Jul 08, 2025
Protocol for Ultrasound Guided: Pelvic Floor Strengthening for Urinary Incontinence
- Dr. Nupur Akter1,
- Dr. Sharmila Jahan1
- 1Department of Physiotherapy and Rehabilitation, Jashore University of Science and Technology, Bangladesh
- Gynecology and Women's Health
Protocol Citation: Dr. Nupur Akter, Dr. Sharmila Jahan 2025. Protocol for Ultrasound Guided: Pelvic Floor Strengthening for Urinary Incontinence. protocols.io https://dx.doi.org/10.17504/protocols.io.5qpvodn97g4o/v1
License: This is an open access protocol distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited
Protocol status: Working
We use this protocol and it's working
Created: July 08, 2025
Last Modified: July 08, 2025
Protocol Integer ID: 221964
Keywords: reducing incontinence severity, stress urinary incontinence, guided pelvic floor exercise, incontinence severity, urinary incontinence, women with stress urinary incontinence, pelvic floor exercise, receiving conventional kegel exercise, pelvic floor rehabilitation, guided kegel exercise, conventional kegel exercise, urinary incontinence background, kegel exercise, effectiveness of ultrasound, urinary leakage, pelvic floor, protocol for ultrasound guided, undergoing ultrasound, frequency of urinary tract infection, urinary tract infection, uti risk, potential of ultrasound, urinalysis finding, ultrasound guided, uti, ultrasound, floor exercise, department of physiotherapy, physiotherapy, hour pad test
Funders Acknowledgements:
Department of Physiotherapy and Rehabilitation, Jashore University of Science and Technology
Abstract
Background and Purpose: Stress urinary incontinence (SUI) significantly affects women's quality of life. This study aims to evaluate the effectiveness of ultrasound-guided pelvic floor exercise (PFE) compared to conventional Kegel exercises in reducing incontinence severity, post-void residual (PVR) volume, and urinary tract infection (UTI) frequency. Methods: A single-blinded randomized clinical trial will be conducted from June to December 2025 at the Department of Physiotherapy and Rehabilitation, Jashore University of Science and Technology and nearby rural communities involving 220 women with stress urinary incontinence (SUI). Participants will be divided into two groups: one receiving conventional Kegel exercises, and the other undergoing ultrasound-guided Kegel exercises with real-time biofeedback. Both groups will train twice weekly for 8 weeks, with physician-prescribed medication allowed if needed. Primary outcomes include urinary leakage (1-hour pad test) and post-void residual (PVR) volume, while secondary outcomes involve urinalysis findings. Discussion: This study will explore the potential of ultrasound as a biofeedback tool to enhance pelvic floor rehabilitation. Visual feedback may improve patient engagement, neuromuscular control, and accuracy in PFE - key for effective conservative SUI treatment. Improved muscle targeting may also reduce PVR volume and UTI risk. Despite practical challenges such as equipment access and adherence, this intervention could offer a cost-effective, non-invasive option in low-resource settings. Conclusion: The findings of this study suggest that ultrasound-guided pelvic-floor exercises are effective in reducing incontinence severity, lowering post-void residual volume, and decreasing the frequency of urinary tract infections in women with stress urinary incontinence.
Guidelines
IRB No: PTR-JUST/IRB/2025/04/03
Condition: Stress urinary incontinence diagnosed according to International Continence Society (ICS) criteria.
Eligibility criteria:
Inclusion Criteria:
- Women aged 18 to 65 years.
- Parous (Given birth to 1 child).
- Nulliparous (Never given birth).
- Diagnosed as Urinary Tract Infection and Stress Urinary Incontinence.
- BMI of 18–30 kg/m2.
Exclusion Criteria:
- Pregnant or birth in the past six months.
- History of pelvic surgery.
- Chronic respiratory diseases.
- Diabetes.
- Use of medications for Urinary Tract Infection.
- Cardiac pacemaker implanted.
- Psychological disorders.
Study sites with contact person of study site(s):
- Musculoskeletal Lab Room - 301, Department of Physiotherapy and Rehabilitation, Jashore University of Science and Technology, Bangladesh. Contact Person: Arafatuzzaman Babu. Email: [email protected] Phone: 01915900191.
- Nurul Islam Orthopedic Rehabilitation and Physiotherapy Care, Jashore, Bangladesh. Contact Person: Jahid Hasan. Email: [email protected] Phone: 01744129353.
Anticipated date of recruitment: 20.07.2025
Study method: Randomized Clinical Trial
Reporting guideline: CONSORT
Intervention details:
1) Experimental Group: Experimental group will receive Ultrasound guided Kegel exercise in lying position according to the registered protocol of prescribing PFE for SUI. A curvilinear probe will be placed in the lower-abdomen focusing on the urinary bladder and tell the patient to perform the exercise. USG will act as a biofeedback in this case.
2) Control Group: Control group will receive Kegel exercise in lying position according to the registered protocol of prescribing PFE for SUI.
Treatment duration: Treatment will be provided for twice a week, one session for 45 minutes, and in total 8 weeks.
Intervention provider qualification(s): Physiotherapist with Completed Bachelor and Master on Specific Discipline.
Tools: Pad Test (1 hr.), PVR, Urine RME.
Principal investigator/researcher with contact: Dr. Nupur Akter, MPT - Gynecology and Women’s Health (Fellow), Department of Physiotherapy and Rehabilitation, JUST. Email: [email protected] Contact: +8801403460594
Supervisor(s) with contact: Dr. Sharmila Jahan, Assistant Professor, Department of Physiotherapy and Rehabilitation, JUST. Email: [email protected] Contact: +8801717362485
Funding source(s) with contact: This study will be partially funded by Department of Physiotherapy and Rehabilitation, JUST.
Materials
Transversus abdominis Strengthening:
- Abdominal Drawing-In Maneuver Exercise
- Dead Bug Exercise
External Oblique Strengthening:
- Side Plank Exercise
- Bicycle Crunch Exercise
Internal Oblique Strengthening:
- Bridge Pose Exercise
- Reverse Crunch Exercise
Troubleshooting
Exercise protocol description
Transversus abdominis Strengthening
Abdominal Drawing-In Maneuver Exercise
Dead Bug Exercise
External Oblique Strengthening
Side Plank Exercise
Bicycle Crunch Exercise
Internal Oblique Strengthening
Bridge Pose Exercise
Reverse Crunch Exercise