The effectiveness of dynamic neuromuscular stabilization on incontinence severity, pelvic floor strength and quality of life in women with urinary incontinence

Introduction: Pelvic floor muscle training (PFMT) is one of the primary treatment approaches in the management of urinary incontinence. In recent years, Dynamic Neuromuscular Stabilization (DNS), which targets intra-abdominal pressure regulation and postural stability, has emerged as a comprehensive exercise approach of interest. Purpose: This study aims to compare the effects of DNS training with PFMT on the severity of stress urinary incontinence (SUI), pelvic floor muscle strength, and quality of life in women diagnosed with SUI. Methods: The study included 52 women aged 18-65 diagnosed with SUI, divided equally into two groups (Group 1: DNS, Group 2:PFMT). Exercises were conducted under the supervision of a physiotherapist 2 times/week, with additional home programs 3 times/week over a period of 12 weeks. Assessments were based on incontinence severity (Incontinence Severity Index - ISI, 24-hour Pad Test, Urinary Diary), pelvic floor muscle strength (digital palpation), quality of life (King's Health Questionnaire), and treatment satisfaction (Global Rating of Change Scale). Data were analyzed using SPSS 24.0-software (p<0.05). Results: Significant improvements in ISI scores were observed in both groups post-treatment (p<0.05), with a significant advantage noted for the DNS group (p=0.046; ES=0.575). Improvements in Pad Test, Urinary Diary, and pelvic floor muscle strength (p<0.05), were similar between both groups (p>0.05). Overall improvements in quality of life were observed with both interventions (p<0.05), with the DNS group showing superiority in emotional well-being (p<0.001; ES=1.133) and sleep disturbance sub-dimension (p=0.002; ES=0.964). Treatment satisfaction was reported higher in the DNS group (p<0.001). Conclusion: DNS and PFMT methods have been found effective in the treatment of SUI. DNS, particularly, demonstrated superior outcomes in terms of incontinence severity, emotional well-being, sleep quality, and treatment satisfaction. These findings support the integration of DNS as a complementary or alternative approach in programs targeting pelvic floor health.