A group-based yoga program for urinary incontinence in ambulatory women: feasibility, tolerability, and change in incontinence frequency over 3 months in a single-center randomized trial

Abstract

Structured Abstract Background: Due to the limitations of existing clinical treatments for urinary incontinence, many women with incontinence are interested in complementary strategies for managing their symptoms. Yoga has been recommended as a behavioral self-management strategy for incontinence, but evidence of its feasibility, tolerability, and efficacy is lacking. Objectives: To evaluate the feasibility and tolerability of a group-based therapeutic yoga program for ambulatory middle-aged and older women with incontinence and examine preliminary changes in incontinence frequency as the primary efficacy outcome after 3 months. Study Design: Ambulatory women aged 50 years or older who reported at least daily stress-, urgency-, or mixed-type incontinence, were not already engaged in yoga, and were temporarily willing to forgo clinical incontinence treatments were recruited into a randomized trial in the San Francisco Bay area. Women were randomly assigned to take part in a program of twice weekly group classes and once weekly home practice focused on Iyengar-based yoga techniques selected by an expert yoga panel (yoga group) or a non-specific muscle stretching and strengthening program designed to provide a rigorous time-and-attention control (control group) for 3 months. All participants also received written, evidence-based information about behavioral incontinence self-management techniques (pelvic floor exercises, bladder training) consistent with usual first-line care. Incontinence frequency and type were assessed by validated voiding diaries. Analysis of covariance models examined within- and between-group changes in incontinence frequency as the primary efficacy outcome over 3 months. Results: Of the 56 women randomized (28 to yoga, 28 to control), mean age was 65.4 (±8.1) years (range 55–83 years), mean baseline incontinence frequency was 3.5 (±2.0) episodes/day, and 37 (66%) had urgency-predominant incontinence. Fifty women completed their assigned 3-month intervention program (89%), including 27 in the yoga and 23 in the control group (P=0.19). Of those, 24 (89%) in the yoga and 20 (87%) in the control group attended at least 80% of group classes. Over 3 months, total incontinence frequency decreased by an average of 76% from baseline in the yoga and 56% in the control group (P=0.07 for between-group difference). Stress incontinence frequency also decreased by an average of 61% in the yoga group and 35% in controls (P=0.045 for between-group difference), but changes in urgency incontinence frequency did not differ significantly between groups. Forty-eight non-serious adverse events were reported, including 23 in the yoga and 25 in the control group, but none were directly attributable to yoga or control program practice. Conclusions: Findings demonstrate the feasibility of recruiting and retaining incontinent women across the aging spectrum into a therapeutic yoga program and provide preliminary evidence of reduction in total and stress-type incontinence frequency after 3 months of yoga practic...

Efficacy of Mind-Body Therapies for the Treatment of Urinary Incontinence in Women: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

“…All six included studies described the methods used for random sequence generation and were free from reporting bias. Two out of the six included studies reported the methods used for allocation concealment [33,34]. None of the included studies reported blinding of participants; however, assessors were blinded in three out of the six included studies [33][34][35].…”

“…Two out of the six included studies reported the methods used for allocation concealment [33,34]. None of the included studies reported blinding of participants; however, assessors were blinded in three out of the six included studies [33][34][35]. The completeness of outcome data for each main outcome, including attrition and exclusions from the analysis were adequately described in one study [33].…”

“…None of the included studies reported blinding of participants; however, assessors were blinded in three out of the six included studies [33][34][35]. The completeness of outcome data for each main outcome, including attrition and exclusions from the analysis were adequately described in one study [33]. Four out of six studies were free of any other biases [33][34][35][36].…”

“…The completeness of outcome data for each main outcome, including attrition and exclusions from the analysis were adequately described in one study [33]. Four out of six studies were free of any other biases [33][34][35][36].…”

“…Karani Variation (legs up the wall pose), Salamba Set Bandhasana (supported bridge pose), Supta Baddha Konasana (reclined cobbler's pose), and Savasana (corpse pose) [33,37]. Although the effects of yoga were statistically significant, the evidence was from two small studies associated with low [37] to high [33] risk of bias. However, considering the low risks of yoga, this intervention may be considered for clinical use.…”