3Lecturer, Annamalai University.
6Principal, College of Allied Health Sciences, East Coast Institute of Health Sciences.
*Corresponding Author E-mail: sbajpai7@gmail.com
ABSTRACT:
Objective of The Study: The study aims to compare the effectiveness of Paula method and Kegel's exercise in women with urinary incontinence. Background of The Study: Pelvic floor muscle weakness is one of the cause for urinary incontinence. Conservative management such as pelvic floor muscle training and Paula method is commonly recommended as first-line therapy for women with urinary incontinence. The purpose of the study is to examine the efficacy of circular muscle strengthening (Paula method) as opposed to pelvic floor muscle training (PMFT) on stress urinary incontinence. Methodology: This study was a comparative study design with pre and post type with 40 subjects randomly divided into two groups (group A and group B). Group A received Kegel’s exercise and Group B received Paula method. Result: On comparing Pre test and Post test within Group A and Group B of ICIQ score, QOL score, sexuality questionnaire score shows highly significant difference in mean values at P ≤ 0.001. Conclusion: This study concludes that Paula method decreases frequency of urinary incontinence by strengthening sphincter muscles. Compared to the Kegel’s exercise, Paula method showed greater difference in decreasing the frequency of urinary incontinence.
KEYWORDS: Kegel’s exercise, Paula method, urinary incontinence.
INTRODUCTION:
Urinary incontinence, defined as the involuntary leakage of urine affects 15-50% of women in community.1 It has been defined as any involuntary leakage of urine during sneezing coughing or any physical exertion.2 Urinary incontinence affects women of all ages, but is particularly common among older age groups. Approximately 15%–30% of women suffer from urinary incontinence worldwide3. The prevalence of some form of UI in women varies between 12% and 55% depending on age and geographical location SUI being the most common form. The incidence in men is Less than 25% of that in women, with the prevalence ranging between 2% and 3%.
In the community, reported remission rates are about 4-6% in elderly women and 5% in elderly men. In women, however, the incidence exceeds the remission rate such that the prevalence continues to rise with age4
Pelvic floor muscle exercises — Pelvic floor muscle (Kegel) exercises are effective in some women with SUI. This approach is most effective with specific instruction and monitoring by health professionals and diligent performance by motivated patients.5 The aim of the training procedure is to improve pelvic floor muscle (PFM) function. The treatment consists of muscle awareness training, training of strength and coordination9 The Paula method - an alternative to PFMT; it is based on circular muscle exercises and has demonstrated similar efficacy for urinary leakage control The Paula method is a circular muscle exercise protocol that works on the premise that all sphincters in the body are synchronized, so that movement of one sphincter affects distant circular muscles.6
The reliability of the International consultation on incontinence assessment was judged by the patients. Thirty-eight of the 50 patients (76%, 95% confidence limits 62-87) found the urine loss during the test representative of the everyday incontinence 7.
Quality of life total score showed high internal reliability, with values for the Cronbach. 70 for all 4 scores: total score 93; avoidance and limiting behavior, 85; psychosocial impact.89; and social embarrassment, .79. 8
The validity and reliability of this sexuality questionnaire were estimated art 0.86 and 0.82, respectively. In addition, the maximum and cut off point scores of this questionnaire were obtained 60-26 9
METHODOLOGY
This study was a comparative study design with pre and post type with 40 subjects randomly taken in outpatient physiotherapy department of ACS medical college and hospital and took nearly 12 weeks to complete the study. International Consultation on Incontinence Questionnaire, Quality Of Life questionnaire and Sexuality questionnaire would be the outcome measure. Patients with age group of 20-40, with symptoms of urinary incontinence for atleast 12 weeks, Patients with atleast 1 incontinence episodes per day, urinary diurnal frequency of 10 or less per day, nocturia of two or less per day are included. Patients with vaginal or pelvic pain, chronic constipation, obese BMI greater than 30, history of neurological conditions are excluded.
DATA ANALYSIS:
The collected data were tabulated and analyzed using both descriptive and inferential statistics. All the parameters were assessed using statistical package for social science (SPSS) version 24. Paired t-test was adopted to find the statistical difference within the group and Independent t – test (Student t-test) was adopted to find statistical difference between the groups.
Table 1: Comparison of Iciq Score Between Group-A And Group-B Pre Test and Post Test
|
#ICIQ |
Group- A |
Group- B |
t-test |
Df |
significance |
||
|
Mean |
S.D |
Mean |
S.D |
||||
|
Pre test |
6.1 |
1.37 |
6.15 |
1.01 |
0.1285 |
38 |
0.8988* |
|
Post test |
4.65 |
1.31 |
4.5 |
1.07 |
0.3865 |
38 |
0.7012** |
(* -P > 0.05), (** -P ≤ 0.001)
Table 2: Comparison of Quality of Life Score Between Group-A and Group-B in Pre Test and Post Test
|
#Quality of life |
Group-A |
Group-B |
t-test |
df |
significance |
||
|
Mean |
S.D |
Mean |
S.D |
||||
|
Pretest |
6.3 |
1.4525 |
6.9 |
1.5620 |
1.2261 |
38 |
0.8988* |
|
Post test |
5 |
1.4832 |
4.55 |
1.0712 |
1.0721 |
38 |
0.7012** |
Table 3: Comparison of Sexuality Questionnaire Score Between Group-A And Group-B in Pre and Post Test
|
#Sexuality questionnaire |
# Group-A |
#Group-B |
t-test |
df |
significance |
||
|
Mean |
S.D |
Mea N |
S.D |
||||
|
Pre test |
6 |
1.6733 |
7.5 |
1.0723 |
1.0723 |
38 |
0.0021* |
|
Post test |
4.85 |
1.7109 |
6.35 |
1.1521 |
3.739 |
38 |
0.0006** |
(* -P > 0.05), (** -P ≤ 0.001)
Table 4: Comparison of Iciq Score Within Group-A And Group-B Between Pre and Post Test
|
#ICIQ |
Pre test |
Post test |
t-test |
df |
significance |
||
|
Mean |
S.D |
Mean |
S.D |
||||
|
GROUP-A |
6.1 |
1.37 |
6.15 |
1.01 |
12.70 |
19 |
0.000* |
|
GROUP-B |
4.65 |
1.31 |
4.5 |
1.07 |
0.5878 |
19 |
0.05638* |
(* -P ≤ 0.001)
Table 5: Comparison of Quality of Life Score Within Group-A and Group-B Between Pre and Post Test
|
#Quality of life |
Pre test |
Post test |
t-test |
df |
significance |
||
|
Mean |
S.D |
Mean |
S.D |
||||
|
GROUP-A |
6.3 |
1.4525 |
6.9 |
1.5620 |
12.3654 |
19 |
0.000* |
|
GROUP-B |
5 |
1.4832 |
4.55 |
1.0712 |
15.6666 |
19 |
0.000* |
(* -P ≤ 0.001)
Table 6: Comparison of Sexuality Questionnaire Score Within Group-A And Group-B Between Pre And Post Test
|
#Sexuality questionnaire |
Pre test |
Post test |
t-test |
.df |
Significance |
||
|
MEAN |
S.D |
MEAN |
S.D |
||||
|
GROUP-A |
6 |
1.6733 |
7.5 |
1.0723 |
0.5542 |
19 |
0.5859* |
|
GROUP-B |
4.85 |
1.7109 |
6.35 |
1.1521 |
0.5542 |
19 |
0.5859* |
(* -P ≤ 0.001)
RESULT:
On comparing Pre test and Post test within Group A and Group B of ICIQ score, QOL score, sexuality questionnaire score shows highly significant difference in Mean values at P ≤ 0.001
DISCUSSION:
This study aimed to evaluate the effectiveness of kegel’s exercise and paula method in women with urinary incontinence. David D Rahn et.al said that urinary incontinence is one of the most prevalent types of urine urinary incontinence in the world. It has been defines as any involuntary leakage of urine during sneezing coughing.
Totally 40 subjects were selected and included as per inclusion criteria and then they were divided into two groups in which one undergone kegel’s exercise and another undergone paula method. Park J reported that Pelvic floor muscle training is an accepted therapy to improve or cure symptoms of stress or mixed urinary incontinence. In healthy women activation of the pelvic floor muscles before or during physical exertion seems to be an automatic response and does not require conscious effort. D.Shveiky et.al noted the paula theory can rehabilitate damaged muscles by contraction and relaxation of specific ring muscles in other areas of the body. For example levator ani muscle weakness resulting in SUI can be improved by exercising ring muscles of the eye, mouth, nose and others.10
Pre test and post test was done using questionnaires and measured prior to the training and at the end of 12weeks of training. Sandvik H et.al said that the International consultation on incontinence questionnaire has developed a series of international questionnaires and is striving to validate these questionnaires for the investigation lower urinary tract dysfunction in research and clinical settings11.
Some study such as D. Hochner et.al concluded that both the method are efficacious in women with urinary incontinence. But the results suggest superiority of the paula method in terms of cure rate12.
This current study revealed that there was mild improvement in the group A. but group B showed significant improvement due to effect of paula method at the end of 12 weeks of training.
CONCLUSION:
This study concludes that the Paula method decreased the frequency of urinary Incontinence by strengthening the sphincter muscles. Compared to kegel’s exercise, Paula method showed greater difference in decreasing the frequency of urinary incontinence.
REFERENCES:
1. Sigrid Tibaek et. al. Pelvic floor muscle training is effective in women with urinary incontinence : A randomized, controlled and blinded study. Neurology and Urodynamics. 2005 ; 24 : 348-357 doi 10.1002/nau.20134
2. Markus et. al. Pelvic floor muscle training for urinary incontinence: A randomized, controlled trial. Physiother Res Int. 2010 ; 16 : 133-140 doi 10.1002/pri.489
3. Mlieberall-Wischniter et.al Randomized trail of circular muscle versus pelvic floor training for stress urinary incontinence in women. Journal of Women’s Health. 2009 ; 18(3): 377-385 doi 10.1089/jwh.20080950
4. D. Shveiky et. al. Long term efficacy of Paula method as compared with pelvic floor muscle training for urinary incontinence in women . J Wound Ostomy Continence Nurs. 2013; 40 (1): 90-96 doi 10.1097/WON.0b013e318275012f
5. Y. Lavy et. al. Paula method of circular muscle exercises for urinary incontinence-A clinical trail. Int Urogynecol. 2005;16;345-351 doi10.1007/s00192-004-1261-6
6. Peter Perris et. al. Experimental study No.8 stress urinary incontinence results from muscle weakness and ligamentous laxity in the pelvic floor. Pelviperineology. 2008;27:107-109 doi 1O.1016/j.purol.2008.02.006
7. Flavia de Oliveira Camargo. Pelvic Floor Muscle training in female stress urinary incontinence : comparison between group traning and individual treatment. Int Urogynecol. J2009;20:1462 doi 10.1007/s00192-009-0971-1
8. Lauren P et. al. Prevalence and severity of undiagnosed urinary incontinence in women Am J Medical Author Menuscript. 2009;122(11):1037-1042. doi 10.1016/j.amjmed.2009.05
9. S.L Tennstedt et. al. Quality of life for stress urinary incontinence. Int Urogynecol J. 2008;19:1631-1638 doi 10.1007/s00192-008-0700-1
10. Declan P Keane. Urinary incontinence; anatomy, physiology and patho phsyology. Bailliere’s Clinical Obstetrics and Gynaecology. 2000;14(2):2007-226 doi10.1053/beog.1999.0072`
11. Resende AP et.al effects of paula method in electromyographic activation of pelvic floor: A comparative study. Int. Urogynecol. 2011; 22 (6): 677-680 doi 10.1007/s00192-010-1331
12. Valentina Lucia La Rosa et. al. Sexual Life in women with stress urinary incontinence. Oman Medical Journal. 2017;32(2):174-175.doi10.5001/omj2017.33
Received on 10.05.2021 Modified on 21.03.2022
Accepted on 29.09.2022 © RJPT All right reserved
Research J. Pharm. and Tech 2023; 16(7):3261-3263.
DOI: 10.52711/0974-360X.2023.00536