Pelvic Floor Muscle Exercise and Progressive Muscle Relaxation for Stress Urinary Incontinence

Stress urinary incontinence (SUI) is the most common type of urinary incontinence amongwomen and is characterized by the involuntary leakage of urine during activities thatincrease intra‐abdominal pressure, such as coughing, sneezing, laughing, exercising, orlifting heavy objects. Beyond urinary symptoms, SUI has substantial physical,psychological, social, and economic consequences that adversely affect women's dailyfunctioning and overall well‐being. Although pelvic floor muscle exercise (PFME) isrecommended as the first‐line conservative treatment for women with SUI, treatmentoutcomes may be influenced by factors such as exercise adherence, psychological stress,anxiety, and impaired neuromuscular coordination.Progressive muscle relaxation (PMR) is a structured behavioral intervention that aims toreduce muscle tension and psychological stress through the sequential contraction andrelaxation of major muscle groups. Previous studies have demonstrated beneficial effectsof PMR on anxiety, stress‐related symptoms, and muscle relaxation. Because psychologicalfactors may contribute to pelvic floor dysfunction and symptom perception, combining PFMEwith PMR may enhance the effectiveness of conservative rehabilitation by addressing bothphysical and psychophysiological mechanisms. However, evidence regarding the combinedeffects of these interventions on patient comfort remains limited.This study was designed as a prospective, four‐arm, parallel‐group randomized controlledtrial conducted at the Urology Outpatient Clinic of Karaman Training and ResearchHospital, Karaman, Türkiye. Eligible women diagnosed with stress urinary incontinencewere randomly allocated to one of four study groups: (1) pelvic floor muscle exercise(PFME), (2) progressive muscle relaxation (PMR), (3) combined PFME and PMR, or (4)routine outpatient care (control). Participants in the intervention groups followedstandardized home‐based exercise programs for six weeks after receiving individualizededucation from a Physical Medicine and Rehabilitation specialist. Adherence to theintervention was supported through weekly telephone follow‐up and reminder messages.The primary objective of the trial was to compare changes in comfort among the four studygroups over the six‐week intervention period. Comfort was selected as the primarypatient‐centered outcome because it reflects physical, psychospiritual, sociocultural,and environmental well‐being as described in Kolcaba's Comfort Theory. The findings ofthis study are expected to contribute to the evidence supporting conservative managementstrategies for stress urinary incontinence and to determine whether integratingprogressive muscle relaxation into pelvic floor rehabilitation provides additionalclinical benefit beyond conventional pelvic floor muscle training alone.