Pelvic floor muscle training
There is strong scientific evidence that pelvic floor exercises/muscle training can cure or reduce symptoms of urine leakage.
The Tät® app has been evaluated through several research studies at Umeå University. Women who leaked urine upon exertion and who performed exercises for three months with the help of the app, experienced reduced leakage and increased quality of life, compared with a group that did not use Tät®. These improvements were maintained when the women were followed up after two years. One study also showed that improvements were greater the more frequently the women used the app and the more often they performed the exercises. The app treatment includes information about the pelvic floor, stress urinary incontinence and lifestyle habits that affect incontinence, as well as a programme for pelvic floor muscle training. Among pregnant women who used the app for preventive training, 7 out of 10 retained continence after three months.
References
Pelvic floor muscle training during pregnancy and after childbirth
Several scientific reports show that preventive pelvic floor muscle training during pregnancy can reduce the risk of urine leakage in later stages of pregnancy as well as after childbirth.
A systematic review and meta-analysis of 65 studies, examining the effect of pelvic floor muscle training on urinary incontinence and prolapse in the first year after childbirth, found that pelvic floor muscle training reduced the odds of urinary incontinence by 37% and the odds of prolapse by 56%.
A review summarising findings on the effect of pelvic floor muscle training for preventing and treating urinary incontinence and prolapse in pregnant and postpartum women They found the strongest scientific evidence that preventive pelvic floor muscle training during pregnancy could reduce the risk of postpartum urinary incontinence. They also found evidence that pelvic floor muscle training could reduce the symptoms of urinary incontinence for those who already had problems. They found limited evidence that pelvic floor muscle training could reduce the symptoms of prolapse. It is considered that pelvic floor muscle training can be recommended to all women during pregnancy and after childbirth for the prevention and treatment of urinary incontinence and to reduce the symptoms of prolapse.
Pelvic floor training can be started immediately after childbirth, as long as the exercises do not hurt. One scientific study demonstrated that is was uncommon for women to experience pain from pelvic floor muscle training.
Pelvic floor muscle training is effective for women with symptomatic prolapse.
Women diagnosed with a prolapse (447 persons), and who had symptoms, were randomly selected into one of two groups; one that performed pelvic floor muscle training with the support of a physiotherapist or one in which the women were given a brochure with lifestyle advice. At the 12-month follow-up, the women in the training group had fewer symptoms compared to the control group, and the difference was statistically valid.
In another study, 287 women with symptomatic prolapse were randomized to a pelvic floor training group or to a group that received no treatment. In the pelvic floor training group, 57% reported improvement after 3 months compared to 14% in the control group. The improvement on a symptom scale for prolapse symptoms was larger in the pelvic floor training group than in the control group. The differences were statistically significant between the groups.
The women were followed up after 2 years and the improvement seen after three months of training remained in the pelvic floor training group. In this group, 43% now reported improvement compared to 14% in the non-training group.
The conclusion of these two studies was that pelvic floor muscle training should be recommended to women with symptoms of prolapse.
In one study, changes in the pelvic floor were also measured by ultrasound. Women with a history of[LI1] prolapse (109) were randomised to a pelvic floor muscle training group or a control group. Both groups received lifestyle advice and instructions for pelvic floor exercises. After six months of training, the pelvic floor muscle volume had increased, the muscles had become shorter and the pelvic floor plate had been raised in the group that trained intensively. The symptoms of prolapse had also decreased in the exercising group. The differences in symptoms and the changes in the pelvic floor were statistically significant between the groups. The investigator did not know which group the woman belonged to.
There are several systematic reviews of studies on pelvic floor muscle training for prolapse. They conclude that there is scientific support for the effectiveness of pelvic floor muscle training for reducing the symptoms of prolapse and also studies showing that the prolapse itself is reduced. Pelvic floor muscle training is the first line of treatment for prolapse and there is currently no evidence that any other types of exercise reduce discomfort from prolapse more than pelvic floor exercises do.
There are few studies on pelvic floor muscle training for the prevention of prolapse and no firm conclusions can be drawn regarding preventive exercise. There is currently no data to support that exercise before surgery for prolapse improves outcomes.
All studies that have been done have evaluated the effect of pelvic floor muscle training with the support of a physiotherapist, often in combination with home exercises. There are currently no studies showing the effect of training with the support of an app to reduce discomfort from prolapse.
Tips for dealing with prolapse
These pelvic floor muscle training tips are based on evidence from scientific studies, see above.
Tips regarding constipation and body positioning are based on clinical experience and general guidelines published by Swedish health and medical services.
Tips regarding locally-administered oestrogen are based on scientific studies.
A systematic review and compilation of 44 studies: Vaginally administered oestrogen reduces symptoms related to delicate mucus membranes after menopause, e.g., a feeling of dryness, pain during sexual intercourse, frequent urination.
Lethaby A et al. Local estrogen for vaginal atrophy in postmenopausal women (Review). Cochrane Database of systematic reviews 2016 issue B. Art.No :CD001500
Systematic reviews that include the Tät app
A systematic review comparing different methods of providing instruction for pelvic floor muscle training. It was found that, as before, pelvic floor muscle training is the first-line treatment for women with urinary incontinence. Offering training instructions via the internet or mobile apps may be slightly more effective than via leaflets. This review included the Tät internet program, which was the predecessor of the Tät app.
A systematic review and meta-analysis of different distance methods for pelvic floor muscle training programs, comparing novel with traditional methods. The Tät internet program, which was the predecessor to the Tät app, was included in the review as an example of a new method. New methods, such as internet programs and apps, were judged to be as effective as traditional methods for women with stress incontinence.
A systematic review to evaluate the effectiveness of app-based pelvic floor muscle training for urinary incontinence. It was concluded that app-based pelvic floor muscle training was promising in terms of its effect on symptoms, quality of life and perceived improvement, and increased adherence to the pelvic floor muscle training. The Tät app and the internet program that was the predecessor to Tät were included in the evaluation along with four other apps.
A systematic review of apps for pelvic floor muscle training for women, focused on the principles included in the apps that increase adherence to the training. Tät was one of eight apps assessed and the conclusion was that it used three different principles, that it increased adherence to the pelvic floor training and that it was cost-effective.
An evaluation of free apps for urinary incontinence and prolapse focused on how well the apps fulfilled different criteria for good quality in medical apps. Tät was one of 28 apps included and was assessed as being of good quality. Benefits highlighted by the evaluation were that the app contained information about incontinence and was developed by medical professionals.
A systematic review of randomised controlled trials conducted between 2007 to 2020 to evaluate the effect of apps aimed at improving urinary incontinence. Four trials were included, two of which were related to the Tät app. All the trials were deemed to be of high quality and the results showed improved incontinence symptoms and increased adherence to the treatment. They recommend including the use of mobile apps for the treatment of urinary incontinence in current treatment guidelines.
A systematic review of apps for women with urinary incontinence and assessment against a validated scale for mobile apps. Tät was one of 20 apps included and it was the only one that was evidence-based and evaluated through a clinical trial.
A systematic review of non-supervised treatment programmes for urinary problems in women. Ten studies were found that looked at treatment programmes for urinary incontinence, one of which was Tät. They found that non-supervised treatment programmes were effective for the treatment of urinary incontinence in women, and that their usage should be increased.
A systematic review of studies of the use of telemedicine within urology was carried out in 2020. It found that treating stress urinary incontinence with lifestyle advice and pelvic floor training can be carried out safely and effectively via telemedicine, and the Tät app was highlighted as an example.
A 2019 review of mobile technologies to support self-management of urinary incontinence where they found 12 relevant articles including seven from the Tät project. They found evidence that there are benefits to using mobile technologies in terms of improving urinary incontinence, satisfaction, adherence to treatment and costs.
A review and assessment of apps for pelvic floor training. Of the 32 apps identified, Tät was ranked high and was given as an example of one of the few apps that had been evaluated as part of a clinical trial and that showed good results and cost-effectiveness.
A Cochrane review from 2018 looking at the effects of pelvic floor muscle training for urinary incontinence in women states that pelvic floor muscle training can cure or reduce symptoms of incontinence. Only one cost-effectiveness study was found and it was the one covering Tät. They concluded that the economic evaluation of the Tät app shows that app-based pelvic floor training may be a promising strategy for the treatment of urinary incontinence.
Page updated 2025-03-17
