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

NCT07853755 | Not Yet Recruiting

• 1 other identifier: E-10840098-50.04-5397
• Study Type: interventional
• Target: 60
• Locations: 1 country
• Sites: 1

Brief Summary

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.

Conditions

Stress Urinary Incontinence (SUI)

Keywords

Postmenopause; Kinesthetic Motor Imagery; Pelvic Floor Muscle Training

Outcome Measures

Primary Outcomes (1)

• International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form (ICIQ-UI SF) Total Score

  Urinary incontinence severity will be assessed using the International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form (ICIQ-UI SF). The questionnaire assesses the frequency and amount of urinary leakage and its impact on everyday life over the previous four weeks. The total score is calculated by summing three scored items and ranges from 0 to 21, with higher scores indicating greater urinary incontinence severity.

  Baseline (before the first treatment session) and at the end of the 12-week intervention.

Secondary Outcomes (4)

• Mean Daily Stress Urinary Leakage Episodes

  Baseline (before the first treatment session) and at the end of the 12-week intervention.

• Urinary Loss Measured by the 24-Hour Pad Test

  Baseline (before the first treatment session) and at the end of the 12-week intervention.

• Incontinence Quality of Life Questionnaire (I-QOL) Total Score

  Baseline (before the first treatment session) and at the end of the 12-week intervention.

• Mean Pelvic Floor Muscle Electrical Activity During Voluntary Contractions

  Baseline (before the first treatment session) and at the end of the 12-week intervention.

Study Arms (2)

Pelvic Floor Motor Imagery + Pelvic Floor Muscle Training

EXPERIMENTAL

Participants will receive pelvic-floor-specific kinesthetic motor imagery combined with supervised pelvic floor muscle training. Immediately before each physical pelvic floor contraction, participants will imagine the sensation of closing, squeezing, and lifting the pelvic floor muscles, followed by relaxation, without physically contracting during imagery. The program will include 24 supervised sessions over 12 weeks, delivered twice weekly on nonconsecutive days, with each session lasting approximately 30 minutes.

Behavioral: Pelvic Floor Muscle Training; Behavioral: Pelvic-Floor-Specific Kinesthetic Motor Imagery

Hand Motor Imagery + Pelvic Floor Muscle Training

ACTIVE COMPARATOR

Participants will perform kinesthetic motor imagery of making and opening a fist with the dominant hand, without actual hand movement, immediately before each physical pelvic floor contraction. They will receive the same supervised pelvic floor muscle training as the experimental group. Imagery duration, physical exercise dose, and therapist contact will be matched between groups. The program will include 24 supervised sessions over 12 weeks, delivered twice weekly on nonconsecutive days, with each session lasting approximately 30 minutes.

Behavioral: Pelvic Floor Muscle Training; Behavioral: Dominant-Hand Kinesthetic Motor Imagery

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.

Hand Motor Imagery + Pelvic Floor Muscle Training; Pelvic Floor Motor Imagery + Pelvic Floor Muscle Training

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.

Pelvic Floor Motor Imagery + Pelvic Floor Muscle Training

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.

Hand Motor Imagery + Pelvic Floor Muscle Training

Eligibility Criteria

• Age: 45 Years - 65 Years
• Sex: female
• Healthy Volunteers: No
• Age Groups: Adult (18-64), Older Adult (65+)

You may qualify if:

• 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.

You may not qualify if:

• 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.

Sponsors & Collaborators

• Istanbul Medipol University Hospital: lead

Study Sites (1)

Istanbul Medipol University

Istanbul, Istanbul, 34815, Turkey (Türkiye)

Location

MeSH Terms

Conditions

Urinary Incontinence, Stress

Condition Hierarchy (Ancestors)

Urinary Incontinence; Urination Disorders; Urologic Diseases; Female Urogenital Diseases; Female Urogenital Diseases and Pregnancy Complications; Urogenital Diseases; Male Urogenital Diseases; Lower Urinary Tract Symptoms; Urological Manifestations; Signs and Symptoms; Pathological Conditions, Signs and Symptoms

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: SINGLE
• Who Masked: OUTCOMES ASSESSOR
• Purpose: TREATMENT
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: Assistant professor

Model Details: This two-arm, parallel-group randomized controlled trial will allocate 60 participants in a 1:1 ratio (30 per group) to pelvic floor muscle training preceded by either pelvic-floor-specific kinesthetic motor imagery or kinesthetic imagery of making and opening a fist with the dominant hand. Both groups will receive the same supervised pelvic floor muscle training twice weekly for 12 weeks. Assessments will be conducted at baseline and at the end of week 12.

Study Record Dates

• First Submitted: September 25, 2026
• First Posted: October 2, 2026
• Study Start: September 28, 2026
• Primary Completion (Estimated): January 5, 2027
• Study Completion (Estimated): January 5, 2027
• Last Updated: October 2, 2026

Record last verified: 2026-09

Data Sharing

• IPD Sharing: Will not share

Locations

TU (1)