Women who completed 8 weeks of pelvic floor exercises at home using an online video reported fewer symptoms of stress urinary incontinence (SUI) in a pilot study.

Measures of quality of life, muscle strength, and episodes of leakage showed improvements. However, the researchers were unable to detect changes in muscles that control urine flow.

Meagan Cramer, MD, a fellow in female pelvic medicine and reconstructive surgery at Oregon Health & Science University, Portland, said the program, which combines yoga and Pilates, is meant to “address stress incontinence while also fitting into a woman’s regular daily exercise activity.”

Cramer presented the findings at the American Urogynecologic Society and International Urogynecological Association 2022 Scientific Meeting in Austin, Texas.

Of 78 women that enrolled in the study, 60 completed the program. The average age was 46.6 years. Most were premenopausal (67%), had given birth (65%), and had previously done yoga (76%) and/or Pilates (44%).

At their convenience, participants logged onto a custom website to access a 38-minute video with 17 exercises. The program gave prompts and tracked usage.

Of those who completed the regimen, 73% performed the exercises at least three times per week.

Participants’ mean score on the International Consultation on Incontinence Questionnaire — Urinary Incontinence Short Form (ICIQ-UI SF) fell from 9.5 (95%  CI, 8.7-10.4) before the intervention to 7.1 (95% CI, 6.3-7.9) after. The form uses a range of 0 to 21 with a higher score indicating worse incontinence.

The number of incontinence episodes over 24 hours decreased from an interquartile range of one to three episodes to an interquartile range of zero to one episode. Pelvic floor muscle strength improved from mean score of 7.1 (95% CI, 6.6-7.7) on the Brink scale to 7.7 (95% CI, 7.2-8.2). The Brink scale ranges from 3 to 12, with greater scores reflecting increased strength.

On the Patient Global Impression of Improvement scale, 83% of participants who completed the regimen reported they were “a little better,” “much better,” or “very much better.”

Cramer and her colleagues hypothesized that the exercises enlarge muscles that control the release of urine, located in the urethral rhabdosphincter. However, cross-sectional ultrasound measurements taken before and after the intervention showed no changes.

The study lacked a comparison group of women who did not undergo the intervention, leaving open the possibility that the improvements were a placebo effect.

“A randomized trial comparing this yoga-Pilates intervention to a control group, such as education, or to the current non-surgical standard of care, pelvic floor physical therapy, would be the next step to confirm our positive effect,” Cramer said.

Because the women opted to participate, the findings may not be generalized to individuals who do not already have an interest in exercise, she added.

Alison Huang, MD, a women’s health researcher and professor of medicine at the University of California, San Francisco, cautioned against drawing conclusions about whether participation in the program caused any observed decrease in incontinence symptoms.

However, Huang, who was not involved in the study, said the preliminary data are promising.

“If this type of intervention is found to be effective and well-tolerated in larger, controlled studies, then it might offer a valuable way for women with stress incontinence to improve their own symptoms from the comfort of their own homes,” she said.

Cramer and Huang reported no relevant financial conflicts of interest.

American Urogynecologic Society and International Urogynecological Association 2022 Scientific Meeting. Abstract #195. Presented June 15.

Mary Chris Jaklevic is a healthcare journalist in the Midwest.

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