Synergistic Effects of Traditional Chinese Medicine Practices and Pelvic Floor Muscle Training

Incontinence Episode Frequency (IEF) will be measured using a 72-hour bladder diary maintained by participants. Participants will be provided with a structured bladder diary template, which includes columns for recording each instance of urine leakage, the associated activity (e.g., coughing, sneezing, physical exertion), and the approximate volume of leakage (if subjectively estimable). The frequency of urine leakage episodes will be calculated by averaging the total number of incidents recorded over the three days at each assessment point. The 72-hour urinary incontinence episode values will represent the total number of leakage incidents observed across the three days and will be used to evaluate changes in IEF over time.

Urine leakage will be objectively quantified using the 1-hour pad test, conducted at the same time points as the bladder diary assessments. Participants will be provided with pre-weighed absorbent pads and instructed to wear them for a continuous 1-hour period. During this time, participants will be asked to drink 500 ml of plain water over 15 minutes and perform normal activities, including simple walking for the next 30 minutes. In the last 15 minutes, participants will be instructed to perform the standard ICS provocation exercises in a private area. If a participant is found to have vaginal bleeding or excessive vaginal discharge, the test will be postponed and rescheduled for a later date. After the 1-hour period, participants will seal the pads in provided plastic bags and return them to the study site. Trained assessors will measure the weight difference between the pre- and post-use pads using a precision digital scale .

Pelvic floor muscle function will be assessed using a Peritron 9300V perineometer (Cardio Design Pty Ltd., Melbourne, Australia), a device widely used in clinical and research settings for measuring intravaginal pressure. To standardize measurements, participants will be asked to empty their bladder prior to the test, and the procedure will be thoroughly explained by the assessor to ensure understanding and comfort. Participants will undergo the assessment in a semi-recumbent position with knees bent and feet flat on the examination table. A sterile, single-use intravaginal pressure sensor will be lubricated with a water-based gel and inserted to ensure proper placement and participant comfort. During the assessment, participants will perform three maximal voluntary pelvic floor muscle contractions, each held for 5 seconds, with 10-second rest intervals between contractions to avoid fatigue. The highest pressure recorded from the three attempts will be used for analysis.

This tool is specifically designed to evaluate the effects of urinary incontinence on participants' daily lives, encompassing physical, emotional, and social domains. The IIQ-7 is a subset of the full Incontinence Impact Questionnaire, developed to measure the impact of urinary incontinence on women's quality of life in a concise format. It consists of seven items addressing the extent to which urinary leakage interferes with: physical activities, social interactions and emotional well-being. The total score ranges from 0 to 28, with higher scores indicating a greater negative impact on quality of life.

The UDI-6 is a short-form version of the Urinary Distress Inventory and evaluates symptom-related distress associated with urinary incontinence. The six items target: urinary urgency, frequency, urinary leakage and bladder control issues.

Each item is scored on a 4-point Likert scale ranging from 0 = Not at all to 3 = Greatly. Total scores range from 0 to 24, with higher scores reflecting greater symptom distress.

Psychological well-being will be evaluated using the Perceived Stress Scale (PSS), a validated and widely used questionnaire designed to assess perceived stress levels over the past month. The PSS consists of 10 items, each reflecting an aspect of stress perception, such as feelings of unpredictability, uncontrollability, and being overwhelmed. Participants will rate their responses on a 5-point Likert scale, where 0 = never and 4 = very often, based on their experiences in the preceding month. Total scores range from 0 to 40, with higher scores indicating greater levels of perceived stress.