Female participation in running competitions has increased over the years at both amateur and professional levels. There is a high prevalence of urinary incontinence (UI) among female runners, but no studies have proposed a specific treatment for this condition in this population.

This study aimed to compare two different pelvic floor muscle training (PFMT) regimens with an abdominal hypopressive technique (AHT) exercise program in female runners with UI.

Women who had been running at least 15 km per week for at least six months without interruptions exceeding three weeks and who reported urine leakage during running were included. Participants were required to have a pelvic floor muscle (PFM) strength of = 2 on the Oxford Scale. Exclusion criteria included neuromuscular diseases affecting the PFM, pregnancy, prior pelvic floor physiotherapy, and intolerance to vaginal palpation. Participants were randomized into three groups: isolated PFMT (iPFMT), involving maximal voluntary PFM contractions as the sole task; coordinated PFMT (cPFMT), incorporating maximal PFM contractions coordinated with abdominal activation; and AHT. The primary outcome was the impact of UI on quality of life, assessed using the International Consultation on Incontinence Questionnaire UI– Short Form (ICIQ-UI-SF). The secondary outcomes included PFM strength, evaluated via vaginal palpation and measured by Oxofrd and manometry (using Peritron). An experienced examiner, blinded to group allocation, conducted the assessments. The intervention lasted 12 weeks, twice a week, with progressive levels introduced monthly for the three groups. Reassessment was performed after 24 exercise sessions. Data normality was tested using the Shapiro-Wilk test, and a two-way ANOVA was used for group comparisons.

A total of 102 female runners participated (mean age: 34.2 years, SD: 8.7). Each intervention group had 34 participants who completed their respective programs. At 12 weeks, the mean change in ICIQ-UI-SF scores was -6.5 (95% CI: -7.24 to -5.75) for iPFMT, -6.7 (95% CI: -7.22 to -6.17) for cPFMT, and -1.7 (95% CI: -2.08 to -1.31) for AHT. There was no significant difference between iPFMT and cPFMT, but both were superior to AHT, with the two PFMT regimens achieving the minimum clinically important difference of 4 points. Regarding PFM strength assessed by vaginal palpation (Oxford Scale), the mean change at 12 weeks was 1.1 (95% CI: 0.8 to 1.3) for iPFMT, 1.2 (95% CI: 1.02 to 1.3) for cPFMT, and 0.4 (95% CI: 0.22 to 0.57) for AHT. For mean PFM pressure measured by manometry, the mean change was 22.5 cmH2O (95% CI: 15.84 to 32.71) for iPFMT, 24.4 cmH2O (95% CI: 18.65 to 35.71) for cPFMT, and 10.3 cmH2O (95% CI: 7.17 to 13.34) for AHT. For all PFM evaluations, there was no significant difference between iPFMT and cPFMT, but both were superior to AHT.

There was no difference in effect between coordinated and isolated PFMT, but both PFMT training regimens were superior to AHT.

As demonstrated in the general population of women with UI, PFMT is also an effective treatment for UI in female runners. AHT should not be recommended for this purpose.