from: http://link.springer.com/10.1007/978-1-4471-3715-3_1. [Last accessed on 2019 Aug 12].  Back to cited text no. 5
    
6.
Sagdeo MM, Arora D. Menopausal symptoms: A comparative study in rural and Urban Women. J.K. Sciences; 2011;13:4.  Back to cited text no. 6
    
7.
Goyal A, Mishra N, Dwivedi S. A comparative study of morbidity pattern among rural and urban postmenopausal women of Allahabad, Uttar Pradesh, India. Int J Res Med Sci 2017;5:670.  Back to cited text no. 7
    
8.
Jadhav A, Bavaskar Y. An epidemiological study of the perimenopausal and menopausal health problems in women living in an urban area of Mumbai, Maharashtra. Int J Community Med Public Health 2017;4:3088.  Back to cited text no. 8
    
9.
Parmar LD, Patel BB. Effect of vaginal cone on pelvic floor muscle strength.8:8.  Back to cited text no. 9
    
10.
Capelini MV, Riccetto CL, Dambros M, Tamanini JT, Herrmann V, Muller V. Pelvic floor exercises with biofeedback for stress urinary incontinence. Int Braz J Urol 2006;32:462-8.  Back to cited text no. 10
    
11.
Ganapathy T. Impact of urinary incontinence on quality of life among rural women. Muller J Med Sci Res 2018;9:71.  Back to cited text no. 11
  [Full text]  
12.
Gandhe S, Ganvir S. Perineometer as a strength assessment & training tool for pelvic floor muscles in stress urinary incontinent elderly women; Indian Journal of Basic and Applied Medical Research 2016;5:406-10.  Back to cited text no. 12
    
13.
Gameiro MO, Moreira EH, Gameiro FO, Moreno JC, Padovani CR, Amaro JL. Vaginal weight cone versus assisted pelvic floor muscle training in the treatment of female urinary incontinence. A prospective, single-blind, randomized trial. Int Urogynecol J 2010;21:395-9.  Back to cited text no. 13
    
14.
Pereira VS, de Melo MV, Correia GN, Driusso P. Vaginal cone for postmenopausal women with stress urinary incontinence: Randomized, controlled trial. Climacteric 2012;15:45-51.  Back to cited text no. 14
    
15.
Gaidhane A, Sinha A, Khatib M, Simkhada P, Behere P, Saxena D, et al. A Systematic Review on Effect of Electronic Media on Diet, Exercise, and Sexual Activity among Adolescents. Indian J Community Med 2018;43:S56–65. Available from: https://doi.org/10.4103/ijcm.IJCM_143_18. [Last accessed on 2019 Oct 07].  Back to cited text no. 15
    



 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6], [Table 7]



 

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