Pelvic floor yoga not superior to general muscle strengthening for urinary incontinence in women

1. In this randomized controlled trial, middle-aged and older women who participated in pelvic yoga had similar changes in urinary incontinence frequency compared to those who participated in non-specific physical conditioning.

2. Both treatments led to a decrease in all-type incontinence over 12 weeks.

Evidence Rating Level: 1 (Excellent)

Study Rundown: One-third of midlife and older women suffer from urinary incontinence (UI), with many receiving inadequate treatment due to inaccessibility and a lack of affordable, well-tolerated therapies. Pelvic floor yoga is one complementary modality that has been embraced by many; its purported benefits include increased awareness of the pelvic floor, improved skeletal muscle conditioning, and optimized resting autonomic function. However, it is unclear whether the changes observed in prior studies are unique to the practice of yoga beyond what is seen with other physical-based activities. This study sought to evaluate the efficacy and safety of a group-based pelvic yoga intervention compared to a nonspecific skeletal muscle stretching program. The yoga intervention included standard Hatha postures engaging the pelvic floor, whereas the physical conditioning program emphasized nonspecific stretching but avoided engaging the pelvic floor. Pelvic yoga was found to be similarly effective to physical conditioning for reducing UI, with a more than 60% average decrease in all-type and urgency-type frequency over 12 weeks. Both groups were also similarly effective in reducing most measures of symptom-related bother, but pelvic yoga was significantly more effective than physical conditioning at reducing subjective distress. One limitation of the study was that both groups were active interventions, meaning that the study was not able to compare the efficacy of yoga against no intervention at all. Overall, this study found that pelvic yoga and muscle conditioning were equally effective for the treatment of urinary incontinence.

Click here to read the study in AIM

Relevant reading: Yoga and Pilates compared to pelvic floor muscle training for urinary incontinence in elderly women: A randomized controlled pilot trial

In-Depth [randomized controlled trial]: This multicenter superiority trial involved 240 women aged 45 years or older who reported predominantly urgency-, stress-, or mixed-type UI for at least 3 months. Participants were randomly assigned in a 1:1 ratio to a 12-week program of either pelvic floor yoga or non-specific stretching and strengthening. UI frequency and type were assessed at baseline, 6 weeks, and 12 weeks using a voiding diary. A total of 121 individuals assigned to the pelvic yoga group and 119 to the physical conditioning group. At baseline, the mean age was 62.0 years (SD, 8.7) and an average of 3.4 UI episodes per day (SD, 2.2) were reported, including 1.9 urgency-related episodes per day (SD, 1.9) and 1.4 stress-related episodes per day (SD, 1.7). According to original protocol-proposed models, total UI frequency decreased by 2.3 episodes per day with pelvic yoga versus 1.9 episodes per day with physical conditioning (between group difference, -0.3 episodes per day; 95% CI, -0.7 to 0.0; P = 0.054). The between-group differences were -0.1 episodes per day (CI, -0.3 to 0.2) and -0.3 episodes per day (CI, -0.5 to 0.0) for stress-type and urgency-type UI frequency, respectively. Those who were assigned to pelvic yoga had a 4.9-point (CI, -8.6 to -0.1 point) greater decrease in Urogenital Distress Inventory-6 scores compared to those assigned to physical conditioning, but the two groups had similar changes in scores on the Incontinence Impact Questionnaire (IIQ) and the Patient Perception of Bladder Condition (PPBC). In summary, pelvic yoga therapy was not superior to non-specific muscle stretching and strengthening among patients with urinary incontinence.

Image: PD

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