Pelvic floor electrical stimulation (PFES) has been shown to be an effective treatment for stress incontinence in women; however, its role in a multicomponent behavioral training program has not been defined. A prospective randomized controlled trial to answer this question was conducted by Dr. L. Keith Lloyd and colleagues at the University of Alabama at Birmingham. They randomized 200 women with stress urinary incontinence aged 40 to 78 were randomized among three treatment groups.

Patients were assigned to 8 weeks of behavioral training with biofeedback, 8 weeks of biofeedback and home pelvic floor electrical stimulation with vaginal probes, or 8 weeks of self-administered behavioral treatment using a self-help booklet. They sought primarily reduction in incontinence episodes as documented in bladder diaries. Secondary outcomes were patient satisfaction and changes in quality of life. Results were reported in the July 16, 2003 issue of JAMA.

Analysis of the results showed that incontinence was reduced a mean of 68.6% with biofeedback enhanced behavioral training, 71.9% with biofeedback behavioral training and home PFES, and 52.5% with the self-help booklet. Thus, in comparison with the self-help booklet method, biofeedback behavioral training and similar behavioral training with PFES were significantly more effective, but they were not significantly different from each other. All three treatment groups showed substantial improvement on incontinence-related quality-of-life scores but no significant differences between the treatment groups were found. Patients perceived significantly more progress, however, in the PFES group.

The results of this study show that pelvic floor electrical stimulation did not significantly enhance the outcomes of biofeedback-assisted behavioral training for stress incontinence in women. It was postulated that biofeedback and PFES both help women identify the pelvic floor muscles and that the two technologies might overlap in function. Either may improve the results of pelvic floor muscle exercise training, but both are probably not needed for most women with stress incontinence. These technologies may help however, in the treatment of women who fail initial therapy with home pelvic floor exercises.

JAMA 2003;290:345-352