My squeeze number went up at the six week review but I am leaking exactly the same. Which one do I believe?

Six week review was this afternoon and I have come home more confused than I went in, which I did not think was possible.

The good news, apparently, is that the reading on the sensor thing has gone up. She showed me the number from April next to the number from today and it is definitely higher, she was pleased, I did the polite pleased face back. The bad news is that I am leaking exactly as much as I was in April. Same on the school run, same when the youngest jumps on me, same laughing at the telly. I have the diary to prove it because I did the three days again before the appointment like a good girl and the two diaries are basically photocopies of each other.

So what I want to know is which one is real. Is the number the thing that matters and the leaking will catch up, or is the leaking the thing that matters and the number is a bit of a party trick? Because if I have a stronger muscle and the same knickers situation I am struggling to see what I have actually got for six weeks of squeezing in the car park. And a small part of me thinks the number went up because I was trying really hard in front of her and it would not go up on a Tuesday night when I am knackered.

She did not say it was not working, to be fair. She changed some things. But I asked her straight out whether the number going up meant the leaking would stop and she gave me a very careful answer that I could not turn into a yes or a no.

Mine is the other way round, for what it is worth. Nobody has ever shown me a squeeze number. What they count is pads, how many a day and how heavy, and I have learned the hard way that "dry" means whatever the person counting it has decided it means.

First course, years ago now, I was never measured at all. Every appointment started with "how are you getting on" and I said "fine, I think" because what else do you say, and we both nodded and I was discharged on nods. I have no idea to this day whether anything moved because nothing was ever written down.

Second course I had a number and honestly it was a relief even when it was a boring number, because at least somebody was comparing something with something. What I would say from that, and this is only my own experience, is that the number and the leaking did not move at the same time for me either. Number first, by a distance. I remember being cross about it in exactly the way you are cross now. I would not have believed anyone who told me to wait, so I am not going to tell you to wait, only that I did and it went the way I wanted.

bex1990 said:

a small part of me thinks the number went up because I was trying really hard in front of her

Different problem from yours so read this as a footnote. My number was low at the start and everyone including me read low as weak, so I squeezed more, and the number stayed low and I felt worse. Turned out my muscle was not weak, it was clenched all the time and could not squeeze any harder because it had nowhere to go. The number was true, my reading of it was wrong.

Which is my roundabout way of saying the number is not a party trick, but on its own it does not tell you what to do about it. The examination that goes with it does.

The short answer, Bex, is that both are real and you are looking at two different measurements that were never going to move on the same day. The sensor reading describes the muscle. The diary describes the symptom. The treatment is judged on the second, and the first is how your physiotherapist decides what to change, which by the sound of it is exactly what she used it for.

The evidence is counted in symptoms, and that is worth knowing when you are deciding which number to trust. The Cochrane review that underpins this treatment compared pelvic floor muscle training against no treatment or an inactive control and reported cure in 56% of women with stress urinary incontinence against 6% of controls, from 4 trials and 165 women, at high certainty, and separately 1.23 fewer leakage episodes per 24 hours, from 7 trials and 432 women. Nobody in those trials was cured of a low reading. They were cured of leaking, counted the way your diary counts it. So your diary is the outcome. A three day diary repeated before each review, kept the same way each time, is the cheapest repeatable measure in the whole field and you are already doing it properly.

The reading is a different currency. A perineometer measures the pressure a contraction produces, and it is genuinely useful for one thing: checking that the movement you are practising is the movement that was prescribed, and whether it is getting stronger, longer or faster. The review of the field I would cite says training needs proper instruction and close follow-up to be effective, and that is the job the sensor does. It is not a forecast. On your worry that you tried harder in front of her, that is a fair point and a known limitation; the reading is a snapshot of effort on a day, which is why nobody should be changing a programme on the reading alone, and why the diary sits beside it.

On timing. Six weeks is inside the minimum, not past it. NICE NG210 recommendation 1.6.14 offers at least three months of supervised training for stress or mixed urinary incontinence, and 1.6.18 asks for at least one review during the programme and one at the end, so what you had this afternoon is the first of two, and a first review that produces a changed prescription is the system working rather than failing. There is no published week by week curve for when leaking starts to change, and I would be cautious of anyone who gives you one. What I can say is that leaking has more parts than strength: timing and coordination under load matter as much as the size of the squeeze, and those are often the later things to arrive.

Mo's footnote deserves a proper answer because it is the exception that matters. A number that goes up while symptoms stay the same is one picture. A number that will not move while symptoms get worse, or an ache that grows with more effort, is a different picture and it needs reassessing rather than pushing through, because an overactive floor can test as weak and strengthening it runs the wrong way. From your post that is not what you are describing, but it is the reason the reading needs an examination beside it and not just a diary.

What to take to the next review: the two diaries, plus a third column recording at what point in an activity the leak happened rather than only whether it did. That is often where the first change shows before the count moves. The page on how progress is measured explains what each tool actually shows, including the pad test Gerry was describing and why "dry" moves with the definition, and if the muscle side of it interests you, how pelvic floor muscle training works covers why a stronger floor is not automatically a better behaved one.

What I cannot tell you is what your reading means for your programme, or whether the changes she made are the right ones. She examined you and I have not, and she gave you a careful answer because a careful answer was the accurate one.

Coming back to this because I promised myself I would if it changed, and it did.

Diary at the fourteen week mark was the first one that looked different. Not dry. But the school run was fine most days and the laughing thing had mostly stopped, and the third column Bethan suggested was the giveaway, because the leaks that were still happening had moved to the very end of things rather than the start. Which is the same thing she said in June and I nodded along to without believing a word of it.

The number went up again too but I have stopped caring about the number, which I think is the point.