Stress urinary incontinence (SUI) affects many women, particularly those who are postmenopausal. Pelvic floor muscle training (PFMT) is the first-line treatment, but it has low adherence rates. Mat Pilates (MP) has been proposed as an alternative treatment for SUI. Pilates instructors believe the method can strengthen the pelvic floor muscles, making it an appealing alternative for treating SUI. However, current evidence is not robust enough to conclude that MP has a clinically relevant effect on SUI treatment.

To compare the effects of MP combined with maximum voluntary contraction of the pelvic floor muscles (PFM) and compare it to the gold standard PFMT in postmenopausal women with SUI.

This is a randomized controlled clinical trial with two groups: the experimental group (EG): MP combined with maximum voluntary contraction of the PFM, and the control group (CG): PFMT. Inclusion criteria included postmenopausal women aged 45 to 65 years with SUI. Both training programs consisted of 36 sessions, three times a week on alternate days over a 3-month period. Both groups performed the same number of PFM contractions, with training progression occurring every 12 sessions by increasing the load and number of maximum contractions. Assessments were performed using the ICIQ-SF (International Consultation on Incontinence Questionnaire), physical assessment of the PFM with a one-finger palpation measured using the Oxford Scale, and the Peritron equipment. To test the normality of the data, the Shapiro-Wilk test was applied, and repeated measures Two-Way ANOVA with a Tukey post hoc test was used.

Preliminary results showed the following average age: EG 57.87 (± 4.48) years and CG 57.36 (± 4.70) years. The average number of childbirths in the EG was 2.60 (± 0.93) and in the CG 2.31 (± 0.95). The average BMI in the EG was 30.27 (± 4.84) Kg/m² and in the CG 30.47 (± 4.49) Kg/m². The ICIQ-SF in the EG changed from 11.07 (± 5.61) to 7.13 (± 3.58), and in the CG from 11.79 (± 4.42) to 3.86 (± 2.71), inter-group (p = 0.047) and intra-group (p < 0.001). All muscle variables improved: In the EG, strength increased from 3.00 (± 0.85) to 3.73 (± 0.80), and in the CG from 3.00 (± 1.11) to 3.71 (± 0.91), inter-group (p = 0.973) and intra-group (p < 0.001); in the EG, endurance increased from 4.80 (± 1.42) to 6.67 (± 2.16), and in the CG from 3.71 (± 0.91) to 5.14 (± 1.92), inter-group (p = 0.215) and intra-group (p < 0.001); peak pressure in the EG was 34.48 (± 18.48) to 38.98 (± 17.18), and in the CG was 37.57 (± 17.53) to 38.98 (± 21.98), inter-group (p = 0.801) and intra-group (p = 0.408).

Preliminary results suggest that PFMT is more effective in treating SUI in postmenopausal women when compared to Mat Pilates.

PFMT remains the level A evidence treatment and should be the first choice for physical therapists in the management of SUI.