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What is the evidence regarding specific methods of pelvic floor exercise for a patient with urinary stress incontinence and mild anterior wall prolapse?

The purpose of “Evidence in Practice” is to illustrate the literature search process to obtain evidence that can guide clinical decision making. This article is not a case report. The examination, evaluation, and intervention sections are purposely abbreviated.

A 35-year-old woman was referred to my (KF) outpatient clinic by her gynecologist for treatment of urine leakage and symptoms of heaviness in her pelvis. She had a medical diagnosis of anterior vaginal wall prolapse and urinary stress incontinence. The diagnosis of urinary stress incontinence was confirmed by the results of urodynamic testing. Six months earlier she had delivered twin, full-term daughters vaginally. During the latter stages of her pregnancy, she had begun having feelings of heaviness and pressure in her pelvis and urine leakage while lifting and coughing and also during her walking exercise program (3 days a week for 30 minutes). These symptoms progressively worsened over the 6 months following the birth of her daughters. She had no pain or difficulty with urination, elimination, or intercourse. There was no other relevant medical history.

The patient was an elementary school teacher, and she had resumed teaching 3 months before her referral for examination. Her daily fluid intake typically consisted of several cups of coffee and tea and one glass of water. Her schedule permitted her to use the restroom only every 4 to 5 hours. The patient's goals were to reduce the feelings of heaviness and pressure and to eliminate episodes of incontinence because these problems interfered with her ability to teach without interruption and made her less eager to resume walking.

I examined her posture and bony alignment to screen for asymmetry or misalignment, reasoning that these problems could affect the function of the musculoskeletal system relative to the pelvis. With the patient standing as described by Isaacs and Bookhout, …