[Pelvic floor conditioning with vaginal weights--post partum and in urinary incontinence].Zentralbl Gynakol. 1996; 118(1):18-28.ZG
To check on the efficacy of cone training 71 women were thoroughly examined six to eight weeks after spontaneous deliveries at various risk levels. Their pelvic floor was examined by palpation, inspection, manometry and gravimetry. All of them were re-examined in the same way after four to six weeks of daily cone training. Thirty women with moderate genuine stress incontinence (16) or stress/urge incontinence (14) were evaluated by the same procedure, independent of gestation. A control group included 20 women prior to and after conventional puerperal pelvic floor exercises and eight nulliparae of the same age prior to and after the same cone training, using a five-cone set. The number of puerperae not capable of voluntary pelvic floor contraction declined from 34 % before to 6 % after training. Optimum initial and posttraining responses, on the other hand, were exhibited by all nulliparae. Differences in childbirth risk for pelvic floor damage played a less important role than childbirth proper. Training related differences were of minor importance, as well, between cone and conventional exercise groups. Notwithstanding different initial values, all puerperae increased their contractility to 10 mm Hg on average, while the increase accomplished by nulliparae was from 15 mm Hg to 21 mm Hg. Cone Nos. 1-3 (20.0-45.0g) were most frequently required at the beginning of training and Nos. 3-5 (45.0-70.0 g) towards the end, for an average increase by one or two cone numbers. 25 % of the cone women and 35 % of the conventional exercise probands failed to complete the training, which was indicative of limited patient compliance after delivery. A positive correlation was found to exist between motivation and training success. Cone training also had positive effects on sexuality. It has proved to work well alternatively or complementary to conventional postpartum exercises and, therefore, may be recommended to all women who are not capable of holding with their pelvic floor vaginal cones of 20-70 g in the postpartum period. In women with urinary incontinence (UI) no pelvic floor response was recordable, prior to training, from five women (17 %). Response was not even recorded from eight women (21 %) by palpation. After training, the capability of voluntary and reflex contraction of pelvic floor muscles was restored in all women. The best post-training result was obtained from palpation (27 positive responses). Manometry and capability of the pelvic floor to hold vaginal cones were other suitable methods in this context: in 15 women (50 %) cone weights were extremely low at the beginning of treatment (Cone no. 1-2), while after treatment 19 women (63 %) held cones up to Nos. 4-5. All healthy women of the control group started with Cone No. 5. In conformity with postpartum groups average increase in pelvic floor contractility was from 5 mm to 10 mm Hg in UI patients. Twenty-four women (80 %) were cured from UI (57 %) or were improved (23 %). Twenty-six women asked for continuation of cone training. Pelvic floor conditioning, using vaginal cones, is a good alternative to poor acceptance or insufficient availability of conventional pelvic floor exercises in conservative treatment of urinary incontinence and descensus.