Pelvic Floor Muscle Training Outperforms Pilates in Women with Stress Urinary Incontinence: A Randomized Controlled Trial

INTRODUCTION AND HYPOTHESIS: The objective was to compare the effects of a Pilates exercise program performed with or without voluntary pelvic floor muscle contraction versus pelvic floor muscle training (PFMT) on urinary incontinence impact and pelvic floor muscle function in women with stress urinary incontinence. METHODS: A randomized controlled trial with three parallel groups: Pilates, Pilates + voluntary pelvic floor muscle contraction (Pilates + VPFMC), and PFMT was conducted. The primary outcome was the impact of urinary incontinence assessed by the International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF). Secondary outcomes included pelvic floor muscle strength (Modified Oxford Scale) and vaginal squeeze pressure (Peritron manometry). Participants completed 12 supervised sessions over 6 weeks. Outcomes were assessed by a blinded evaluator. RESULTS: A significant overall effect of time was observed for ICIQ-SF scores, pelvic floor muscle strength, and vaginal squeeze pressure (p < 0.001). The mean reduction in ICIQ-SF was -0.7 for Pilates, -0.7 for Pilates + VPFMC, and -4.4 for PFMT. PFMT demonstrated superior outcomes compared with both Pilates groups across all the outcomes assessed. Pelvic floor muscle strength increased by 0.3, 0.7, and 1.7 points (Modified Oxford Scale), and peak vaginal squeeze pressure increased by 5.7, 6.1, and 24.4 mmHg in the Pilates, Pilates + VPFMC, and PFMT groups respectively. Between the Pilates groups, a difference was observed only in muscle strength, favoring the Pilates + VPFMC group. CONCLUSIONS: Pelvic floor muscle training was superior to Pilates in reducing the impact of urinary incontinence and improving pelvic floor muscle function, regardless of the inclusion of voluntary pelvic floor muscle contraction.