ORIGINAL ARTICLE Intensive supervised versus unsupervised pelvic floor muscle training for the treatment of stress urinary incontinence: a randomized comparative trial Mônica Faria Felicíssimo & Márcia Mendonça Carneiro & Cristina Said Saleme & Rafael Zambelli Pinto & Andrea Moura Rodrigues Maciel da Fonseca & Agnaldo Lopes da Silva-Filho Received: 27 September 2009 / Accepted: 4 February 2010 / Published online: 24 February 2010 # The International Urogynecological Association 2010 Abstract Introduction and hypothesis Pelvic floor muscle training (PFMT) is considered to be the first-line treatment for female stress urinary incontinence (SUI). There are few studies that have tested the efficacy of unsupervised PFMT. The aim of this study was to compare the effectiveness of intensive supervised PFMT to unsupervised PFMT in the treatment of female SUI. Methods Sixty-two women with SUI were randomized to either supervised or unsupervised PFMT after undergoing supervised training sessions. They were evaluated before and after the treatment with the Oxford grading system, pad test, quality of life questionnaire, subjective evaluation, and exercise compliance. Results After treatment, there were no differences between the two groups regarding PFM strength (p =0.20), Interna- tional Consultation on Incontinence Questionnaire-Short Form score (p =0.76), pad test (p =0.78), weekly exercise compliance (p =0.079), and subjective evaluation of urinary loss (p =0.145). Conclusions Both intensive supervised PFMT and unsu- pervised PFMT are effective to treat female SUI if training session is provided. Keywords Pelvic floor . Pelvic floor muscle training . Stress urinary incontinence . Quality of life Introduction The International Continence Society (ICS) defines stress urinary incontinence (SUI) as involuntary urine leakage upon effort, exertion, sneezing, or coughing [1]. SUI is the most common type of urinary incontinence (UI) and is reported by approximately 50% of incontinent women [2]. SUI can affect women of all ages and has an overall prevalence of 10-30% in girls and women between the ages of 15 and 64 years [3]. Despite the scarce research data available in Brazil, prevalence is estimated to be around 35%, but only 59% of the affected women seek medical support [4]. SUI is a distressing disorder that has a major impact on a woman’ s quality of life, interfering with social, professional, and family activities [5]. Pelvic floor muscle training (PFMT) constitutes a low- cost conservative treatment, which is currently regarded as the first-line treatment for women with SUI [6]. Success rates of 56-75% have been reported [7, 8]. PFMT leads to hypertrophy of muscle fibers, enhanced cortical awareness of muscle groups, strengthening of connective tissue in the muscles, and more effective recruitment of active motor neurons. It has been suggested that increasing the power and tone of the pelvic floor muscles leads to permanent M. F. Felicíssimo Department of Physiotherapy, Catholic University of Minas Gerais (PUC), Belo Horizonte, MG, Brazil M. M. Carneiro : C. S. Saleme : R. Z. Pinto : A. L. da Silva-Filho Department of Obstetrics and Gynecology, Federal University of Minas Gerais (UFMG), Belo Horizonte, MG, Brazil A. M. R. M. da Fonseca (*) Department of Obstetrics and Gynecology, Federal University of Minas Gerais (UFMG), Avenida Professor Alfredo Balena, 190, Santa Efigênia, 30130-100 Belo Horizonte, Minas Gerais, Brazil e-mail: deamrodrigues@hotmail.com Int Urogynecol J (2010) 21:835–840 DOI 10.1007/s00192-010-1125-1