In Nepal, urinary incontinence (UI) is a significant yet under-recognized public health issue among reproductive-age women. This study hypothesized that pelvic floor muscle training (PFMT) would effectively reduce the symptoms of UI in Nepali women, as PFMT is considered as the first-line treatment internationally (1). The lack of evidence from Nepal necessitates to determine the efficacy of PFMT in Nepalese women, potentially informing future public health strategies and interventions.

An assessor-blinded, parallel-group, randomized controlled trial included 150 women aged 18 to 45 years with self-reported UI who responded and agreed to participate. The sample size was determined based on power calculation, with an additional 10% added to account for loss to follow-up. Eligible participants were randomized in a 1:1 ratio into either control group (Education) or intervention group (Education + supervised PFMT). To ensure allocation concealment and minimize selection bias, randomization was done using sealed envelopes containing a note marked either ‘control’ or ‘intervention’. All participants received a 30-minute education session about UI and PFMT, including a PFMT pamphlet. The intervention group received two individual sessions in addition to 10 supervised group exercise classes and were encouraged to do additional PFMT at home. The primary outcome was change-score on the Nepali version of International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form (ICIQ-UI SF) (2) at baseline, 12 weeks and 6 months.

At baseline, all 75 in each group completed the ICIQ-UI SF questionnaire. At 12-week follow-up, 126 remained while 10 were lost in the control group and 14 in the intervention group. Fifty-five (73%) completed 12 visits to exercise classes. We have no data on home exercise adherence. At 6-month follow-up 122 remained. An additional three from the control group and one from the intervention group were lost. 

There was no difference between the intervention and control group (8.49 ± 4.73 vs 9.41 ± 4.41, p=0.220) at baseline. At 12 weeks, reduced mean ICIQ-UI SF scores demonstrated similar improvement in both groups (intervention-group 5.46±4.98, control-group 5.20±4.78) with no significant difference in change between groups (mean difference: -0.259 (95% CI: -1.980 to 1.462). At 6 months, the mean reduction from baseline indicated retained improvement in both groups (intervention-group 5.98±5.31, control-group 6.98±4.71), but still no significant differences in change between groups.

Improved outcomes in both groups, but with no difference between groups, might be explained by both groups receiving profound education and instruction in PFMT. It is a limitation that we do not know whether the intervention group did perform home exercises or not. It might be that both groups performed similar amount of home exercises. Future studies should monitor dosage of exercising and investigate determining factors for improvement.

We found no difference in effect of an education program of PFMT compared to an education program plus group exercises. As both groups improved it might be that the dosage of PFMT was similar in both groups

Dumoulin C, Cacciari LP, Hay-Smith EJC. Pelvic floor muscle training versus no treatment, or inactive control treatments, for urinary incontinence in women. Cochrane Database Syst Rev. 2018;10(10):Cd005654.
Khadgi B, Stensdotter AK, Acharya RS, Brandt C, Stuge B. Translation and cross-cultural adaptation of the Nepali version of the International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form. J Nepal Health Res Counc. 2024;22(2):316–23.
Frawley H, Shelly B, Morin M, Bernard S, Bø K, Digesu GA, et al. An International Continence Society (ICS) report on the terminology for pelvic floor muscle assessment. Neurourol Urodyn. 2021;40(5):1217–60.