Constipation as a Hidden Barrier to Pelvic Floor Tele-Rehabilitation: A Randomized Controlled Trial in Women with...

To investigate whether integrating constipation management into tele-supervised pelvic floor muscle training (PFMT) improves continence outcomes compared with PFMT alone, and to determine whether constipation, pelvic floor self-efficacy, body awareness, and adherence predict treatment response.

In this randomized controlled trial, 200 women aged 18-60 years with stress urinary incontinence (SUI) were randomized to group A (tele-supervised PFMT only) or group B (PFMT plus constipation management). All participants completed a 12-week live Zoom®-based PFMT program. In addition, group B received dietary fiber regulation, hydration guidance, bowel habit training, optimal defecation posture instruction, and osmotic laxatives when clinically indicated according to Rome IV and Wexner criteria. Outcomes-ICIQ-UI SF, 1-h pad test, Oxford pelvic floor strength, self-efficacy, body awareness, constipation severity (Wexner), bowel frequency, and quality of life (ICIQ-LUTSqol)-were assessed at baseline, week 12 and 3-month follow-up. Analyses were performed under an intention-to-treat framework with multiple imputation; longitudinal changes were examined using repeated-measures ANOVA (or Friedman tests for non-normal variables), and baseline-adjusted between-group comparisons were evaluated using ANCOVA.

Both groups improved significantly in urinary symptoms, leakage, muscle strength, self-efficacy, and body awareness (p < 0.001). However, group B showed greater improvement in ICIQ-UI SF scores (-7.9 ± 2.6 vs -6.4 ± 2.8; p = 0.021), pad-test leakage (-6.6 g vs -5.4 g; p = 0.034) and quality of life (-12.0 vs -9.3; p = 0.026). Constipation severity decreased only in group B (p < 0.001).

Functional constipation reduces responsiveness to PFMT-based tele-rehabilitation in women with SUI. Integrating bowel management, self-efficacy strengthening, and body awareness into PFMT supports a multidisciplinary, gut-informed continence rehabilitation approach.