Dynamic Neuromuscular Stabilization vs Pelvic Floor Muscle Training in Women With Stress Urinary Incontinence (DYNA-SUI)

Izmir Katip Celebi University

Status: Not yet enrolling

Conditions: Stress Urinary Incontinence (SUI); Quality of Life; Muscle Morphology; Dynamic Neuromuscular Stabilization; Urinary Symptoms; Pelvic Floor Muscle Training

Treatments: Other: Pelvic Floor Muscle Training; Other: Dynamic Neuromuscular Stabilization Training

Study type: Interventional

Funder types: Other

Identifiers

NCT07075900

DYNAPELVIS-SUI2025

Details and patient eligibility

About

This randomized controlled trial aims to compare the pre- and post-treatment effects of Dynamic Neuromuscular Stabilization (DNS) training and Pelvic Floor Muscle Training (PFMT) on pelvic floor muscle function, pelvic floor morphometry, urinary symptoms, quality of life, sexual function, and physical activity levels in women with stress urinary incontinence (SUI).

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.

Full description

Stress urinary incontinence (SUI) is defined by the International Continence Society as involuntary urine leakage due to insufficient urethral closure pressure during episodes of increased intra-abdominal pressure (IAP), such as coughing, sneezing, laughing, or physical activity. The continence mechanism involves intrinsic urethral closure, structural support of the urethra, and lumbopelvic stability. These components are interconnected through the endopelvic fascia and neural pathways.

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?

Enrollment: 51 estimated patients

Sex: Female

Ages: 18 to 65 years old

Volunteers: No Healthy Volunteers

Inclusion criteria

• Female participants aged between 18 and 65 years
• 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

• Pregnancy
• 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

Trial design

Primary purpose: Treatment

Allocation: Randomized

Interventional model: Parallel Assignment

Masking: Single Blind

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51 participants in 3 patient groups

DNS group

Experimental group

Description:

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.

Treatment:

Other: Dynamic Neuromuscular Stabilization Training

PFMT group

Active Comparator group

Description:

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.

Treatment:

Other: Pelvic Floor Muscle Training

Control

No Intervention group

Description:

Receiving patient education only and no exercise was applied to the subjects included in the control group.