Pelvic floor muscle training versus no treatment, or inactive control treatments, for urinary incontinence in women

  • Review
  • Intervention


  • Jean Hay-Smith,

    Corresponding author
    1. Department of Medicine, Rehabilitation Teaching and Research Unit, Wellington South, Wellington, New Zealand
    • Jean Hay-Smith, Rehabilitation Teaching and Research Unit, Department of Medicine, Wellington School of Medicine and Health Sciences, University of Otago, PO Box 7343, Wellington South, Wellington, New Zealand.

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  • Chantale Dumoulin

    1. University of Montreal, School of rehabilitation, Faculty of Medicine, Montreal, Quebec, Canada
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Pelvic floor muscle training is the most commonly used physical therapy treatment for women with stress urinary incontinence. It is sometimes recommended for mixed and less commonly urge urinary incontinence.


To determine the effects of pelvic floor muscle training for women with urinary incontinence in comparison to no treatment, placebo or sham treatments, or other inactive control treatments.

Search strategy

The Cochrane Incontinence Group Specialised Trials Register was searched. The date of the most recent search was 1 December 2004.

Selection criteria

Randomised or quasi-randomised trials in women with stress, urge or mixed urinary incontinence (based on symptoms, signs, or urodynamics). One arm of the trial included pelvic floor muscle training (PFMT). Another arm was a no treatment, placebo, sham, or other inactive control treatment arm.

Data collection and analysis

Trials were independently assessed for eligibility and methodological quality. Data were extracted then cross-checked. Disagreements were resolved by discussion. Data were processed as described in the Cochrane Handbook (Higgins 2005). Trials were subgrouped by diagnosis. Formal meta-analysis was not undertaken because of study heterogeneity.

Main results

Thirteen trials involving 714 women (375 PFMT, 339 controls) met the inclusion criteria, but only six trials (403 women) contributed data to the analysis. Most studies were at moderate to high risk of bias, based on the trial reports. There was considerable variation in interventions used, study populations, and outcome measures.

Women who did PFMT were more likely to report they were cured or improved than women who did not. PFMT women also experienced about one fewer incontinence episodes per day. There were too few data to draw conclusions about effects on other outcomes such as condition specific quality of life. Of the few adverse effects reported, none were serious. The trials in stress urinary incontinent women which suggested greater benefit recruited a younger population and recommended a longer training period than the one trial in women with detrusor overactivity (urge) incontinence.

Authors' conclusions

Overall, the review provides some support for the widespread recommendation that PFMT be included in first-line conservative management programmes for women with stress, urge, or mixed, urinary incontinence. Statistical heterogeneity reflecting variation in incontinence type, training, and outcome measurement made interpretation difficult. The treatment effect might be greater in younger women (in their 40's and 50's) with stress urinary incontinence alone, who participate in a supervised PFMT programme for at least three months, but these and other uncertainties require testing in further trials.

Plain language summary

Pelvic floor muscle training helps reduce urinary incontinence in women.

Stress incontinence is the involuntary leakage of urine with a physical activity such as coughing or sneezing and can happen if the pelvic floor muscles are weak. Urge leakage occurs with a strong need to urinate, but the person cannot make it to the toilet in time and is caused by an involuntary contraction of the bladder muscle. A combination of stress and urge leakage is called mixed incontinence. The review of trials found that pelvic floor muscle training (muscle-clenching exercises) helps women with all types of incontinence although women with stress incontinence who exercise for three months or more benefit most.