Dynamic Neuromuscular Stabilization vs Pelvic Floor Muscle Training in Women With Stress Urinary Incontinence
NCT ID: NCT07075900
Last Updated: 2025-07-24
Study Results
The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.
Basic Information
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NOT_YET_RECRUITING
NA
51 participants
INTERVENTIONAL
2025-07-16
2025-12-31
Brief Summary
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Participants diagnosed with SUI by a specialist physician will be randomly assigned to one of three groups: DNS, PFMT, or a control group. Both DNS and PFMT interventions will be delivered as 12-week home exercise programs, performed five days a week and at least three times per day. To support adherence, participants will use an exercise diary. In addition, participants in the DNS and PFMT groups will attend the clinic twice a week for supervised sessions led by a physiotherapist.
The control group will receive a brochure containing lifestyle and bladder health recommendations but will not engage in any structured exercise program.
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Detailed Description
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The core musculature-including the diaphragm, transversus abdominis (TrA), pelvic floor muscles, and lumbar multifidus-functions synergistically within the myofascial system to regulate IAP. This coordination is essential for maintaining the optimal function of genitourinary organs, especially the bladder.
Dynamic Neuromuscular Stabilization (DNS) targets this integrated spinal stabilization system. DNS exercises are based on developmental kinesiology principles, comparing adult stabilization patterns to those of healthy infants. The goal is to retrain the neuromuscular system through repetitive, functional movements to restore automatic IAP regulation and trunk stability.
Although DNS has demonstrated clinical effectiveness in managing musculoskeletal disorders, cerebral palsy, hemiplegia, and athletic injuries, its role in the management of SUI remains underexplored. By promoting synchronous activation of the deep stabilizers-including the diaphragm, TrA, multifidus, and pelvic floor-DNS may offer a more comprehensive therapeutic approach than isolated pelvic floor muscle training.
In this context, the main questions of this study it aims to answer are:
Does Dynamic Neuromuscular Stabilization (DNS) training have an effect on pelvic floor muscle function, pelvic floor morphometry, symptoms, quality of life, sexual function, and physical activity levels in women with stress urinary incontinence (SUI)? Does Pelvic Floor Muscle Training (PFMT) improve pelvic floor muscle function, pelvic floor morphometry, symptoms, quality of life, sexual function, and physical activity levels in women with stress urinary incontinence (SUI)? Is there a difference between DNS exercises and PFMT in terms of their effects on pelvic floor muscle function, pelvic floor morphometry, symptoms, quality of life, sexual function, and physical activity levels before and after treatment in women with SUI?
Conditions
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Study Design
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RANDOMIZED
PARALLEL
TREATMENT
SINGLE
Study Groups
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DNS group
Women aged 18-65 who have stress or stress-dominant mixed urinary incontinence. They are followed up for 12 weeks, consisting of 2 days/week face-to-face training sessions with the physiotherapist and 5 days/week sessions conducted by themselves.
Dynamic Neuromuscular Stabilization Training
According to the principles of Dynamic Neuromuscular Stabilization (DNS), proper activation of the integrated spinal stabilization system requires that the abdominal muscles expand not only in the caudal direction but also posteriorly and laterally.Therefore, firstly, the physiotherapist will assess the expansion of the entire abdominal wall and teach the patient to regulate intra-abdominal pressure through correct breathing techniques. During training and exercises, a belt will be used. Participants will be instructed to maintain abdominal expansion toward the belt during exercises performed in positions supported by proper alignment. A four-phase exercise protocol based on developmental kinesiology principles will be implemented for the DNS group, beginning with supine-position exercises appropriate for the 3-month developmental stage.
They will be instructed to repeat the exercises at least three times per day.Patients will record their home exercise program using an exercise diary.
PFMT group
Women aged 18-65 who have stress or stress-dominant mixed urinary incontinence. They are followed up for 12 weeks, consisting of 2 days/week face-to-face training sessions with the physiotherapist and 5 days/week sessions conducted by themselves.
Pelvic Floor Muscle Training
Participants in the PFMT group will undergo a structured pelvic floor muscle training program supervised by a physiotherapist. The training will include verbal and manual instructions to ensure correct identification and isolated activation of the pelvic floor muscles without compensatory movements from the gluteal, abdominal, or thigh muscles using a NeuroTrac Simplex EMG-Biofeedback device.
The exercise protocol will consist of both slow and fast contractions, focusing on endurance, strength, and coordination.
The exercises will be performed in various positions (e.g., supine, sitting, standing) and will gradually progress in intensity and complexity over time, following the principles of motor learning stages. They will be instructed to repeat the exercises at least three times per day. Patients will record their home exercise program using an exercise diary.
Control
Receiving patient education only and no exercise was applied to the subjects included in the control group.
No interventions assigned to this group
Interventions
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Dynamic Neuromuscular Stabilization Training
According to the principles of Dynamic Neuromuscular Stabilization (DNS), proper activation of the integrated spinal stabilization system requires that the abdominal muscles expand not only in the caudal direction but also posteriorly and laterally.Therefore, firstly, the physiotherapist will assess the expansion of the entire abdominal wall and teach the patient to regulate intra-abdominal pressure through correct breathing techniques. During training and exercises, a belt will be used. Participants will be instructed to maintain abdominal expansion toward the belt during exercises performed in positions supported by proper alignment. A four-phase exercise protocol based on developmental kinesiology principles will be implemented for the DNS group, beginning with supine-position exercises appropriate for the 3-month developmental stage.
They will be instructed to repeat the exercises at least three times per day.Patients will record their home exercise program using an exercise diary.
Pelvic Floor Muscle Training
Participants in the PFMT group will undergo a structured pelvic floor muscle training program supervised by a physiotherapist. The training will include verbal and manual instructions to ensure correct identification and isolated activation of the pelvic floor muscles without compensatory movements from the gluteal, abdominal, or thigh muscles using a NeuroTrac Simplex EMG-Biofeedback device.
The exercise protocol will consist of both slow and fast contractions, focusing on endurance, strength, and coordination.
The exercises will be performed in various positions (e.g., supine, sitting, standing) and will gradually progress in intensity and complexity over time, following the principles of motor learning stages. They will be instructed to repeat the exercises at least three times per day. Patients will record their home exercise program using an exercise diary.
Eligibility Criteria
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Inclusion Criteria
* Diagnosed with stress urinary incontinence or stress-dominant mixed urinary incontinence by a specialist physician
* Having the ability to voluntarily contract the pelvic floor muscles
* Literate in Turkish
* Willing and voluntarily consenting to participate in the study
Exclusion Criteria
* Presence of urgency-predominant urinary incontinence symptoms or fecal incontinence
* Inability to understand or cooperate with assessment procedures
* Presence of any neurological or rheumatological disease
* Severe cardiac or pulmonary disease
* Uncontrolled diabetes mellitus or hypertension
* Chronic liver and/or kidney failure
* Advanced pelvic organ prolapse (greater than grade 2)
* History of abdominal or pelvic surgery (including cesarean section) within the past year
* History of spinal surgery
* Current urinary tract infection
* History of pelvic radiation therapy
* Presence of spinal deformity
* History of acute low back pain within the past 4-6 weeks
* Receiving pelvic floor muscle training within the past three months
18 Years
65 Years
FEMALE
No
Sponsors
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Izmir Katip Celebi University
OTHER
Responsible Party
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Sevtap Günay
Associate Professor
Principal Investigators
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Ayse Kardelen ACAR, MSc
Role: PRINCIPAL_INVESTIGATOR
Izmir Katıp Celebi University, Institute of Health Sciences
Sevtap GUNAY UCURUM, Associate Professor
Role: STUDY_DIRECTOR
Izmir Katıp Celebi University, Faculty of Health Sciences, Department of Physiotherapy and Rehabilitation
Ahmet Ozgur YENIEL, Professor
Role: STUDY_CHAIR
Ege University, Faculty of Medicine, Department of Obstetrics & Gynecology
Locations
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Ege University, Faculty of Medicine, Department of Obstetrics & Gynecology
Izmir, , Turkey (Türkiye)
Countries
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Central Contacts
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Facility Contacts
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Other Identifiers
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DYNAPELVIS-SUI2025
Identifier Type: -
Identifier Source: org_study_id
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