Stress Urinary Incontinence (SUI)
Conditions
Keywords
Progressive Muscle Relaxation, Pelvic Floor Muscle Exercise, Comfort, Stress Urinary Incontinence
Brief summary
Stress urinary incontinence (SUI) is a common condition in women that causes involuntary urine leakage during activities such as coughing, sneezing, laughing, or exercising. This condition can negatively affect physical, emotional, and social well-being and reduce overall comfort. Pelvic floor muscle exercise (PFME) is the recommended first-line conservative treatment for SUI, while progressive muscle relaxation (PMR) may help reduce muscle tension and improve psychological well-being. However, the combined effects of these two interventions on comfort have not been well studied. This randomized controlled trial aims to compare the effects of PFME, PMR, their combined application, and routine care on comfort in women with stress urinary incontinence. Participants will be randomly assigned to one of four study groups and followed for six weeks. Comfort will be assessed at baseline and at Weeks 2, 4, and 6 using a validated questionnaire. The findings are expected to provide evidence for improving conservative treatment strategies and enhancing patient-centered care for women with stress urinary incontinence.
Detailed description
Stress urinary incontinence (SUI) is the most common type of urinary incontinence among women and is characterized by the involuntary leakage of urine during activities that increase intra-abdominal pressure, such as coughing, sneezing, laughing, exercising, or lifting heavy objects. Beyond urinary symptoms, SUI has substantial physical, psychological, social, and economic consequences that adversely affect women's daily functioning and overall well-being. Although pelvic floor muscle exercise (PFME) is recommended as the first-line conservative treatment for women with SUI, treatment outcomes may be influenced by factors such as exercise adherence, psychological stress, anxiety, and impaired neuromuscular coordination. Progressive muscle relaxation (PMR) is a structured behavioral intervention that aims to reduce muscle tension and psychological stress through the sequential contraction and relaxation of major muscle groups. Previous studies have demonstrated beneficial effects of PMR on anxiety, stress-related symptoms, and muscle relaxation. Because psychological factors may contribute to pelvic floor dysfunction and symptom perception, combining PFME with PMR may enhance the effectiveness of conservative rehabilitation by addressing both physical and psychophysiological mechanisms. However, evidence regarding the combined effects of these interventions on patient comfort remains limited. This study was designed as a prospective, four-arm, parallel-group randomized controlled trial conducted at the Urology Outpatient Clinic of Karaman Training and Research Hospital, Karaman, Türkiye. Eligible women diagnosed with stress urinary incontinence were randomly allocated to one of four study groups: (1) pelvic floor muscle exercise (PFME), (2) progressive muscle relaxation (PMR), (3) combined PFME and PMR, or (4) routine outpatient care (control). Participants in the intervention groups followed standardized home-based exercise programs for six weeks after receiving individualized education from a Physical Medicine and Rehabilitation specialist. Adherence to the intervention was supported through weekly telephone follow-up and reminder messages. The primary objective of the trial was to compare changes in comfort among the four study groups over the six-week intervention period. Comfort was selected as the primary patient-centered outcome because it reflects physical, psychospiritual, sociocultural, and environmental well-being as described in Kolcaba's Comfort Theory. The findings of this study are expected to contribute to the evidence supporting conservative management strategies for stress urinary incontinence and to determine whether integrating progressive muscle relaxation into pelvic floor rehabilitation provides additional clinical benefit beyond conventional pelvic floor muscle training alone.
Interventions
BEHAVIORALPelvic Floor Muscle Exercise
Participants received a standardized pelvic floor muscle exercise (PFME) program delivered individually by a Physical Medicine and Rehabilitation specialist. During the initial 40-minute face-to-face session, participants received education on pelvic floor anatomy, urinary continence mechanisms, identification of the correct pelvic floor muscles, and proper exercise techniques. Participants were instructed to perform slow maximal voluntary contractions of the pelvic floor muscles with progressive contraction duration (3-10 seconds) followed by equal periods of relaxation. The home-based exercise program consisted of three sets of ten contractions performed daily for six weeks. Participants received an educational booklet, an exercise diary, and weekly telephone follow-up to monitor adherence and reinforce compliance.
BEHAVIORALProgressive Muscle Relaxation (PMR)
articipants received progressive muscle relaxation (PMR) training based on Jacobson's relaxation technique. The intervention was introduced during an individual face-to-face session conducted by a Physical Medicine and Rehabilitation specialist. Participants were instructed to sequentially contract and relax major muscle groups while practicing slow diaphragmatic breathing to reduce muscle tension and promote physical and psychological relaxation. The standardized home-based PMR program was performed once daily for approximately 20-30 minutes over a six-week period. Participants were provided with written instructions and received weekly telephone follow-up to encourage adherence.
BEHAVIORALCombined Pelvic Floor Muscle Exercise and Progressive Muscle Relaxation
Participants received both the standardized pelvic floor muscle exercise (PFME) program and the progressive muscle relaxation (PMR) program throughout the six-week intervention period. PFME and PMR were introduced during individualized face-to-face training sessions by a Physical Medicine and Rehabilitation specialist. Participants were instructed to perform both interventions daily according to the standardized protocols. Weekly telephone follow-up, an exercise diary, and reminder messages were used to support adherence and ensure consistency of the combined intervention.
Sponsors
Karamanoğlu Mehmetbey University
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
SUPPORTIVE_CARE
Masking
NONE
Masking description
This was an open-label trial because the nature of the exercise interventions did not permit blinding of participants or intervention providers. Outcome assessments were performed using standardized procedures to ensure consistency across all study groups.
Intervention model description
This study was designed as a prospective, single-center, four-arm, parallel-group randomized controlled trial. Eligible women with stress urinary incontinence were randomly assigned in a 1:1:1:1 ratio to one of four study groups: (1) Pelvic Floor Muscle Exercise (PFME), (2) Progressive Muscle Relaxation (PMR), (3) Combined PFME and PMR, or (4) Routine Care (Control). Participants remained in their allocated intervention group throughout the six-week intervention period. Outcome assessments were performed at baseline and at Weeks 2, 4, and 6. Owing to the nature of the interventions, participant and therapist blinding was not feasible; however, outcome assessments were conducted using standardized procedures, and statistical analyses were performed by an investigator blinded to group allocation.
Eligibility
Sex/Gender
FEMALE
Age
45 Years to 55 Years
Healthy volunteers
Yes
Inclusion criteria
Female participants aged 45-55 years Diagnosis of stress urinary incontinence Turkish-speaking Literate Access to the internet Access to a smartphone No active urinary tract infection Not pregnant No neurological or cognitive disorder
Exclusion criteria
Previous participation in pelvic floor muscle exercise (PFME) or progressive muscle relaxation (PMR) training programs. Withdrawal from the study after enrollment.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Change in Comfort Level | Baseline, Week 2, Week 4, and Week 6 | To evaluate the effect of pelvic floor muscle exercises, progressive muscle relaxation exercises, and their combined application on comfort levels in women with stress urinary incontinence. Comfort level was assessed using the Urinary Incontinence and Frequency Comfort Questionnaire (UIFCQ). |
Countries
Turkey (Türkiye)
Outcome results
None listed