Efeitos do Mat Pilates associado a contração voluntária dos músculos do assoalho pélvico em mulheres na pós-menopausa com incontinência urinária de esforço: ensaio clínico randomizado e controlado

Abstract

Introduction: Urinary incontinence (UI) affects more than 50% of postmenopausal women. However, it remains unclear whether Mat Pilates provides additional benefits over Pelvic Floor Muscle Training (PFMT) for the treatment of UI. Objective: To evaluate the benefits of Mat Pilates combined with voluntary pelvic floor muscle (PFM) contraction in postmenopausal women with stress urinary incontinence (SUI). Methods: A randomized controlled trial was conducted. Ninety-two women with SUI, PFM strength ≥ 2, and no use of hormone therapy were randomized into an experimental group (57.6 ± 5.2 years, n = 46), which underwent Mat Pilates combined with voluntary PFM contraction (MP + vcPFM), and a control group (57.3 ± 4.4 years, n = 46), which underwent PFMT. Both groups completed 36 sessions, three times per week, for three months, with equalization of the number of PFM contractions and training progression every 12 sessions. Before the intervention, all participants attended three sessions of perineal awareness training. The following outcomes were assessed: the impact of UI using the International Consultation on Incontinence Questionnaire–Short Form (ICIQ-SF), the amount of urinary leakage using the one-hour Pad test, urinary habits using a 3-day bladder diary, and PFM function using digital palpation and vaginal manometry. Statistical analysis was performed using linear mixed models, considering group (PFMT vs. Mat Pilates), time (pre- and post-intervention), and the group × time interaction as fixed effects (α = 5%). Results: Regarding the impact of UI on quality of life, the PFMT group showed a reduction from 11.28 (±4.22) to 5.51 (±4.58), whereas the MP + vcPFM group showed a reduction from 12.17 (±4.56) to 7.45 (±4.16), with a mean difference of 0.96 (95% CI −1.00 to 2.92) and no superiority between interventions (p = 0.334). Regarding urinary habits, urinary frequency decreased from 3.15 (±1.29) to 2.19 (±0.71) in the PFMT group and from 2.82 (±0.93) to 2.64 (±0.92) in the MP + vcPFM group, with a mean difference of 0.80 (95% CI 0.37 to 1.23), demonstrating superiority in favor of PFMT (p < 0.001). Urinary leakage episodes decreased from 1.82 (±2.19) to 0.45 (±0.74) in the PFMT group and from 1.56 (±1.33) to 0.96 (±1.16) in the MP + vcPFM group, with a mean difference of 0.76 (95% CI 0.09 to 1.42), with PFMT demonstrating superiority (p = 0.026). In the PFM assessment, only maximal PFM contractions showed superiority between interventions, in favor of PFMT (p = 0.047). In the PFMT group, maximal PFM contractions increased from 4.24 (±1.86) to 6.19 (±2.11), whereas in the MP + vcPFM group they increased from 4.41 (±1.33) to 5.35 (±1.85), with a mean difference of −0.99 (95% CI −1.97 to −0.01). The cure rate was 70% (32/46) in the PFMT group and 43% (20/46) in the MP + vcPFM group. Conclusion: Both interventions improved the impact of SUI on quality oflife. However, PFMT was superior in relevant urinary and functional outcomes, reinforcing its indication as the first-line conservative treatment for postmenopausal women with SUI.