Pelvic floor muscle training and KAATSU for women with stress urinary incontinence
IUGA Academy. Due U. Jun 30, 2018; 212818
Topic: Stress Incontinence
Mrs. Ulla Due
Mrs. Ulla Due

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Pelvic floor muscle training and KAATSU for women with stress urinary incontinence

Due, U1; Klarskov, N2; Gräs, S2; Lose, G2

1: Department of Obstetrics and Gynecology and Department of Occupational and Physical therapy, Herlev and Gentofte Hospital, University of Copenhagen, Denmark; 2: Department of Obstetrics and Gynecology, Herlev and Gentofte Hospital, University of Copenhagen, Denmark

Introduction: Women with stress urinary incontinence (SUI) have reduced pelvic floor muscle strength and the effect of pelvic flor muscle training (PFMT) is limited. KAATSU involves training a muscle with partly reduced blood flow using a pressure cuff (1). KAATSU is performed as low-intensity training (<50% of one repetition maximum) and has been found to produce hypertrophy similar to a high intensity strength training program. One study found cross-transfer effect on an upper arm muscle that was trained with low-intensity without KAATSU but in relation to KAATSU of a thigh (2). This effect could be similar in other muscles trained in relation to KAATSU.

Objective: Aim of this study was to explore if KAATSU added to PFMT could increase subjective and objective effect of PFMT in women with SUI.

Methods: Single-blinded randomized controlled pilot study conducted at a large tertiary unit from 1th of March 2016 to 1th.of June 2017. Women with SUI and an ICIQ-SF score of ≥ 12 were randomized to a low-intensity PFMT program followed by KAATSU of a thigh (Group A) or to a low-intensity PFMT program without KAATSU (group B), both performed four times a week for 12 weeks. Primary outcome was change in the ICIQ-SF score at a 12-week follow-up. Secondary outcomes were changes in the urethral opening pressure (UOP) measured with urethral pressure reflectometry (UPR) at rest, during contraction and straining at the 12-week follow-up examination. Finally, the women were asked if the training program had caused them any bother.

Results: Forty-one women, median age 45 (35-72) with SUI (ICIQ-SF median 13 (12-16)) were included, 20 women in group A and 21 women in group B. Fourteen women in group A and 17 women in group B completed the study. Both groups had a significant and clinically relevant improvement of the ICIQ-SF score (3) but no significant difference between the groups was observed. The UOP during contraction increased insignificantly in group A and decreased significantly in group B (p =0.02), which resulted in a significant difference between the two groups (p=0.004). No difference was seen in the resting and straining UOP (table 1). Seven of the 14 women in group A found the pressure cuff irritating, while no women in either group reported bother from the PFMT program.

Conclusion: KAATSU training did not increase the effect of low-intensity PFMT and while subjective effect was both significantly and clinically relevant in both groups this was not reflected in the UPR measures. KAATSU is an interesting principle but our protocol was not well tolerated and we cannot recommend it.

Table 1 Between-group differences of changes


Group A

Group B

p value

ICIQ-SF median (range)

-5.5 (-13/+4)

-5.0 (-8/+3)


UOP-resting, mean (SD)

1.0 (4.75)

1.2 (4.89)


UOP-contraction, mean (SD)

2.3 (4.55)

-3.4 (5.32)


UOP-straining, mean (SD)

4.0 (7.73)

2.9 (7.21)


  1. J Strength Cond Res.2013 Oct;27(10):2914-26
  2. Med Sci Sports Exerc.2008 Feb;40(2):258-63.
  3. Neurourol Urodyn.2015 Nov;34(8):747-51


Work supported by industry: yes, by Lundbeck Foundation. A consultant, employee (part time or full time) or shareholder is among the authors (Ulla Due has received fees for developing free website information ( and apps for women about pelvic floor disorders for Gynzone, Gunnar Lose is part time consultant for Contura).

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