Without a doubt, pelvic floor physical therapy (PFPT) has robust evidence-based support and clear benefit as a first-line treatment for most pelvic floor disorders, including urinary incontinence (Wallace, et al, 2019). Unfortunately, studies show that many people fail to obtain treatment from any healthcare provider in part due to 1) not telling their provider about their incontinence, 2) not knowing incontinence can be effectively treated, 3) not having access to a provider who can treat incontinence, and/or 4) not having the final resources for services.
Is there an alternative? Well, based on research at the University of California San Francisco, yoga may offer a valuable alternative for people with incontinence.
Huang and colleagues (2014) investigated the effects of a 6-week yoga practice, done 2 times/week for 90 minutes, with an experienced teacher. Participants in the study were all women over the age of 40. In addition to attending 2 in-person yoga sessions per week, the women were expected to practice the postures at home 1 time/week.
The program was designed by experts Judith Hanson Lasater, PT, PhD, and Leslie Howard, originator of Pelvic Floor Yoga™ and consisted of the postures (asanas) seen below (Images from POCKETYOGA). While teaching the asanas, the instructor emphasized specific ways of practicing each posture to foster awareness of the pelvic floor and increase control of the pelvic floor muscles while promoting mindfulness, deep breathing, and relaxation.
Tadasana (Mountain pose)
Utkatasana (Chair pose)
Trikonasana (Triangle pose)
Malasana (Squat pose)
Viparita Karani Variation (Legs up the wall pose)
Salamba Setu Bandhasana (Supported bridge pose)
(Seen here is Setu Bandha Sarvangasana [Bridge pose, unsupported])
Supta Baddha Konasana (Reclined cobbler’s pose)
Shavasana (Corpse Pose)
Women who participated in the yoga sessions were compared to similar women who did not practice yoga. Besides being 40 years old or older, all the women needed to have had incontinence for at least 3 months with at least 7 episodes of stress-type or urgent-type incontinence over 7 days.
Stress incontinence happens when putting pressure on the bladder causes leakage. This type of incontinence can happen with coughing, laughing, sneezing, jumping, running, or lifting heavy objects.
Urge incontinence is when there is a sudden, intense urge to urinate with an involuntary loss of urine.
The researchers used standardized tools to measure incontinence including the Urogenital Distress Inventory 6 (UDI-6), the Patient Perception for Bladder Condition (PPBC), and the Incontinence Impact Questionnaire Short Form (IIQ-7) before and after the 6-weeks of yoga. All women also completed a voiding diary.
Huang and her colleagues found that women who participated in the yoga sessions had significantly better outcomes than those who did not practice yoga.
- Women in the yoga group had their total incontinence frequency decrease by 66% with a reduction of 1-2 incontinence episodes per day.
- Women in the yoga group decreased stress incontinence frequency by 85% (approx. 1 episode/ day)
- Women who did not practice yoga had a 25% increase in stress incontinence.
- Although there was no significant difference in urge incontinence between the two groups, the women who practiced yoga had a decrease of 0-2 episodes/day.
As with the reporting of any one clinical trial, more investigation is needed to better understand yoga’s potential for helping people with urinary incontinence. Nevertheless, the findings of this study suggest that the selected yoga asanas practiced 2 times/week, with a weekly home practice may reduce the frequency of incontinence and should be considered as an alternative or complementary approach for women over 40.
Huang, A. J., Jenny, H. E., Chesney, M. A., Schembri, M., & Subak, L. L. (2014). A group-based yoga therapy intervention for urinary incontinence in women: a pilot randomized trial. Female pelvic medicine & reconstructive surgery, 20(3), 147–154. https://doi.org/10.1097/SPV.0000000000000072
Wallace, S. L., Miller, L. D., & Mishra, K. (2019). Pelvic floor physical therapy in the treatment of pelvic floor dysfunction in women. Current Opinion in Obstetrics & Gynecology, 31(6), 485–493. https://doi.org/10.1097/GCO.0000000000000584
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