To describe the experiences of middle aged women with urinary incontinence, undergoing pelvic floor muscle training (PFMT) with EMG biofeedback for 3 months. This study focused on understanding patient- centric clinical, engagement and self-management outcomes in a LMIC setting.

Methods: This qualitative study was conducted by interviewing 11 women aged 40-66 years with stress urinary incontinence or/and pelvic organ prolapse of grade I or II. These women had been recruited as part of a larger interventional study, in a tertiary care hospital that aimed to assess the changes in pelvic floor function using EMG biofeedback in middle aged women with incontinence. The program consisted of 8 sessions of therapist supervised PFMT with EMG biofeedback, a patient education booklet and counselling regarding healthy toileting habits. Semi-structured interviews were conducted post-intervention to capture in-depth patient perspectives. Interviews were audio-recorded, transcribed verbatim, and analysed using an inductive thematic analysis approach. Coding and theme development were performed to identify patterns related to awareness, engagement, learning processes, adherence, and perceived outcomes.

Four major themes emerged along with corresponding sub themes. 1- Delayed help-seeking and initial awareness, 2-Contextual factors influencing engagement 3- Guided learning  4- Perceived impact and outcomes. All participants reported a lack of awareness about pelvic floor training before commencing the program. Most women resorted to unverified resources of exercises or assumed medical intervention as line of treatment.  Easy accessibility and flexible appointment timings were the main reasons for enrolling and continuing training. Work and household responsibilities posed as barriers to remain consistent for the entire period of the program. The participants expressed that supervised and guided sessions with biofeedback made the exercise experience easy and ’fun’. Most of the participants reported reduction in leakage episodes, improved bladder holding capacity and enhanced confidence in attending social events. Participants’ recommendations were also recorded. They highlighted the need for continued support and to create awareness and knowledge through educational videos for other women in need.

The findings suggest that PFMT with EMG biofeedback functions not only as a therapeutic intervention but also as a behavioural and educational transformation model. It enables patients to progress from limited awareness to active self-management through guided learning and improved body awareness. The qualitative approach provides valuable insights into patient experiences, highlighting multidimensional benefits and contextual barriers.

The key highlight of this study is its qualitative exploration of patient experiences, which reveals that PFMT with EMG biofeedback is an effective, patient-centred intervention that improves both clinical outcomes and self-efficacy. This study has captured nuanced changes in awareness, beliefs, adherence, and quality of life that quantitative outcomes alone may not fully reflect. This study also highlights that patient education is crucial in clinical practice to enhance understanding, engagement, and long-term self-management outcomes.

Continence 19S (2026) 102719
DOI: 10.1016/j.cont.2026.102719