Can Yoga-Based Therapy Improve Urinary Incontinence in Women? A Systematic Review and Meta-Analysis
DOI:
https://doi.org/10.11594/bjurology.2025.006.02.5Keywords:
efficacy, urinary incontinence, woman, yogaAbstract
Introduction. Urinary incontinence (UI) is the involuntary leakage of urine, significantly impacting quality of life, including contributing to depression, sexual dysfunction, and substantial medical, psychosocial, and economic
burdens. Aims to evaluate the effectiveness of yoga-based therapy as a treatment intervention for urinary incontinence in women.
Methods. This systematic review followed the PRISMA 2020 guidelines using the PICO framework (population: women with UI; intervention: yoga therapy; control: standard care; outcomes: UI frequency, symptom severity [ICIQ-UI-SF], quality of life [IIQ/UDI-6], and adverse effects). A comprehensive search was conducted in PubMed, ProQuest, Scopus, Cochrane Library, Web of Science, and Google Scholar up to April 1, 2025, using keywords related to yoga and UI. Risk of bias was assessed using Cochrane RoB2, and statistical analysis was performed using R 4.4.3.
Results. Out of 1,926 screened articles, 5 RCTs met the inclusion criteria. Results indicated a significant reduction in symptom severity (ICIQ-SF; MD: -5.6748; 95% CI: -14.3359 to 2.9862; p=0.1991) and improved quality of life (IIQ: MD -1.4795; 95% CI: -18.3035 to 15.3446; UDI-6: MD 3.3937; 95% CI: 0.2439 to 6.5435), despite high heterogeneity (I²=50.6–97.8%). UI frequency did not show significant improvement (MD 0.7413; 95% CI: 0.0948 to 1.3877; p=0.0246). No serious adverse effects were reported.
Conclusion. Yoga is effective in reducing symptom severity and improving quality of life in women with UI but does not significantly decrease UI frequency. These findings support the consideration of yoga as an adjunct therapy in UI management.
Keywords: efficacy, urinary incontinence, woman, yoga
References
Bethel K. Yoga for treating urinary incontinence in women: commentary on a Cochrane review. Explore (NY). 2019 Jul;15(4):320–2. doi: 10.1002/14651858.CD012668.pub2.
Russo E, Caretto M, Giannini A, Bitzer J, Cano A, Ceausu I, et al. Management of urinary incontinence in postmenopausal women: an EMAS clinical guide. Maturitas. 2021 Jan;143:223–30. doi: 10.1016/j.maturitas.2020.09.005.
Sussman RD, Syan R, Brucker BM. Guideline of guidelines: urinary incontinence in women. BJU Int. 2020 May;125(5):638–55. doi: 10.1111/bju.14927.
Denisenko AA, Clark CB, D’Amico M, Murphy AM. Evaluation and management of female urinary incontinence. Can J Urol. 2021;28(Suppl 2):27–32.
Kannan P, Hsu WH, Suen WT, Chan LM, Assor A, Ho CM. Yoga and Pilates compared to pelvic floor muscle training for urinary incontinence in elderly women: a randomised controlled pilot trial. Complement Ther Clin Pract. 2022 Feb;46:101502. doi: 10.1016/j.ctcp.2021.101502.
Todhunter-Brown A, Hazelton C, Campbell P, Elders A, Hagen S, McClurg D. Conservative interventions for treating urinary incontinence in women: an overview of Cochrane systematic reviews. Cochrane Database Syst Rev. 2022 Sep;2022(9). doi: 10.1002/14651858.CD012337.pub2.
Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ. 2021 Mar 29;n71. doi: 10.1136/bmj.n71.
Page MJ, Moher D, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. PRISMA 2020 explanation and elaboration: updated guidance and exemplars for reporting systematic reviews. BMJ. 2021 Mar 29;n160. doi: 10.1136/bmj.n160.
Harding CK, Lapitan MC, Arlandis S, Bø K, Costantini E, Groen J, et al. EAU guidelines on management of non-neurogenic female lower urinary tract symptoms (LUTS). Arnhem: EAU Guidelines Office; 2023.
Minozzi S, Cinquini M, Gianola S, Gonzalez-Lorenzo M, Banzi R. The revised Cochrane risk of bias tool for randomized trials (RoB 2) showed low interrater reliability and challenges in its application. J Clin Epidemiol. 2020 Oct;126:37–44. doi: 10.1016/j.jclinepi.2020.06.015.
Higgins JPT, Altman DG, Gotzsche PC, Juni P, Moher D, Oxman AD, et al. The Cochrane Collaboration’s tool for assessing risk of bias in randomised trials. BMJ. 2011 Oct 18;343:d5928. doi: 10.1136/bmj.d5928.
Luo D, Wan X, Liu J, Tong T. Optimally estimating the sample mean from the sample size, median, mid-range, and/or mid-quartile range. Stat Methods Med Res. 2018 Jun;27(6):1785–805. doi: 10.1177/0962280216669183.
Wan X, Wang W, Liu J, Tong T. Estimating the sample mean and standard deviation from the sample size, median, range and/or interquartile range. BMC Med Res Methodol. 2014 Dec;14(1):135. doi: 10.1186/1471-2288-14-135.
Abbas A, Hefnawy MT, Negida A. Meta-analysis accelerator: a comprehensive tool for statistical data conversion in systematic reviews with meta-analysis. BMC Med Res Methodol. 2024 Oct 18;24(1):243. doi: 10.1186/s12874-024-02356-6.
RStudio Team. RStudio: integrated development for R. Boston, MA: RStudio, PBC; 2020. Available from: http://www.rstudio.com/
Kepes S, Wang W, Cortina JM. Heterogeneity in meta-analytic effect sizes: an assessment of the current state of the literature. Organ Res Methods. 2024 Jul;27(3):369–413. doi: 10.1177/10944281231169942.
Oliveros H. Heterogeneity in meta-analyses: our greatest ally? Colomb J Anesthesiol. 2015 Jul;43(3):176–8.
Borenstein M. How to understand and report heterogeneity in a meta-analysis: the difference between I-squared and prediction intervals. Integr Med Res. 2023 Dec;12(4):101014. doi: 10.1016/j.imr.2023.101014.
Haddaway NR, Page MJ, Pritchard CC, McGuinness LA. PRISMA2020: an R package and Shiny app for producing PRISMA 2020-compliant flow diagrams, with interactivity for optimised digital transparency and open synthesis. Campbell Syst Rev. 2022 Jun;18(2):e1230. doi: 10.1002/cl2.1230.
Shafaq S, Khan AA, Kazi M. Effects of Iyengar Yoga on Pelvic Floor Muscle Strength and Endurance among Young Females with Stress Urinary Incontinence. PAFMJ. 2022 Nov 10;72(5):1518–21. doi: 10.51253/pafmj.v72i5.7691.
Huang AJ, Jenny HE, Chesney MA, Schembri M, Subak LL. A Group-Based Yoga Therapy Intervention for Urinary Incontinence in Women: A Pilot Randomized Trial. Female Pelvic Med Reconstr Surg. 2014 May;20(3):147–54. doi: 10.1097/SPV.0000000000000072.
Huang AJ, Chesney M, Lisha N, Vittinghoff E, Schembri M, Pawlowsky S, et al. A group-based yoga program for urinary incontinence in ambulatory women: feasibility, tolerability, and change in incontinence frequency over 3 months in a single-center randomized trial. Am J Obstet Gynecol. 2019 Jan;220(1):87.e1-87.e13. doi: 10.1016/j.ajog.2018.10.031.
Huang AJ, Chesney M, Schembri M, Raghunathan H, Vittinghoff E, Mendes WB, et al. Efficacy of a Therapeutic Pelvic Yoga Program Versus a Physical Conditioning Program on Urinary Incontinence in Women: A Randomized Trial. Ann Intern Med. 2024 Oct;177(10):1339–49. doi: 10.7326/M23-3051.
Batmani S, Jalali R, Mohammadi M, Bokaee S. Prevalence and factors related to urinary incontinence in older adult women worldwide: a comprehensive systematic review and meta-analysis of observational studies. BMC Geriatr. 2021 Dec;21(1):212. doi: 10.1186/s12877-021-02135-8.
Tenfelde S, Janusek LW. Yoga: A Biobehavioral Approach to Reduce Symptom Distress in Women with Urge Urinary Incontinence. J Altern Complement Med. 2014 Oct;20(10):737–42. doi: 10.1089/acm.2013.0308.
Tenfelde S, Tell D, Garfield L, Mathews H, Janusek L. Yoga for Women With Urgency Urinary Incontinence: A Pilot Study. Female Pelvic Med Reconstr Surg. 2021 Jan;27(1):57–62. doi: 10.1097/SPV.0000000000000723.
Nicosia FM, Lisha NE, Chesney MA, Subak LL, Plaut TM, Huang A. Strategies for evaluating self-efficacy and observed success in the practice of yoga postures for therapeutic indications: methods from a yoga intervention for urinary incontinence among middle-aged and older women. BMC Complement Med Ther. 2020 Dec 14;20(1):148. doi: 10.1186/s12906-020-02934-3.
Tunuguntla HSGR, Tunuguntla R, Kathuria H, Sidana A, Chaudhari N, Verma S, et al. App-Based Yoga of Immortals: A Novel, Easy-to-use Intervention in the Management of Urinary Incontinence. Urology. 2022 Sep;167:73–81. doi: 0.1016/j.urology.2022.06.011.
Kim GS, Kim EG, Shin KY, Choo HJ, Kim MJ. Combined pelvic muscle exercise and yoga program for urinary incontinence in middle‐aged women. Japan J Nurs Sci. 2015 Oct 23;12(4):330–9. doi: 10.1111/jjns.12072.
Sweta K, Godbole A, Awasthi HH, Pandey U. Mulabandha yoga therapy and its utility in cases of urinary incontinence in females: A randomized clinical trial. Yoga Mimamsa. 2020;52(1):12–9. doi: 10.4103/ym.ym_3_20.
Vinchurkar SA, Arankalle DV. Integrating Yoga Therapy in the Management of Urinary Incontinence. J Evid Based Complementary Altern Med. 2015 Apr 24;20(2):154–6. doi: 10.1177/2156587214563311.
Baker J, Costa D, Guarino JM, Nygaard I. Comparison of Mindfulness-Based Stress Reduction Versus Yoga on Urinary Urge Incontinence. Female Pelvic Med Reconstr Surg. 2014 May;20(3):141–6. doi: 10.1097/SPV.0000000000000061.
Published
How to Cite
Issue
Section
Copyright (c) 2025 Brawijaya Journal of Urology
This work is licensed under a Creative Commons Attribution 4.0 International License.
