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Motor Imagery-Assisted Pelvic Floor Muscle Training for Stress Urinary Incontinence in Postmenopausal Women

Sponsor: Istanbul Medipol University Hospital • ClinicalTrials.gov ID: NCT07853755

Registry updated: 2026-10-08

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Description

This study will evaluate whether adding mental rehearsal of pelvic floor muscle contractions to pelvic floor muscle training improves stress urinary incontinence in postmenopausal women. Stress urinary incontinence is urine leakage during activities such as coughing, sneezing, or physical exertion. Mental rehearsal involves imagining the sensation of a movement without physically performing it. The study will include 60 women aged 45 to 65 years who have completed natural menopause and have stress urinary incontinence. Participants will be randomly assigned to one of two groups. Both groups will receive the same supervised pelvic floor muscle training twice a week for 12 weeks. Before performing the pelvic floor exercises, one group will imagine contracting and relaxing the pelvic floor muscles. The other group will imagine making and opening a fist with their dominant hand. Assessments will take place before treatment and at the end of 12 weeks. The main outcome will be urinary incontinence symptom severity. Additional assessments will examine urine leakage frequency and amount, incontinence-related quality of life, and pelvic floor muscle electrical activity.

Interventions

Pelvic Floor Muscle Training (Behavioral)
Both groups will receive the same progressive, supervised pelvic floor muscle training program, including slow and fast contractions, graded contractions, and pre-contraction before coughing or physical effort (the Knack). Training will progress across three four-week phases, with increasing contraction demands and progression toward standing and functional activities. The program will be delivered as part of 24 supervised sessions over 12 weeks, twice weekly on nonconsecutive days. Each session, including the assigned motor imagery component, will last approximately 30 minutes. No additional home exercise program will be prescribed.
Pelvic-Floor-Specific Kinesthetic Motor Imagery (Behavioral)
Participants will mentally rehearse the sensation of closing, squeezing, and lifting the pelvic floor muscles around the urethra and vagina, followed by relaxation, without physically contracting during imagery. Kinesthetic imagery will be performed immediately before each corresponding physical pelvic floor contraction. This component will be integrated into all 24 supervised sessions over 12 weeks. Imagery duration and therapist contact will be matched to the dominant-hand imagery condition.
Dominant-Hand Kinesthetic Motor Imagery (Behavioral)
Participants will mentally rehearse the sensation of making and opening a fist with their dominant hand, without actual hand movement. This imagery will be performed immediately before each physical pelvic floor contraction and will be integrated into all 24 supervised sessions over 12 weeks. Imagery duration and therapist contact will be matched to the pelvic-floor-specific imagery condition. Participants will receive the same physical pelvic floor muscle training program as the experimental group.

Eligibility criteria

Inclusion Criteria: * Women aged 45 to 60 years. * Natural postmenopause, defined as the absence of menstruation for at least 12 consecutive months without a pathological, pharmacological, or surgical cause. * Physician-diagnosed stress urinary incontinence. * Sufficient cognitive and communication abilities to understand instructions in Turkish and complete the questionnaires and a three-day bladder/leakage diary. * A score of at least 30 on each of the visual and kinesthetic imagery subscales of the Kinesthetic and Visual Imagery Questionnaire-20 (KVIQ-20), assessed before randomization. Exclusion Criteria: * Urgency, mixed, overflow, or neurogenic urinary incontinence. * Stage III or IV pelvic organ prolapse according to the Pelvic Organ Prolapse Quantification (POP-Q) system. * Inability to correctly and voluntarily contract the pelvic floor muscles. * Active urinary tract or vaginal infection, unexplained hematuria, or postmenopausal vaginal bleeding. * Severe vaginal atrophy, vaginismus, genital lesions, or pelvic pain that prevents intravaginal assessment. * Previous surgery for stress urinary incontinence or previous pelvic radiotherapy. * Pelvic floor rehabilitation for urinary incontinence within the previous 12 months. * Neurological or cognitive disorders, or uncontrolled psychiatric illness, that could affect pelvic floor control, continence, or motor imagery ability. * Serious or uncontrolled systemic or musculoskeletal conditions that prevent safe participation in the exercise program. * Changes in hormone therapy within the previous six months or changes in medications affecting urinary system function within the previous three months.

Conditions

Stress Urinary Incontinence (SUI)

Locations

Istanbul Medipol University — Istanbul, Istanbul, Turkey (Türkiye)

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Official Source

Data sourced from ClinicalTrials.gov, a service of the U.S. National Institutes of Health.

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