Hip Muscle Strengthening and Electrical Stimulation As Adjuncts to Pelvic Floor Training on Urinary Incontinence Publisher



Torkzadeh A ; Rasanani M R H ; Zargham M ; Nitsche M ; Gorji Z ; Jalaie S ; Yeniyol F
Source: International Urogynecology Journal Published:2026

Abstract

Introduction and Hypothesis: Stress and mixed urinary incontinence (SUI and MUI) adversely affect women’s quality of life. Although pelvic floor muscle training (PFMT) is the first-line conservative treatment, a proportion of patients have difficulty performing or sustaining correct contractions. Adjunctive interventions, such as hip muscle strengthening or intravaginal electrical stimulation (ES), may enhance outcomes. This study compared the effects of biofeedback-assisted PFMT (BF-PFMT) with those of BF-PFMT combined with hip rotator exercises or intravaginal ES in women with SUI and MUI. Methods: In this randomized controlled trial, 60 women aged 30–65 years with SUI or MUI were allocated to three groups: BF-PFMT (n = 17), BF-PFMT plus hip rotator strengthening (n = 19), and BF-PFMT plus intravaginal ES (n = 19). The 6-week intervention involved supervised exercises. Primary outcomes were pelvic floor muscle (PFM) strength (perineometer), Oxford Grading Scale (OGS), and myoelectric activity (EMG). Quality of life was assessed using the I-QoL questionnaire. Data were analyzed using ANOVA and Kruskal–Wallis tests (α = 0.05). Results: Fifty-five participants completed the study. All groups demonstrated significant within-group improvements in all outcomes (p < 0.05). Between-group analysis revealed a significant difference in PFM strength (F = 13.74, p = 0.001, η2 = 0.346). The BF-PFMT plus hip strengthening group showed the greatest improvement compared to BF-PFMT alone (mean difference = 4.44 cm H2O, d = 1.43) and BF-PFMT plus ES (d = 0.37). Adjunctive groups showed greater but nonsignificant improvements in OGS and I-QoL scores. Conclusion: Biofeedback-assisted PFMT significantly improves pelvic floor function and QoL. Adding hip rotator exercises or intravaginal ES provides additional benefit, with hip strengthening producing the greatest improvement in PFM strength. Trial Registration: This trial was registered in the Iranian Registry of Clinical Trials (IRCT20090301001722N30). © The Author(s), under exclusive license to International Urogynecological Association 2026.