Yoga for treating urinary incontinence in women
- PMID: 30816997
- PMCID: PMC6394377
- DOI: 10.1002/14651858.CD012668.pub2
Yoga for treating urinary incontinence in women
Abstract
Background: Urinary incontinence in women is associated with poor quality of life and difficulties in social, psychological and sexual functioning. The condition may affect up to 15% of middle-aged or older women in the general population. Conservative treatments such as lifestyle interventions, bladder training and pelvic floor muscle training (used either alone or in combination with other interventions) are the initial approaches to the management of urinary incontinence. Many women are interested in additional treatments such as yoga, a system of philosophy, lifestyle and physical practice that originated in ancient India.
Objectives: To assess the effects of yoga for treating urinary incontinence in women.
Search methods: We searched the Cochrane Incontinence and Cochrane Complementary Medicine Specialised Registers. We searched the World Health Organization International Clinical Trials Registry Platform (WHO ICTRP) and ClinicalTrials.gov to identify any ongoing or unpublished studies. We handsearched Proceedings of the International Congress on Complementary Medicine Research and the European Congress for Integrative Medicine. We searched the NHS Economic Evaluation Database for economic studies, and supplemented this search with searches for economics studies in MEDLINE and Embase from 2015 onwards. Database searches are up-to-date as of 21 June 2018.
Selection criteria: Randomised controlled trials in women diagnosed with urinary incontinence in which one group was allocated to treatment with yoga.
Data collection and analysis: Two review authors independently screened titles and abstracts of all retrieved articles, selected studies for inclusion, extracted data, assessed risk of bias and evaluated the certainty of the evidence for each reported outcome. Any disagreements were resolved by consensus. We planned to combine clinically comparable studies in Review Manager 5 using random-effects meta-analysis and to carry out sensitivity and subgroup analyses. We planned to create a table listing economic studies on yoga for incontinence but not carry out any analyses on these studies.
Main results: We included two studies (involving a total of 49 women). Each study compared yoga to a different comparator, therefore we were unable to combine the data in a meta-analysis. A third study that has been completed but not yet fully reported is awaiting assessment.One included study was a six-week study comparing yoga to a waiting list in 19 women with either urgency urinary incontinence or stress urinary incontinence. We judged the certainty of the evidence for all reported outcomes as very low due to performance bias, detection bias, and imprecision. The number of women reporting cure was not reported. We are uncertain whether yoga results in satisfaction with cure or improvement of incontinence (risk ratio (RR) 6.33, 95% confidence interval (CI) 1.44 to 27.88; an increase of 592 from 111 per 1000, 95% CI 160 to 1000). We are uncertain whether there is a difference between yoga and waiting list in condition-specific quality of life as measured on the Incontinence Impact Questionnaire Short Form (mean difference (MD) 1.74, 95% CI -33.02 to 36.50); the number of micturitions (MD -0.77, 95% CI -2.13 to 0.59); the number of incontinence episodes (MD -1.57, 95% CI -2.83 to -0.31); or the bothersomeness of incontinence as measured on the Urogenital Distress Inventory 6 (MD -0.90, 95% CI -1.46 to -0.34). There was no evidence of a difference in the number of women who experienced at least one adverse event (risk difference 0%, 95% CI -38% to 38%; no difference from 222 per 1000, 95% CI 380 fewer to 380 more).The second included study was an eight-week study in 30 women with urgency urinary incontinence that compared mindfulness-based stress reduction (MBSR) to an active control intervention of yoga classes. The study was unblinded, and there was high attrition from both study arms for all outcome assessments. We judged the certainty of the evidence for all reported outcomes as very low due to performance bias, attrition bias, imprecision and indirectness. The number of women reporting cure was not reported. We are uncertain whether women in the yoga group were less likely to report improvement in incontinence at eight weeks compared to women in the MBSR group (RR 0.09, 95% CI 0.01 to 1.43; a decrease of 419 from 461 per 1000, 95% CI 5 to 660). We are uncertain about the effect of MBSR compared to yoga on reports of cure or improvement in incontinence, improvement in condition-specific quality of life measured on the Overactive Bladder Health-Related Quality of Life Scale, reduction in incontinence episodes or reduction in bothersomeness of incontinence as measured on the Overactive Bladder Symptom and Quality of Life-Short Form at eight weeks. The study did not report on adverse effects.
Authors' conclusions: We identified few trials on yoga for incontinence, and the existing trials were small and at high risk of bias. In addition, we did not find any studies of economic outcomes related to yoga for urinary incontinence. Due to the lack of evidence to answer the review question, we are uncertain whether yoga is useful for women with urinary incontinence. Additional, well-conducted trials with larger sample sizes are needed.
Conflict of interest statement
LSW: none known. NS: none known. ZSL: none known. SP: none known. DC: none known. NS: none known.
Figures




Update of
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Yoga for treatment of urinary incontinence in women.Cochrane Database Syst Rev. 2017;5(5):CD012668. doi: 10.1002/14651858.CD012668. Epub 2017 May 19. Cochrane Database Syst Rev. 2017. Update in: Cochrane Database Syst Rev. 2019 Feb 28;2:CD012668. doi: 10.1002/14651858.CD012668.pub2. PMID: 29081716 Free PMC article. Updated.
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References
References to studies included in this review
Baker 2014 {published and unpublished data}
-
- Baker J, Costa D, Guarino JM, Nygaard I. Comparison of mindfulness‐based stress reduction versus yoga on urinary urge incontinence: a randomized pilot study with 6‐month and 1‐year follow‐up visits. Female Pelvic Medicine & Reconstructive Surgery 2014;20(3):141‐6. [sr‐incont60609; PUBMED: 24763155] - PubMed
-
- NCT01470560. Mindfulness‐based stress reduction techniques and yoga for treatment of urinary urge incontinence (MBSR‐Yoga). clinicaltrials.gov/ct2/show/NCT01470560 (first received 11 November 2011). [sr‐incont49230]
Huang 2014a {published data only}
-
- Huang AJ, Jenny HE, Chesney MA, Schembri M, Subak LL. Yoga for urinary incontinence in middle‐aged and older women: results of a pilot randomized trial. Journal of General Internal Medicine 2014;29(1 Suppl):S261. [Abstract: Tracking ID #1926774; sr‐incont61847]
-
- Jenny HE, Subak LL, Chesney MA, Schembri M, Huang AJ. Yoga for urinary incontinence in middle‐aged and older women: results of a pilot randomized trial. Journal of the American Geriatrics Society 2014;62(Suppl s1):S98. [Abstract number B27; sr‐incont61850]
-
- NCT01672190. Lessening incontinence by learning yoga (LILY). clinicaltrials.gov/ct2/show/NCT01672190 (first received 24 August 2012). [sr‐incont49228]
References to studies excluded from this review
Burgio 2003 {published data only}
-
- Burgio KL, Goode PS, Locher JL, Richter HE, Roth DL, Wright KC, et al. Predictors of outcome in the behavioral treatment of urinary incontinence in women. Obstetrics and Gynecology 2003;102(5 Pt 1):940‐7. [sr‐incont17367; PUBMED: 14672467] - PubMed
Burgio 2006 {published data only}
-
- Burgio KL, Goode PS, Richter HE, Locher JL, Roth DL. Global ratings of patient satisfaction and perceptions of improvement with treatment for urinary incontinence: validation of three global patient ratings. Neurourology and Urodynamics 2006;25(5):411‐7. [sr‐incont22346; PUBMED: 16652380] - PubMed
Felsted 2017 {published data only}
-
- Felsted K, NCT03176901. Comparing approaches to treat older adult women's urge incontinence: pilot feasibility and randomized controlled trial (SHUW) [Comparing mindfulness‐based stress reduction with the health enhancement program in the treatment of urinary urge incontinence in older adult women: a pilot feasibility and randomized controlled trial]. clinicaltrials.gov/show/NCT03176901 (first received 6 June 2017). [NCT03176901; sr‐incont76187]
Wein 2015 {published data only}
-
- Wein AJ. Re: A group‐based yoga therapy intervention for urinary incontinence in women: a pilot randomized trial. Journal of Urology 2015; Vol. 193, issue 4:1313. [PUBMED: 25890531] - PubMed
Wells 1999 {unpublished data only}
-
- Wells T, Mayer R, Brink C, Brown R. Pelvic muscle exercise: a controlled clinical trial [notification of unpublished manuscript via personal communication]. Email to: Jean Hay‐Smith. 3 November 2008. [sr‐incont26977]
References to studies awaiting assessment
Huang 2018 {unpublished data only}
-
- Huang A, Chesney M, Schembri M, Subak L. A randomized trial of a group‐based therapeutic yoga program for ambulatory women with urinary incontinence. Journal of Urology 2018;199(4 Suppl):e645. [DOI: 10.1016/j.juro.2018.02.1544; Abstract number PD32‐01; sr‐incont77829] - DOI
-
- NCT02342678. Lessening incontinence through low‐impact activity (LILA) [Lessening incontinence through low‐impact activity, a.k.a. yoga to enhance behavioral self‐management of urinary incontinence in women]. clinicaltrials.gov/ct2/show/NCT02342678 (first received 21 January 2015). [sr‐incont67528]
Additional references
Abrams 2013
-
- Abrams P, Andersson KE, Artibani W, Birder I, Bliss D, Brubaker L, et al. Recommendations of the International Scientific Committee: Evaluation and treatment of urinary incontinence, pelvic organ prolapse and faecal incontinence. Incontinence: 5th International Consultation on Incontinence. Paris: ICUD‐EAU 2013, 2013:1895‐945.
AHRQ 2018
-
- Balk E, Adam GP, Kimmel H, Rofeberg V, Saeed I, Jeppson P, et al. Nonsurgical treatments for urinary incontinence in women: a systematic review update. Rockville (MD): Agency for Healthcare Research and Quality (AHRQ); 2018 August. Comparative Effectiveness Review No. 212. (Prepared by the Brown Evidence‐based Practice Center under Contract No. 290‐2015‐00002‐I for AHRQ and PCORI.) AHRQ Publication No.: 18‐EHC016‐EF. PCORI Publication No.: 2018‐SR‐03. Available at effectivehealthcare.ahrq.gov/topics/urinary‐incontinence‐update/final‐re.... [DOI: 10.23970/AHRQEPCCER212] - DOI - PubMed
Ayeleke 2015
-
- Ayeleke RO, Hay‐Smith EJ, Omar MI. Pelvic floor muscle training added to another active treatment versus the same active treatment alone for urinary incontinence in women. Cochrane Database of Systematic Reviews 2015, Issue 11. [DOI: 10.1002/14651858.CD010551.pub3; PUBMED: 26526663] - DOI - PMC - PubMed
Barber 2001
-
- Barber MD, Kuchibhatla MN, Pieper CF, Bump RC. Psychometric evaluation of 2 comprehensive condition‐specific quality of life instruments for women with pelvic floor disorders. American Journal of Obstetrics and Gynecology 2001;185(6):1388‐95. [PUBMED: 11744914] - PubMed
Bø 2000
-
- Bø K, Berghmans LC. Nonpharmacologic treatments for overactive bladder ‐ pelvic floor exercises. Urology 2000;55(5A Suppl):7‐11; discussion 14‐6. [PUBMED: 10767443] - PubMed
Bø 2004
-
- Bø K. Pelvic floor muscle training is effective in treatment of female stress urinary incontinence, but how does it work?. International Urogynecology Journal and Pelvic Floor Dysfunction 2004;15(2):76‐84. [PUBMED: 15014933] - PubMed
Bø 2013
-
- Bø K, Herbert RD. There is not yet strong evidence that exercise regimens other than pelvic floor muscle training can reduce stress urinary incontinence in women: a systematic review. Journal of Physiotherapy 2013;59(3):159‐68. [PUBMED: 23896331] - PubMed
Bø 2017
-
- Bø K, Frawley HC, Haylen BT, Abramov Y, Almeida FG, Berghmans B, et al. An International Urogynecological Association (IUGA)/International Continence Society (ICS) joint report on the terminology for the conservative and nonpharmacological management of female pelvic floor dysfunction. International Urogynecology Journal 2017;28(2):191‐213. [PUBMED: 27921161] - PubMed
Cannon 2004
-
- Cannon TW, Damaser M. Pathophysiology of the lower urinary tract: continence and incontinence. Clinical Obstetrics and Gynecology 2004;47(1):28‐35. [PUBMED: 15024270] - PubMed
Clarke 2015
-
- Clarke TC, Black LI, Stussman BJ, Barnes PM, Nahin RL. Trends in the use of complementary health approaches among adults: United States, 2002‐2012. Hyattsville (MD): National Center for Health Statistics. National Health Statistics Reports; no. 79. www.cdc.gov/nchs/data/nhsr/nhsr079.pdf (accessed 14 May 2018).
Covidence 2017 [Computer program]
-
- Veritas Health Innovation. Covidence. Version accessed 26 June 2018. Melbourne, Australia: Veritas Health Innovation, 2017.
Cramer 2013
Cramer 2015
-
- Cramer H, Ward L, Saper R, Fishbein D, Dobos G, Lauche R. The safety of yoga: a systematic review and meta‐analysis of randomized controlled trials. American Journal of Epidemiology 2015;182(4):281‐93. [PUBMED: 26116216] - PubMed
Cramer 2016
-
- Cramer H, Ward L, Steel A, Lauche R, Dobos G, Zhang Y. Prevalence, patterns, and predictors of yoga use: results of a U.S. nationally representative survey. American Journal of Preventive Medicine 2016;50(2):230‐5. [PUBMED: 26497261] - PubMed
Deeks 2011
-
- Deeks JJ, Higgins JPT, Altman DG. Chapter 9: Analysing data and undertaking meta‐analyses. In: Higgins JP, Green S, editor(s). Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0 (updated March 2011). The Cochrane Collaboration, 2011. Available from handbook.cochrane.org.
DeLancey 1988
-
- DeLancey JOL. Anatomy and mechanics of structures around the vesical neck: how vesical position may affect its closure. Neurourology and Urodynamics 1988;7:161‐2.
Dumoulin 2018
Egger 1997
Guyatt 2011a
-
- Guyatt G, Oxman AD, Akl EA, Kunz R, Vist G, Brozek J, et al. GRADE guidelines: 1. Introduction ‐ GRADE evidence files and summary of findings tables. Journal of Clinical Epidemiology 2011;64(4):383‐94. - PubMed
Guyatt 2011b
-
- Guyatt GH, Oxman AD, Kunz R, Brozek J, Alonso‐Coello P, Rind D, et al. GRADE guidelines 6. Rating the quality of evidence ‐ imprecision. Journal of Clinical Epidemiology 2011;64(12):1283‐93. - PubMed
Haylen 2010
-
- Haylen BT, Ridder D, Freeman RM, Swift SE, Berghmans B, Lee J, et al. An International Urogynecological Association (IUGA)/International Continence Society (ICS) joint report on the terminology for female pelvic floor dysfunction. International Urogynecology Journal 2010;21(1):5‐26. [PUBMED: 19937315] - PubMed
Herderschee 2011
Hewitt 2001
-
- Hewitt J. The Complete Yoga Book. New York: Schocken Books Inc, 2001.
Higgins 2011a
-
- Higgins JPT, Green S, editor(s). Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0 (updated March 2011). The Cochrane Collaboration, 2011. Available from handbook.cochrane.org.
Higgins 2011b
-
- Higgins JPT, Deeks JJ, Altman DG, editor(s). Chapter 16: Special topics in statistics. In: Higgins JP, Green S, editor(s). Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0 (updated March 2011). The Cochrane Collaboration, 2011. Available from handbook.cochrane.org.
Huang 2014b
Imamura 2015
Kim 2015
-
- Kim GS, Kim EG, Shin KY, Choo HJ, Kim MJ. Combined pelvic muscle exercise and yoga program for urinary incontinence in middle‐aged women. Japan Journal of Nursing Science: JJNS 2015;12(4):330‐9. [PUBMED: 25705816] - PubMed
Long 2008
-
- Long RM, Giri SK, Flood HD. Current concepts in female stress urinary incontinence. Surgeon 2008;6(6):366‐72. [PUBMED: 19110826] - PubMed
Lose 2001
Microsoft Excel 2018 [Computer program]
-
- Microsoft Corporation. Microsoft Excel for Mac. Version 16.20. Redmond, WA, USA: Microsoft Corporation, 2018.
Miller 1998
-
- Miller JM, Ashton‐Miller JA, DeLancey JO. A pelvic muscle precontraction can reduce cough‐related urine loss in selected women with mild SUI. Journal of the American Geriatrics Society 1998;46(7):870‐4. [PUBMED: 9670874] - PubMed
Milsom 2017
-
- Milsom I, Altman D, Cartwright R, Lapitan MC, Nelson R, Sjöström S, et al. Epidemiology of urinary incontinence (UI) and other lower urinary tract symptoms (LUTS), pelvic organ prolapse (POP) and anal (AI) incontinence. Incontinence: 6th International Consultation on Incontinence. Bristol UK: International Continence Society, 2017:5‐93. [ISBN: 978‐0‐9569607‐3‐3]
Minassian 2013
Moher 2009
Monz 2007
-
- Monz B, Chartier‐Kastler E, Hampel C, Samsioe G, Hunskaar S, Espuna‐Pons M, et al. Patient characteristics associated with quality of life in European women seeking treatment for urinary incontinence: results from PURE. European Urology 2007;51(4):1073‐81; discussion 1081‐2. [PUBMED: 17081676] - PubMed
Nystrom 2015
-
- Nystrom E, Sjostrom M, Stenlund H, Samuelsson E. ICIQ symptom and quality of life instruments measure clinically relevant improvements in women with stress urinary incontinence. Neurourology and Urodynamics 2015;34(8):747‐51. [PUBMED: 25154378] - PubMed
Park 2014
Patrick 1999
-
- Patrick DL, Martin ML, Bushnell DM, Yalcin I, Wagner TH, Buesching DP. Quality of life of women with urinary incontinence: further development of the incontinence quality of life instrument (I‐QOL). Urology 1999;53(1):71‐6. [PUBMED: 9886591] - PubMed
Reference Manager 2012 [Computer program]
-
- Thomson Reuters. Reference Manager Professional Edition. Version 12. New York: Thomson Reuters, 2012.
Review Manager 2014 [Computer program]
-
- Nordic Cochrane Centre, The Cochrane Collaboration. Review Manager 5 (RevMan 5). Version 5.3. Copenhagen: Nordic Cochrane Centre, The Cochrane Collaboration, 2014.
Sandvik 1993
Shemilt 2011
-
- Shemilt I, Mugford M, Byford S, Drummond M, Eisenstein E, Knapp M, et al. Chapter 15: Incorporating economics evidence. In: Higgins JP, Green S, editor(s). Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0 (updated March 2011). The Cochrane Collaboration, 2011. Available from handbook.cochrane.org.
Sinclair 2011
-
- Sinclair AJ, Ramsay IN. The psychosocial impact of urinary incontinence in women. Obstetrician & Gynaecologist 2011;13(3):143‐8. [DOI: 10.1576/toag.13.3.143.27665] - DOI
Steers 2002
Sterne 2011
-
- Sterne JA, Sutton AJ, Ioannidis JP, Terrin N, Jones DR, Lau J, et al. Recommendations for examining and interpreting funnel plot asymmetry in meta‐analyses of randomised controlled trials. BMJ (Clinical research ed.) 2011;343:d4002. [PUBMED: 21784880] - PubMed
Taneja 2014
Tenfelde 2014
-
- Tenfelde S, Logan R, Abernethy M. Yoga from the pelvic floor. Beginnings (American Holistic Nurses' Association) 2014;34(1):24‐6. [PUBMED: 24683704] - PubMed
Uebersax 1995
-
- Uebersax JS, Wyman JF, Shumaker SA, McClish DK, Fantl JA. Short forms to assess life quality and symptom distress for urinary incontinence in women: the Incontinence Impact Questionnaire and the Urogenital Distress Inventory. Continence Program for Women Research Group. Neurourology and Urodynamics 1995;14(2):131‐9. [PUBMED: 7780440] - PubMed
Wallace 2004
Wieland 2013
Wójtowicz 2014
-
- Wójtowicz U, Plaszewska‐Zywko L, Stangel‐Wójcikiewicz K, Basta A. Barriers in entering treatment among women with urinary incontinence. Ginekologia Polska 2014;85(5):342‐7. [PUBMED: 25011214] - PubMed
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