The Aims of the study were to find out the Effect of Tanzberger Exercises  on Pelvic floor muscle strength  and Quality of Life  in Women with Stress Urinary Incontinence.

Study design: Pre-Post Test Design 

Materials: 

1.Chair (firm surface)
2.Swiss Ball (approx. 68-70 cm in diameter)
3. Hand Gloves
4. King's Health Questionnaire.

Selection Criteria:

Inclusion Criteria:

 Women suffering from stress urinary incontinence
 Women above 40 years of age

Exclusion Criteria: 

 Diabetic Neuropathies
 Congenital Urological Disease
 Urinary Tract Infection
 Neurogenic Bladder
 Tumors of the Bladder
 Women with Prolapse

Procedure: Twenty females diagnosed with clinical diagnosis of  stress urinary incontinence at the Obstetrics and Gynecology Department participated in the study.  Participants were explained about the procedure of the study in their local language and an informed written consent was obtained from all .Participants were asked to clear their all queries.

Prior to giving the first treatment session, assessment of the pelvic floor muscle strength and quality of life was done.

Assessment of the Pelvic Floor Muscle Strength: The strength of the pelvic floor muscles was done manually using the Modified Oxford Scale (MOS) (Laycock and Jerwood, 2001). 
It is a 6- point scale described as: grade zero- no contraction, grade one- flicker of contraction, grade two- weak contraction, grade three- moderate contraction (with lift), grade four- good contraction (with lift), grade five- strong contraction (with lift). 
The participant was asked to lie on her back, with the lower body exposed and the legs abducted. The labium was separated and the gloved index finger was used to palpate the walls of the vagina. The participants were then asked to contract the pelvic floor muscles by squeezing on the finger and the pelvic floor strength was graded accordingly.

Assessment of Quality of Life: The effect of stress urinary incontinence on the participant’s quality of life was assessed by the Kings Health Questionnaire (KHQ). 
It comprises of 21 questions, divided into 8 domains: general health perception (one item), UI impact (one item), role limitations (two items), physical limitations (two items), social limitations (two items), personal relationships (one item), emotions (three items) and sleep/energy (two items). The score for each domain ranges from 0- 100; higher the score, worst the QOL related to that domain.


Rehabilitation of the Pelvic Floor Muscles: Rehabilitation was done using the Tanzberger Exercises, founded  by German Physical Therapist, Renate Tanzberger. The participant was made to sit on a Swiss Ball with the hip and the knee flexed to 90o and the feet properly placed on the ground. The participants were explained in detail about the PFM. The landmarks were explained by making them sit on a firm surface (chair) and by making them feel for the contraction and relaxation of the gluteal, anal and the vaginal muscles.

1. Exercise 1- Rolling the Ball Forward: The participant was asked to roll the ball forward towards the knee without lifting off the feet and keeping the lumbar spine erect. While rolling, contraction of the PFM was to be done and while returning, relaxation. 

2. Exercise 2-Back to Back Sitting: The participant and the therapist sat on the Swiss Ball back to back. The participant was asked to pull the ball towards the knees which do not move and this activity was restricted or slowed down by the therapist who tried to pull the ball in opposite direction. While doing so participants were asked to breath normally  and also instructed not to hold the breath .This brings about the isometric contraction of the pelvic floor muscles. 

The participant were asked to contract the pelvic floor muscles (50 contractions for each exercise) while exhaling and relax while inhaling. Treatment was given for 4 weeks, 3 sessions per week. Each session continued for about 20-30 minutes depending upon the fatigue level of each individual subject with sufficient rest break in between each exercise.They were asked to do all sessions with empty bladder. At the end of the last session, the pelvic floor muscle strength and the quality of life were again assessed. The data collected was analyzed and interpreted and final conclusion was made.

Statistical analysis was done by GraphPad InStat software (Trial version 3.03) using the paired ‘t’ test. The results were concluded to be very significant. Paired ‘t’ test was used to compare the mean of the pelvic floor muscle strength and quality of life scores before and after treatment.

There was a significant difference found in the mean of the PFM strength in 20 women with stress urinary incontinence (t= 3.684, P=0.0016) before and after treatment with Tanzberger Exercises. 

There was a significant difference found in the mean of the QOL score in 20 women with stress urinary incontinence (t= 3.833, P= 0.0011) before and after treatment with Tanzberger Exercises.

The results showed that the Tanzberger Exercises significantly improves strength of the pelvic floor muscles and also improves quality of life.

The woman’s physical well being is not only affected by Urinary Incontinence, but there is also a significant impact on the psychological and socio-economic aspect of the woman’s life.

Tanzberger Exercises incorporate the use of a Swiss ball for the retraining of the weak pelvic floor musculature. Exercises are functional because they activate the pulmonary diaphragm, the abdominal and back muscles which results in the restoration of the pelvic floor and with each movement the sensory awareness of the pelvic floor is also improved. Pelvic floor muscle fibres are multidirectional and its amalgam of slow and fast twitch fibres. Strengthening is done for the fibres running in all direction whereas,   which The exercise “Rolling the ball forward” helps in activating and strengthening of the slow twitch fibres running in the anterior- posterior direction.

In day to day life, very less attention is paid to the problem of SUI, mainly due to lack of education, hesitancy and embarrassment. The quality of life of women living in rural area is hampered because of incontinence and results from this study prove that treatment with Tanzberger Exercises helps to improve the quality of life.

Tanzberger Exercises can be utilised as simple  and cost effective conservative treatment for urinary incontinence in  females residing in Rural areas with limited  health and technology resources.