Yoga-Pilates Exercise & the Effects on Urethral Rhabdosphincter Morphology and Stress Urinary Incontinence

Stress urinary incontinence (SUI) affects up to 1/3 of women and negatively impacts multiple aspects of a woman's life. Pelvic floor physical therapy has been shown to improve stress incontinence through multiple mechanisms, including rhabdosphincter hypertrophy. Yoga and Pilates have also been shown to improve stress incontinence but there is a key gap in understanding how yoga-Pilates impacts urethral function and if these exercises represent a viable option for treating SUI.

To fill this gap a new exercise is proposed: a web-based 8-week yoga-Pilates pelvic floor workout. The investigators plan to enroll women with SUI and compare urethral rhabdosphincter cross-sectional area in a pre-post intervention study. The investigators will also administer validated quality of life and severity measures for SUI to evaluate the potential efficacy of yoga-Pilates. The overarching goal of this project is to determine how yoga-Pilates impact urethral function and if these exercises decrease SUI symptoms.

Inclusion criteria

• English-speaking
• >50% episodes of leakage are stress over urge incontinence on a 1-day voiding diary and/OR an answer of "when you are performing some physical activities, such as coughing, sneezing, lifting, or exercise" on the 3-Incontinence Questions (3IQ) Questionnaire
• Access to the Internet and active email address

Exclusion criteria

• Inability to perform yoga or Pilates due to mobility issues (specifically, inability to get up from chair without assistance or to get up from prone position on floor without assistance)
• Chronic back or neck injury that would prevent yoga or Pilates
• Dementia
• Multiple sclerosis and other neurological disorders such as stroke
• Engaged in yoga, Pilates, or pelvic floor physical therapy in past 6 months
• Current pregnancy or pregnancy in the last 6 months
• Untreated urinary tract infection (UTI), unevaluated hematuria, history of >3 diagnosed UTIs in past year
• History of bladder or rectal fistula
• Pelvic cancer or radiation
• Interstitial cystitis or chronic pelvic pain
• Congenital defect leading to urinary incontinence
• Prior anti-incontinence or urethral surgery, prior surgery for pelvic floor disorder
• Current symptomatic pelvic organ prolapse (Stage 2 or greater on exam, i.e. prolapse more than 1cm beyond the hymen)
• Majority of incontinence episodes related to urgency urinary incontinence