Acupuncture combined with pelvic floor muscle training for treating postpartum stress urinary incontinence

Abstract

Objective: To explore the clinical application of acupuncture combined with pelvic floor muscle training (PFMT) in treating postpartum stress urinary incontinence (PSUI) based on patient data.

Methods: A retrospective analysis was performed on 97 PSUI patients treated at the Second People's Hospital of Nantong from July 2021 to June 2023. Patients voluntarily chose between the two treatment groups: PFMT alone or the combination of acupuncture and PFMT. Multiple indicators, including pad test positive rate, urinary scores, leakage volume, incontinence degree, treatment effectiveness, pelvic floor muscle strength, and sexual quality of life, were compared between the two groups.

Results: The pad test positive rate was significantly lower in the combined treatment group (7.69%) than in the PFMT group (28.89%) (P = 0.013). The combined treatment group had lower urinary scores (t = 9.288-16.020, all P < 0.001) and higher overall efficacy (92.31% vs. 68.89%, P < 0.05). Both groups demonstrated improved pelvic floor muscle strength, with the combined intervention group showing greater enhancement compared to PFMT alone (P < 0.05). Urinary leakage volume and incontinence degree scores decreased more in the combined treatment group (P < 0.001) than in the PFMT group (P < 0.001 between groups). The combined treatment group had better sexual quality of life and greater reductions in SAS and SDS scores (P < 0.05).

Conclusion: Acupuncture combined with PFMT demonstrated significantly superior outcomes to PFMT alone for PSUI treatment, with significant improvements in incontinence symptoms, psychological status, muscle strength, and quality of sexual life. Findings support the clinical adoption of this combined strategy for PSUI.

Keywords: Acupuncture; efficacy; pelvic floor muscle training; postpartum; stress urinary incontinence.

Figure 1

Flow chart of cases inclusion, exclusion, and grouping study. Note: PFMT: PSUI: postpartum stress urinary incontinence; pelvic floor muscle training.

Figure 2

Electromyogram of the pelvic floor muscles. Note: Pre-resting phase: This phase tests the muscle state at rest. A value > 4 μV, accompanied by variability exceeding the reference range, may suggest possible muscle overactivity. Rapid contraction phase: It is used to assess the function of fast-twitch muscles. A markedly low maximum value indicates insufficient muscle strength, while abnormal relaxation times may reflect potential muscle overactivity. Tense contraction phase: This phase measures the strength of slow-twitch muscles. An abnormally low average value indicates insufficient muscle strength, whereas elevated variability indicates poor muscle stability. Endurance contraction phase: It examines the endurance of slow-twitch muscles. A very low average value implies diminished endurance of slow-twitch muscles. Post-resting phase: This phase determines whether the muscle returns to its normal state following a series of contractions. A value > 4 uv, together with the variability above the reference threshold, may suggest muscle overactivity.

Figure 3

Electromyogram of the pelvic floor muscles. Note: Pre-resting phase: This phase tests the muscle state at rest. A value > 4 μV, accompanied by variability exceeding the reference range, may suggest possible muscle overactivity. Rapid contraction phase: It is used to assess the function of fast-twitch muscles. A markedly low maximum value indicates insufficient muscle strength, while abnormal relaxation times may reflect potential muscle overactivity. Tense contraction phase: This phase measures the strength of slow-twitch muscles. An abnormally low average value indicates insufficient muscle strength, whereas elevated variability indicates poor muscle stability. Endurance contraction phase: It examines the endurance of slow-twitch muscles. A very low average value indicates diminished endurance of slow-twitch muscles. Post-resting phase: This phase determines whether the muscle returns to its normal state following a series of contractions. A value > 4 uv, together with the variability above the reference threshold, may suggest potential muscle overactivity.

Figure 4

Rates of positive cases detected by pad tests between combined treatment group vs PFMT group. Note: The rate of positive cases of the combined treatment group (n = 52) was lower than that of pelvic floor muscle training (PFMT) group (n = 45) (P < 0.05). A. Combined treatment group; B. PFMT group.

Figure 5

Comparison of urinary frequency score between PFMT group vs combined treatment group. Note: **indicated that a statistically significant difference was found in comparison between two groups (P < 0.05). Urinary frequency in the combined treatment group were lower than those in the PFMT group at 1 week, 2 weeks, and 3 weeks after treatment. PFMT: pelvic floor muscle training.

Figure 6

Comparison of urinary leakage volume and incontinence degree score between PFMT group vs combined treatment group. Note: Before treatment, there were no significant differences between the two groups in urinary leakage volume and incontinence degree score, while after treatment, both groups showed decrease in urinary leakage volume and incontinence degree score. PFMT: pelvic floor muscle training. **indicated that a statistically significant difference was found in comparison between two groups (P < 0.05).