Effects of Pilates With and Without Voluntary Pelvic Floor Muscle Contraction Compared to Pelvic Floor Muscle Training in Women With Stress Urinary Incontinence

Federal University of Uberlandia78 enrolled

Overview

This assessor-blinded randomized controlled trial aims to compare the effectiveness of three exercise programs for the treatment of stress urinary incontinence (SUI) in women: (1) Pilates without voluntary pelvic floor muscle contraction, (2) Pilates combined with voluntary pelvic floor muscle contraction, and (3) isolated pelvic floor muscle training (PFMT). Seventy-eight women aged over 18 years with self-reported SUI are randomly allocated into three parallel groups. Interventions last 6 weeks, with two sessions per week (12 sessions). The primary outcome is the change in the International Consultation on Incontinence Questionnaire - Short Form (ICIQ-SF) score from baseline to post-intervention. Secondary outcomes include urinary frequency and leakage episodes (72-hour bladder diary), pelvic floor muscle strength (Modified Oxford Scale), endurance, rapid contractions, and vaginal squeeze pressure measured by perineal manometry (Peritron). The hypothesis is that Pilates combined with voluntary pelvic floor muscle contraction will be superior to Pilates alone and comparable or superior to isolated PFMT.

Study Type

INTERVENTIONAL

Allocation

RANDOMIZED

Purpose

TREATMENT

Masking

SINGLE

Enrollment

Conditions

Stress Urinary Incontinence (SUI)

Interventions

Pelvic Floor Muscle TrainingOTHER

Supervised isolated pelvic floor muscle exercises performed in supine, sitting, and standing positions, including sustained and rapid contractions, twice weekly for 12 sessions.

Pilates Exercise ProgramOTHER

12-session supervised Pilates program including mat and apparatus exercises (Reformer, Chair, Cadillac), performed twice weekly. Abdominal activation during expiration is required, without voluntary pelvic floor muscle contraction instruction.

Pilates With Voluntary Pelvic Floor Muscle ContractionOTHER

Same 12-session supervised Pilates protocol, with simultaneous voluntary pelvic floor muscle contraction during each expiratory phase.

Eligibility

Sex: FEMALEMin age: 18 Years

Medical Language ↔ Plain English

Inclusion Criteria: * Women ≥18 years * Self-reported stress urinary incontinence * Positive response to stress-related leakage question Exclusion Criteria: * Inability to read/respond to questionnaires * Urinary tract infection within last 2 weeks * Current smoking * Previous pelvic surgery (except cesarean section) * Previous pelvic radiotherapy * Neurological disease * Pelvic floor muscle strength grade 0-1 (Modified Oxford Scale) * Pregnancy or \<3 months postpartum

Outcomes

Primary Outcomes

Change in International Consultation on Incontinence (ICIQ-SF) total score

Difference in total score from baseline to post-intervention. Higher scores indicate worse urinary incontinence impact.

Time frame: Baseline and 6 weeks

Secondary Outcomes

Change in urinary leakage episodes (72-hour bladder diary)

Change from baseline to 12 weeks in the number of urinary leakage episodes recorded in a 72-hour bladder diary. Higher values indicate worse symptom severity.

Time frame: Baseline and 6 weeks

Change in Pelvic Floor Muscle Strength (Modified Oxford Scale, 0-5)

Change from baseline to12 session in pelvic floor muscle strength measured using the Modified Oxford Scale (0 = no contraction; 5 = strong contraction with lift toward the pubic symphysis). Higher scores indicate greater muscle strength.

Time frame: baseline and 6 weeks