Alternative Exercise Regimens for Stress Urinary Incontinence in Women: A Systematic Review and Meta-analysis

This systematic review and meta-analysis aims to synthesize existing evidence on the effectiveness of alternative exercise regimens for managing stress urinary incontinence in women, compared to pelvic floor muscle training or usual care/placebo.

A comprehensive search of MEDLINE, Cochrane Library, CINAHL, Embase, PubMed, and Scopus, was conducted up to April 26, 2025. Randomized controlled trials investigating alternative exercises, including Pilates, lumbopelvic stabilization, breathing exercises, resisted hip rotation, yoga, and the Paula method, were included. A random-effects model was applied in the meta-analysis to compute standardized mean differences (SMDs) for urinary incontinence severity and quality of life.

Fourteen RCTs involving 797 women were included. Among them, nine studies were evaluated as good quality, and five as fair. Meta-analysis showed no significant difference between the effectiveness of alternative exercises and pelvic floor muscle training on urinary incontinence severity (SMD 0.04, 95% CI -0.15 to 0.23, p = 0.68) and quality of life (SMD -0.11, 95% CI -0.26 to 0.04, p = 0.14). Alternative exercises significantly outperformed usual care/placebo in improving symptom severity (SMD -1.34, 95% CI -1.85 to -0.83, p < 0.001) and quality of life (SMD -1.03, 95% CI -1.52 to -0.54, p < 0.001). No adverse events were reported.

Alternative exercise regimens provide comparable benefits to pelvic floor muscle training and significantly outperform usual care/placebo, making them viable, evidence-based options for stress urinary incontinence management.