For many postmenopausal women, a simple sneeze, laugh, or lift of the grocery bag can lead to something far less simple: urinary incontinence.
In a new systematic review of 15 randomized controlled trials, researchers found that pelvic floor muscle training (PFMT) improves urinary continence and pelvic muscle function in postmenopausal women.
The review, which included 895 participants, showed that 14 of the 15 studies reported statistically significant benefits of this training.
Pelvic floor dysfunction affects nearly half of postmenopausal women, largely due to hormonal changes that weaken pelvic tissues and muscles. Stress urinary incontinence is common and is often triggered by activities such as coughing, sneezing, or lifting, and PFMT is widely recommended as a first-line, nonpharmacologic treatment.
Researchers analyzed PFMT protocols using the FITT framework—frequency, intensity, time, and type of exercise. Training frequency ranged from 2 to 7 sessions per week (mean 3 ± 2). Intervention duration ranged from 2 to 24 weeks (mean 10 ± 6 weeks). In the 8 studies that reported exercise intensity, maximal voluntary pelvic floor contraction was the standard.
Only 8 of 15 studies described all 4 FITT components, which are necessary to replicate training interventions in practice.
Outcomes were assessed using tools such as the 1-hour pad test, digital palpation, surface electromyography (sEMG), and validated questionnaires like the International Consultation on Incontinence Questionnaire–Urinary Incontinence Short Form (ICIQ-UI SF). Most studies showed improvements in muscle strength and reductions in incontinence episodes, alongside reported quality-of-life gains.
Some studies combined PFMT with other physical activities such as Pilates, Rumba dance, or aerobic walking. Others incorporated adjunct modalities like electrical stimulation, high-intensity focused electromagnetic therapy (HIFEMT), and biofeedback tools, including EMG devices and gamified training using virtual reality platforms.
The only study that did not report significant improvement had the lowest training frequency—roughly 1 session every 2 weeks. On average, participants completed 29 ± 26 sessions over the course of their respective interventions.
The review also noted variability in how studies reported exercise parameters. Many lacked detail on training intensity or progression, which limited reproducibility. Standardized reporting would improve comparison and implementation in clinical settings.
“PFMT is an effective method of improving pelvic floor muscle function in postmenopausal women regardless of the specific form of the training intervention,” wrote lead author Magdalena Piernicka, MSc, of the Faculty of Physical Culture at Gdansk University of Physical Education and Sport in Poland, along with colleagues.
Risk of bias was assessed across all studies. One trial was rated high risk, 12 raised some concerns (mostly related to randomization and outcome assessment), and 1 was rated low risk.
Further research is needed to standardize protocols and confirm long-term effectiveness.
The authors reported no conflicts of interest.
Source: Journal of Clinical Medicine