Efficacy of a Therapeutic Pelvic Yoga Program Versus a Physical Conditioning Program on Urinary Incontinence in Women : A Randomized Trial

Abstract

Background: Pelvic floor yoga has been recommended as a complementary treatment strategy for urinary incontinence (UI) in women, but evidence of its efficacy is lacking.

Objective: To evaluate the effects of a therapeutic pelvic floor yoga program versus a nonspecific physical conditioning program on UI in women.

Design: Randomized trial. (ClinicalTrials.gov: NCT03672461).

Setting: Three study sites in California, United States.

Participants: Ambulatory women aged 45 years or older reporting daily urgency-, stress-, or mixed-type UI.

Intervention: Twelve-week program of twice-weekly group instruction and once-weekly self-directed practice of pelvic floor-specific Hatha yoga techniques (pelvic yoga) versus equivalent-time instruction and practice of general skeletal muscle stretching and strengthening exercises (physical conditioning).

Measurements: Total and type-specific UI frequency assessed by 3-day voiding diaries.

Results: Among the 240 randomly assigned women (age range, 45 to 90 years), mean baseline UI frequency was 3.4 episodes per day (SD, 2.2), including 1.9 urgency-type episodes per day (SD, 1.9) and 1.4 stress-type episodes per day (SD, 1.7). Over a 12-week time period, total UI frequency (primary outcome) decreased by an average of 2.3 episodes per day with pelvic yoga and 1.9 episodes per day with physical conditioning (between-group difference of -0.3 episodes per day [95% CI, -0.7 to 0.0]). Urgency-type UI frequency decreased by 1.2 episodes per day in the pelvic yoga group and 1.0 episode per day in the physical conditioning group (between-group difference of -0.3 episodes per day [CI, -0.5 to 0.0]). Reductions in stress-type UI frequency did not differ between groups (-0.1 episodes per day [CI, -0.3 to 0.3]).

Limitation: No comparison to no treatment or other clinical UI treatments; conversion to videoconference-based intervention instruction during the COVID-19 pandemic.

Conclusion: A 12-week pelvic yoga program was not superior to a general muscle stretching and strengthening program in reducing clinically important UI in midlife and older women with daily UI.

Primary funding source: National Institutes of Health.

Figure 1:. CONSORT (Consolidated Standards of Reporting Trials) Flow Diagram.

During the exploratory 24- and 36-week post-intervention follow-up period, follow-up data were missing for an additional 24 participants in the pelvic yoga group (including 20 lost to follow-up, 1 with an adverse event, 1 who was too busy, and 2 for other reasons), and for another 24 participants in the physical conditioning group (including 21 lost to follow-up, 2 with adverse events, and 1 for other reasons).