A Pelvic Muscle Precontraction Can Reduce Cough‐Related Urine Loss in Selected Women with Mild SUI

OBJECTIVES: To test the hypothesis that selected older women with mild‐to‐moderate stress urinary incontinence (SUI) can learn to demonstrate significantly reduced urine loss in 1 week by intentionally contracting the pelvic floor muscles before and during a cough (a skill we have termed “The Knack”). DESIGN: A prospective, randomized, single‐blind interventional study. SETTING: The Older American Independence Center, a federally sponsored research program affiliated with the University of Michigan in Ann Arbor, Michigan. PARTICIPANTS: Twenty‐seven women with a mean (SD) age of 68.0 (5.5) years, self‐reported SUI, and demonstrable urine loss during a deep cough. INTERVENTION: Women were randomized to an immediate intervention group (Group I: n = 13) who were taught the Knack after their first clinic visit, or a wait‐listed control group (Group II: n = 14) who were taught the Knack after 1 month. MEASUREMENTS: At 1 week after instruction, we tested the efficacy of the Knack in a standing stress test by (1) comparing the volumes of cough‐related urine loss leaked by all subjects, with and without use of the Knack, and (2) comparing the volumes of cough‐related urine loss leaked by Group I, using the Knack, with Group II, which had not yet been taught the Knack. RESULTS: Intra‐individual results showed that at 1‐week follow‐up, the Knack was used to reduce urine loss resulting from a medium cough by an average of 98.2%, compared with that of a similar cough performed 1 minute before without the Knack (P =.009); likewise urine loss was reduced by an average of 73.3% (P =.003) in a deep cough. Reduction in urine loss was not significantly correlated with a digital measure of pelvic floor muscle strength. CONCLUSION: Within 1 week, selected older women with mild‐to‐moderate SUI can acquire the skill of using a properly‐timed pelvic floor muscle contraction to significantly reduce urine leakage during a cough.