Dynamic Neuromuscular Stabilization vs Pelvic Floor Muscle Training in Women With Stress Urinary Incontinence

Summary

This randomized controlled trial aims to compare the pre- and post-treatment effects of Dynamic Neuromuscular Stabilization (DNS) training and Pelvic Floor Muscle Training (PFMT) on pelvic floor muscle function, pelvic floor morphometry, urinary symptoms, quality of life, sexual function, and physical activity levels in women with stress urinary incontinence (SUI).

Participants diagnosed with SUI by a specialist physician will be randomly assigned to one of three groups: DNS, PFMT, or a control group. Both DNS and PFMT interventions will be delivered as 12-week home exercise programs, performed five days a week and at least three times per day. To support adherence, participants will use an exercise diary. In addition, participants in the DNS and PFMT groups will attend the clinic twice a week for supervised sessions led by a physiotherapist.

The control group will receive a brochure containing lifestyle and bladder health recommendations but will not engage in any structured exercise program.

Conditions

• Stress Urinary Incontinence (SUI)
• Dynamic Neuromuscular Stabilization
• Pelvic Floor Muscle Training
• Muscle Morphology
• Urinary Symptoms
• Quality of Life

Interventions

OTHER

Dynamic Neuromuscular Stabilization Training

According to the principles of Dynamic Neuromuscular Stabilization (DNS), proper activation of the integrated spinal stabilization system requires that the abdominal muscles expand not only in the caudal direction but also posteriorly and laterally.Therefore, firstly, the physiotherapist will assess the expansion of the entire abdominal wall and teach the patient to regulate intra-abdominal pressure through correct breathing techniques. During training and exercises, a belt will be used. Participants will be instructed to maintain abdominal expansion toward the belt during exercises performed in positions supported by proper alignment. A four-phase exercise protocol based on developmental kinesiology principles will be implemented for the DNS group, beginning with supine-position exercises appropriate for the 3-month developmental stage. They will be instructed to repeat the exercises at least three times per day.Patients will record their home exercise program using an exercise diary.

OTHER

Pelvic Floor Muscle Training

Participants in the PFMT group will undergo a structured pelvic floor muscle training program supervised by a physiotherapist. The training will include verbal and manual instructions to ensure correct identification and isolated activation of the pelvic floor muscles without compensatory movements from the gluteal, abdominal, or thigh muscles using a NeuroTrac Simplex EMG-Biofeedback device. The exercise protocol will consist of both slow and fast contractions, focusing on endurance, strength, and coordination. The exercises will be performed in various positions (e.g., supine, sitting, standing) and will gradually progress in intensity and complexity over time, following the principles of motor learning stages. They will be instructed to repeat the exercises at least three times per day. Patients will record their home exercise program using an exercise diary.

Sponsors & Collaborators

• Izmir Katip Celebi University

  lead OTHER

Principal Investigators

• Ayse Kardelen ACAR, MSc · Izmir Katıp Celebi University, Institute of Health Sciences

• Sevtap GUNAY UCURUM, Professor · Izmir Katıp Celebi University, Faculty of Health Sciences, Department of Physiotherapy and Rehabilitation

• Ahmet Ozgur YENIEL, Professor · Ege University, Faculty of Medicine, Department of Obstetrics & Gynecology

Study Design

Allocation

RANDOMIZED

Purpose

TREATMENT

Masking

SINGLE

Model

PARALLEL

Eligibility

Min Age

18 Years

Max Age

65 Years

Sex

FEMALE

Healthy Volunteers

No

Timeline & Regulatory

Start

2025-07-16

Primary Completion

2026-08-30

Completion

2026-12-30

Countries

• Turkey (Türkiye)

Study Locations