Motor Imagery-Assisted Pelvic Floor Muscle Training for Stress Urinary Incontinence in Postmenopausal Women

Condition(s) studied

Investigational drug(s) / intervention(s)

Pelvic Floor Muscle Training: Both groups will receive the same progressive, supervised pelvic floor muscle training program, including slow and fast contractions, graded contractions, and pre-contraction before coughing or physical effort (the Knack). Training will progress across three four-week phases, with increasing contraction demands and progression toward standing and functional activities. The program will be delivered as part of 24 supervised sessions over 12 weeks, twice weekly on nonconsecutive days. Each session, including the assigned motor imagery component, will last approximately 30 minutes. No additional home exercise program will be prescribed.

Pelvic-Floor-Specific Kinesthetic Motor Imagery: Participants will mentally rehearse the sensation of closing, squeezing, and lifting the pelvic floor muscles around the urethra and vagina, followed by relaxation, without physically contracting during imagery. Kinesthetic imagery will be performed immediately before each corresponding physical pelvic floor contraction. This component will be integrated into all 24 supervised sessions over 12 weeks. Imagery duration and therapist contact will be matched to the dominant-hand imagery condition.

Dominant-Hand Kinesthetic Motor Imagery: Participants will mentally rehearse the sensation of making and opening a fist with their dominant hand, without actual hand movement. This imagery will be performed immediately before each physical pelvic floor contraction and will be integrated into all 24 supervised sessions over 12 weeks. Imagery duration and therapist contact will be matched to the pelvic-floor-specific imagery condition. Participants will receive the same physical pelvic floor muscle training program as the experimental group.

Study summary

This study will evaluate whether adding mental rehearsal of pelvic floor muscle contractions to pelvic floor muscle training improves stress urinary incontinence in postmenopausal women. Stress urinary incontinence is urine leakage during activities such as coughing, sneezing, or physical exertion. Mental rehearsal involves imagining the sensation of a movement without physically performing it.

The study will include 60 women aged 45 to 65 years who have completed natural menopause and have stress urinary incontinence. Participants will be randomly assigned to one of two groups. Both groups will receive the same supervised pelvic floor muscle training twice a week for 12 weeks. Before performing the pelvic floor exercises, one group will imagine contracting and relaxing the pelvic floor muscles. The other group will imagine making and opening a fist with their dominant hand.

Assessments will take place before treatment and at the end of 12 weeks. The main outcome will be urinary incontinence symptom severity. Additional assessments will examine urine leakage frequency and amount, incontinence-related quality of life, and pelvic floor muscle electrical activity.

Eligibility

Primary outcome measure(s)

• International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form (ICIQ-UI SF) Total Score — Baseline (before the first treatment session) and at the end of the 12-week intervention.
  Urinary incontinence severity will be assessed using the International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form (ICIQ-UI SF). The questionnaire assesses the frequency and amount of urinary leakage and its impact on everyday life over the previous four weeks. The total score is calculated by summing three scored items and ranges from 0 to 21, with higher scores indicating greater urinary incontinence severity.

Trial sites (1)

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