Clinical Pilates in Practice: Pelvic Floor Muscle Training for Stress Urinary Incontinence (December 2020)


"The aims of the present systematic review and meta-analysis were:

  1. To analyze the effectiveness of pelvic floor muscle exercises ... in women with stress urinary incontinence (SUI), and
  2. To determine which pelvic floor muscle training characteristics (length of the program, frequency, duration, exercises) produced the greatest adaptations for decreasing urine loss."


García-Sánchez E, Ávila-Gandía V, López-Román J, Martínez-Rodríguez A, Rubio-Arias JÁ. What Pelvic Floor Muscle Training Load is Optimal in Minimizing Urine Loss in Women with Stress Urinary Incontinence? A Systematic Review and Meta-Analysis. Int J Environ Res Public Health. 2019 Nov 8;16(22):4358. doi: 10.3390/ijerph16224358. PMID: 31717291; PMCID: PMC6887794



  • 10% of the female population experience stress urinary incontinence (UI) weekly, with 25%-45% of the population experiencing UI occasionally; stress urinary incontinence (SUI) is the most common form of UI. 
  • While overweight and obesity are the main risk factors for UI, others include:
    • Parity.
    • Pregnancy.
    • Mode of delivery.
    • Race and ethnicity.
    • Hysterectomy.
    • Hormone replacement therapy.
    • Diet.
    • Socioeconomic status.
    • Smoking.
    • Physical activity levels.
    • Comorbidities (diabetes, depression, other physical impairments).
  • Conservative treatment includes pelvic floor muscle training, biofeedback, physical therapy, the use of vaginal cones, and electro-stimulation.
  • Electro-stimulation and/or biofeedback should only be used for women who cannot actively contract their pelvic floor muscles. 

Continence Foundation of Australia (2011)

  • Women who engage in pelvic floor muscle training show significant changes in SUI, but the literature shows that there are many different training regimens. 
  • Women who train with equipment or accessories (e.g. vaginal cone) show significant improvements compared to the pelvic floor muscle training groups that did not use equipment.
  • Greater improvements are seen when training with equipment versus biofeedback.
  • Pelvic floor muscle training is helpful regardless of age or BMI.
  • Increased frequency of training, with shorter sessions, is more useful than fewer, longer training sessions.
  • Significant differences were observed when training 3-7 days per week, versus  training programs of less than three sessions per week.

Training sessions of 10-45 minutes for a period greater than 12 weeks showed the most improvement.

  • It is not advised that the number of muscle contractions should exceed 200 per day.
  • Slow and rapid contractions for pelvic floor muscle training should be combined.



  • The authors of the study propose the following parameters for pelvic floor muscle training:
    • Training program should run for a minimum of 6 weeks.
    • Slow contractions should be held for 5-10s.
    • Rapid contractions should be held for 1, 2, and 3s.
    • 1-12s recovery time between contractions/repetitions.
    • Maximum of 9 sets per training session; 1-3 minutes recovery between sets.
    • Add vaginal weights and biofeedback to complement training, as appropriate.



1. "Female Pelvic Floor Muscles." Continence Foundation of Australia. Last modified March 26, 2019.


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