1. In this randomized controlled trial, middle-aged and older women who participated in pelvic yoga showed similar changes in the frequency of urinary incontinence as women who participated in nonspecific exercise training.

2. Both treatments resulted in a reduction in all types of incontinence within 12 weeks.

Evidence assessment level: 1 (Excellent)

Study overview: One-third of middle-aged and older women suffer from urinary incontinence (UI), and many do not receive adequate treatment due to lack of accessibility and lack of affordable, well-tolerated therapies. Pelvic floor yoga is a complementary modality adopted by many. Purported benefits include increased pelvic floor awareness, improved skeletal muscle conditioning, and optimized resting autonomic function. However, it is unclear whether the changes observed in previous studies are unique to the practice of yoga and are not associated with other physical activities. The aim of this study was to evaluate the efficacy and safety of a group-based pelvic floor yoga intervention compared with a nonspecific skeletal muscle stretching program. The yoga intervention included standard Hatha postures that engaged the pelvic floor, while the physical conditioning program targeted nonspecific stretching but avoided loading the pelvic floor. Pelvic floor yoga was found to be similarly effective to physical conditioning in reducing UI, with the frequency of all types and types of urges decreasing by an average of over 60% over 12 weeks. Both groups were also similarly effective in reducing most symptom-related complaints, but pelvic yoga was significantly more effective than exercise training in reducing subjective complaints. A limitation of the study was that both groups were active interventions, meaning the study could not compare the effectiveness of yoga to that of no intervention at all. Overall, this study found that pelvic yoga and muscle training were equally effective in treating urinary incontinence.

Click here to read the study in AIM

Relevant reading: Yoga and Pilates versus pelvic floor exercises for urinary incontinence in older women: A randomized controlled pilot trial

Detailed (randomized controlled trial): This multicenter superiority trial enrolled 240 women aged 45 years or older with predominantly urgency, stress, or mixed urinary incontinence for at least 3 months. Participants were randomly assigned 1:1 to a 12-week program of pelvic floor yoga or nonspecific stretching and strengthening exercises. Frequency and type of urinary incontinence were assessed at baseline and after 6 weeks and 12 weeks using a voiding diary. A total of 121 subjects were assigned to the pelvic floor yoga group and 119 to the fitness training group. At baseline, the mean age was 62.0 years (SD 8.7) and an average of 3.4 urinary incontinence episodes per day (SD 2.2) were reported, including 1.9 urgency episodes per day (SD 1.9) and 1.4 stress-related episodes per day (SD 1.7). According to the models originally proposed in the protocol, the overall frequency of UI was reduced by 2.3 episodes per day with pelvic floor yoga compared with 1.9 episodes per day with the exercise training program (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 the frequency of stress-type and urge-type UI, respectively. In the groups that received pelvic floor yoga, Urogenital Distress Inventory-6 scores decreased by 4.9 points (CI: -8.6 to -0.1 points) more than in the groups that received physical exercise program, but Incontinence Impact Questionnaire (IIQ) and Patient Perception of Bladder Condition (PPBC) scores changed similarly in both groups. In summary, pelvic yoga therapy was not superior to nonspecific muscle stretching and strengthening in patients with urinary incontinence.

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