BACKGROUND: Pelvic floor yoga has been recommended as a complementary treatment strategy for urinary incontinence (UI) in women, but evidence of its efficacy is lacking. OBJECTIVE: To evaluate the effects of a therapeutic pelvic floor yoga program versus a nonspecific physical conditioning program on UI in women. DESIGN: Randomized trial. (ClinicalTrials.gov: NCT03672461). SETTING: Three study sites in California, United States. PARTICIPANTS: Ambulatory women aged 45 years or older reporting daily urgency-, stress-, or mixed-type UI. INTERVENTION: Twelve-week program of twice-weekly group instruction and once-weekly self-directed practice of pelvic floor-specific Hatha yoga techniques (pelvic yoga) versus equivalent-time instruction and practice of general skeletal muscle stretching and strengthening exercises (physical conditioning). MEASUREMENTS: Total and type-specific UI frequency assessed by 3-day voiding diaries. RESULTS: Among the 240 randomly assigned women (age range, 45 to 90 years), mean baseline UI frequency was 3.4 episodes per day (SD 2.2), including 1.9 urgency-type episodes per day (SD 1.9) and 1.4 stress-type episodes per day (SD 1.7). Over a 12-week time period, total UI frequency (primary outcome) decreased by an average of 2.3 episodes per day with pelvic yoga and 1.9 episodes per day with physical conditioning (between-group difference of -0.3 episodes per day (95% CI -0.7 to 0.0)). Urgency-type UI frequency decreased by 1.2 episodes per day in the pelvic yoga group and 1.0 episode per day in the physical conditioning group (between-group difference of -0.3 episodes per day (CI -0.5 to 0.0)). Reductions in stress-type UI frequency did not differ between groups (-0.1 episodes per day (CI -0.3 to 0.3)). LIMITATION: No comparison to no treatment or other clinical UI treatments; conversion to videoconference-based intervention instruction during the COVID-19 pandemic. CONCLUSION: A 12-week pelvic yoga program was not superior to a general muscle stretching and strengthening program in reducing clinically important UI in midlife and older women with daily UI. PRIMARY FUNDING SOURCE: National Institutes of Health.

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