Involuntary reflexive pelvic floor muscle training in addition to standard training versus standard training alone for women with stress urinary incontinence: a randomized controlled trial

Introduction and hypothesis
Although involuntary reflexive pelvic floor muscle contractions seem crucial during stress urinary
incontinence-provoking situations, hitherto existing guidelines feature voluntary pelvic floor muscle training only. Two pelvic
floor muscle protocols were compared regarding their effect on stress urinary incontinence in women: one focusing on standard
physiotherapy with voluntary pelvic floor muscle training, the other additionally including involuntary reflexive pelvic floor
muscle training.
Methods
This study was designed as a triple-blind prospective randomized controlled trial with women suffering from stress
urinary incontinence with two physiotherapy intervention groups (control group: standard physiotherapy, n = 48, experimental
group: standard physiotherapy plus involuntary reflexive pelvic floor muscle training triggered by whole-body movements such
as jumps n = 48). Both interventions lasted 16 weeks (9 personal physiotherapy consultations and 78 home training sessions).
Group differences and development over time were analyzed concerning the primary outcome International Consultation on
Incontinence Modular Questionnaire Urinary Incontinence short form (ICIQ-UIsf) by mixed effect regression models.
Results
The ICIQ-UIsf score decreased significantly over time for both groups by about 3 points from about 10 to about 7 points
with no group differences at any point in time.
Discussion
This trial did not find any additional benefit for stress urinary incontinence by adding involuntary reflexive pelvic
floor muscle training to standard training. Both training protocols showed similar clinically relevant improvements; however,
there was still moderate incontinence after interventions. Future studies should test and apply pelvic floor muscle function-
oriented training methods for pelvic floor muscle hypertrophy, intramuscular coordination, and power, which are more in line
with conventional skeletal muscle training, i.e., performed with higher intensities and workout.