Pelvic floor training with adjunctive technologies for female incontinence: A systematic review with meta-analysis
DOI:
https://doi.org/10.62827/fb.v27i6.1217Keywords:
Urinary Incontinence; Pelvic Floor; Physical Therapy; Physical Therapy Modalities.Abstract
Introduction: Female urinary incontinence is a prevalent condition that compromises quality of life and has a significant clinical, social, and economic impact. Pelvic floor muscle training is the first-line conservative treatment; however, the efficacy of combining it with adjunctive technologies remains inconclusive. Objective: To synthesize current evidence and quantitatively evaluate the efficacy of pelvic floor muscle training combined with adjunctive technologies versus training alone in the management of female urinary incontinence. Methods: A systematic database search was conducted. Of the 148 studies identified between 2020 and 2025, 141 were excluded following the removal of duplicates and the selection process. Seven randomized clinical trials were included, totaling 424 participants. Results: Seven randomized controlled trials were included, totaling 424 women. Combining training with technologies, such as gametherapy, radiofrequency, and manual or focal therapies, resulted in a significantly greater reduction in self-reported urinary symptoms compared to training alone. However, there was no significant difference regarding the objective reduction of urinary leakage or gains in pelvic floor muscle strength. The certainty of evidence ranged from moderate to low. Conclusion: Adjunctive technologies enhance the relief of urinary symptoms and the perception of quality of life but do not outperform pelvic floor muscle training alone in terms of muscle strength gains or the objective reduction of urinary leakage. Its use should be individualized according to each patient's clinical profile.
References
Aoki Y, Brown HW, Brubaker L, Cornu JN, Daly JO, Cartwright R. Urinary incontinence in women. Nat Rev Dis Primers. 2017;3:17042. doi:10.1038/nrdp.2017.42.
Bø K, Frawley HC, Hay-Smith J, et al. An International Urogynecological Association (IUGA)/International Continence Society (ICS) joint report on the terminology for the conservative and nonpharmacological management of female pelvic floor dysfunction. Int Urogynecol J. 2017;28(2):191-213. doi:10.1007/s00192-016-3123-4.
Qaseem A, Dallas P, Forciea MA, Starkey M, Denberg TD. Nonsurgical management of urinary incontinence in women: a clinical practice guideline from the American College of Physicians. Ann Intern Med. 2014;161(6):429-440. doi:10.7326/M13-2410.
Dumoulin C, Cacciari LP, Hay-Smith EJC. Pelvic floor muscle training versus no treatment, or inactive control treatments, for urinary incontinence in women. Cochrane Database Syst Rev. 2018;10(10):CD005654. doi:10.1002/14651858.CD005654.pub4.
Bezerra LO, Oliveira MCE, Silva HKV, Menezes GF, Gonçalves AKS, Pegado R, et al. Impact of pelvic floor muscles training isolated and associated with game therapy on mixed urinary incontinence: a randomized controlled trial. Games Health J. 2020;9(6):420-427. doi:10.1089/g4h.2019.0207.
Nagib ABL, Silva VR, Martinho NM, Marques A, Riccetto C, Botelho S. Pelvic floor muscle training supervised through gametherapy in climacteric women with urinary incontinence: a feasibility study. Rev Bras Ginecol Obstet. 2021;43(7):535-544. doi:10.1055/s-0041-1733979.
Slongo H, Lunardi ALB, Riccetto CLZ, Machado HC, Juliato CRT. Microablative radiofrequency versus pelvic floor muscle training for stress urinary incontinence: a randomized controlled trial. Int Urogynecol J. 2021;32(10):2861-2869. doi:10.1007/s00192-021-04758-2.
Lunardi ALB, Juliato CRT, Slongo H, Machado HC, Riccetto CLZ. Microablative radiofrequency, pelvic floor muscle training or combination of both techniques in climacteric women: randomized controlled trial with 6-month follow-up. Neurourol Urodyn. 2025;44:1412-1424. doi:10.1002/nau.70096.
De Marco M, Arbieto ERM, Da Roza TH, Resende APM, Santos GM. Effects of visceral manipulation associated with pelvic floor muscles training in women with urinary incontinence: a randomized controlled trial. Neurourol Urodyn. 2022;41(3):822-830. doi:10.1002/nau.24836.
Vargas TM, Vargas LM, Antunes EL, Sochodolak RC, Oliveira JV, Goveia JC, et al. Effects of physical exercise on postpartum pelvic floor dysfunctions: a randomized placebo-controlled trial. Fisioter Mov. 2024;37:e37137. doi:10.1590/fm.2024.37137.0.
Bottini DAMC, Silva DV, Silva Filho RM, Lucio A, Sakiki F, Pegorare ABGS. Efeitos do treinamento muscular do assoalho pélvico versus Ginástica Abdominal Hipopressiva (GAH) na incontinência urinária de esforço de mulheres climatéricas: ensaio clínico randomizado. Fisioter Pesqui. 2024;70(3):e20231073. doi: 10.1590/1809-2950/e23000824pt.
Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ. 2021;372:n71. doi:10.1136/bmj.n71.
Higgins JPT, Thomas J, Chandler J, Cumpston M, Li T, Page MJ, Welch VA (editors). Cochrane Handbook for Systematic Reviews of Interventions version 6.4 (updated August 2023). Cochrane, 2023. Disponível em: www.training.cochrane.org/handbook.
Ouzzani M, Hammady H, Fedorowicz Z, Elmagarmid A. Rayyan-a web and mobile app for systematic reviews. Syst Rev. 2016;5(1):210. doi:10.1186/s13643-016-0384-4.
Sterne JA, Savović J, Page MJ, Elbers RG, Blencowe NS, Boutron I, et al. RoB 2: a revised tool for assessing risk of bias in randomised trials. BMJ. 2019;366:l4898. doi:10.1136/bmj.l4898.
McGuinness LA, Higgins JPT. Risk-of-bias VISualization (robvis): An R package and Shiny web app for visualizing risk-of-bias assessments. Res Synth Methods. 2021;12(1):55-61. doi:10.1002/jrsm.1411.
The jamovi project. jamovi (Version 2.3) [Computer Software]. 2023. Disponível em: https://www.jamovi.org.
Guyatt GH, Oxman AD, Vist GE, Kunz R, Falck-Ytter Y, Alonso-Coello P, et al. GRADE: an emerging consensus on rating quality of evidence and strength of recommendations. BMJ. 2008;336(7650):924-926. doi:10.1136/bmj.39489.470347.AD.
GRADEpro GDT. GRADEpro Guideline Development Tool [Software]. McMaster University and Evidence Prime, 2022. Disponível em: gradepro.org.
Ko MJ, Koo MS, Jung EJ, Jeong WJ, Oh JS. Effect of pelvic floor muscle training using pressure biofeedback on pelvic floor muscle contraction and trunk muscle activity in sitting in healthy women. Healthcare. 2022;10(3):570. doi:10.3390/healthcare10030570.
Millheiser LS, Pauls RN, Herbst SJ, Chen BH. Radiofrequency treatment of vaginal laxity after vaginal delivery: nonsurgical vaginal tightening. J Sex Med. 2010;7(9):3088-3095. doi:10.1111/j.1743-6109.2010.01910.x.
Bø K. Pelvic floor muscle training is effective in treatment of female stress urinary incontinence, but how does it work? Int Urogynecol J. 2004;15(2):76-84. doi:10.1007/s00192-004-1125-0.
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Copyright (c) 2026 Talita Larissa de Castro Lousada, Anna Carolina Mendes Penido, Felipe Sampaio Lopes, Gabriel Marçal Costa, Francisco Coelho Jácome de Brito (Autor)
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