Pelvic floor muscle training
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
Mobile app for treatment of stress urinary incontinence: A randomized controlled trial.
Asklund I, Nyström E, Sjöström M, Umefjord G, Stenlund H, Samuelsson E.
Neurourol Urodyn. 2017 Jun;36(5):1369-1376. doi: 10.1002/nau.23116. Epub 2016 Sep 9.
Link to summary Link to article
Treatment of stress urinary incontinence with a mobile app: factors associated with success.
Nyström E, Asklund I, Sjöström M, Stenlund H, Samuelsson E.
Int Urogynecol J 2017 Dec 8. doi: 10.1007/s00192-017-3514-1. [Epub ahead of print]
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User experience of an app-based treatment for stress urinary incontinence: qualitative interview study. Asklund I, Samuelsson E, Hamberg K, Umefjord G, Sjöström M.J Med Internet Res 2019;21(3):e11296. doi:10.2196/11296. Link to summary Link to article
Self-management of stress urinary incontinence via a mobile app: 2–year follow-up of a randomized controlled trial. Hoffman V, Söderström L, Samuelsson E.
Acta Obstet Gynecol Scand. 2017 Jul 17. doi: 10.1111/aogs.13192. [Epub ahead of print]
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Mobile app for treatment of stress urinary incontinence: A cost-effectiveness analysis.
Sjöström M, Lindholm L, Samuelsson E. J Med Internet Res 2017; 19(5): e154. DOI: 10.2196/jmir.7383. Link to summary Link to article
Real-world effectiveness of app-based treatment for urinary incontinence: a cohort study. Rygh P, Asklund I, Samuelsson E. BMJ Open 2021;11:e040819. doi: 10.1136/bmjopen-2020-040819. Link to summary Link to article
Self-management of incontinence using a free mobile app: factors associated with improvement. Nyström, E., Söderström, L. & Samuelsson, E. Int Urogynecol J (2021). https://doi.org/10.1007/s00192-021-04755-5. Link to article
App‐based pelvic floor muscle training in pregnant and postnatal women: a prospective cohort study exploring factors associated with prevention and improvement of urinary incontinence. Löjdahl E, Lindam A, Asklund I. Health Sci Rep2022;5:e781.doi:10.1002/hsr2.781. Link to article
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.
Davenport MH, Nagpal TS, Mottola MF, et al. Prenatal exercise (including but not limited to pelvic floor muscle training) and urinary incontinence during and following pregnancy: a systematic review and meta-analysis. Br J Sports Med. 2018;52(21):1397-404.
Woodley SJ, Lawrenson P, Boyle R, et al. Pelvic floor muscle training for preventing and treating urinary and faecal incontinence in antenatal and postnatal women. Cochrane Database Syst Rev. 2020;5:CD007471.
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.
Neels H, De Wachter S, Wyndaele JJ, Wyndaele M, Vermandel A. Does pelvic floor muscle contraction early after delivery cause perineal pain in postpartum women? Eur J Obstet Gynecol Reprod Biol. 2017 Jan;208:1-5.
Pelvic floor muscle training is effective for reducing the symptoms of prolapse.
Women diagnosed with a prolapse, 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.
Suzanne Hagen, Diane Stark, Cathryn Glazener, Sylvia Dickson, Sarah Barry, Andrew Elders, Helena Frawley, Mary P Galea, Janet Logan, Alison McDonald, Gladys McPherson, Kate H Moore, John Norrie, Andrew Walker, Don Wilson, on behalf of the POPPY Trial Collaborators*. Individualised pelvic floor muscle training in women with pelvic organ prolapse (POPPY): a multicentre randomised controlled trial. Lancet 2014; 383: 796–806.
A compilation of several studies concludes that there is evidence that pelvic floor muscle training is effective for reducing the symptoms of prolapse.
Dumoulin C et al. Adult conservative treatment. In: Abrams P, Cardozo L, Wagg A, Wein A, editors. Incontinence. 6th ed. ICI-ICS. International Continence Society, Bristol, UK2017. p. 1547-60
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.
Rahn, D et al. Vaginal Estrogen for Genitourinary Syndrome of Menopause: A Systematic Review. Obstetrics & Gynecology 2014; 124 (6):1147-56
Systematic reviews that include the Tät app:
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.
Jaffar A, Tan CE, Mohd-Sidik S, Admodisastro N, Goodyear-Smith F. Persuasive Technology in an mHealth App Designed for Pelvic Floor Muscle Training Among Women: Systematic Review. JMIR Mhealth Uhealth 2022;10(3):e28751.
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.
Karsalia M, Malik R. Evaluation of free mobile health applications for pelvic organ prolapse and urinary incontinence. Am J Surg. 2022 Jan;223(1):187-193. doi: 10.1016/j.amjsurg.2021.07.046. Epub 2021 Aug 8. PMID: 34391568.
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.
Widdison R, Rashidi A, Whitehead L. Effectiveness of mobile apps to improve urinary incontinence: a systematic review of randomised controlled trials. BMC Nurs. 2022 Jan 28;21(1):32. doi: 10.1186/s12912-022-00812-6. PMID: 35090464; PMCID: PMC8796429.
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.
Ho L, Macnab A, Matsubara Y, Peterson K, Tsang B, Stothers L. Rating of pelvic floor muscle training mobile applications for treatment of urinary incontinence in women. Urology. 2020. https://doi.org/10.1016/j.urology.2020.08.040.
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.
Wu C, Newman DK, Palmer MH. Unsupervised behavioral and pelvic floor muscle training programs for storage lower urinary tract symptoms in women: a systematic review. Int Urogynecol J. 2020 Dec;31(12):2485-2497. doi: 10.1007/s00192-020-04498-9. Epub 2020 Sep 1. PMID: 32870339.
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.
Novara G, Checcucci E, Crestani A, Abrate A, Esperto F, Pavan N, De Nunzio C, Galfano A, Giannarini G, Gregori A, Liguori G, Bartoletti R, Porpiglia F, Scarpa RM, Simonato A, Trombetta C, Tubaro A, Ficarra V; Research Urology Network (RUN). Telehealth in Urology: A Systematic Review of the Literature. How Much Can Telemedicine Be Useful During and After the COVID-19 Pandemic? Eur Urol. 2020 Dec;78(6):786-811. doi: 10.1016/j.eururo.2020.06.025. Epub 2020 Jun 18. PMID: 32616405; PMCID: PMC7301090.
