“Start with the breath…” That’s what the yoga instructor said today at the class I attended. “What separates us (in yoga) from the rest of fitness is the breath, the emphasis and attention to the breath,” she continued. Just prior to class, I had been working on this piece and rereading two studies published this month investigating the role of yoga in treating urinary incontinence, so the role of the breath was at the top of my mind.
The first study compared a program of Mindfulness-Based Stress Reduction (MBSR) to a yoga program for women with urinary urge incontinence (UUI). Although a small study, 6- and 12-month follow-up was reported, and a significant improvement was reported and maintained for the MBSR group, but not the yoga group.
In the second study, a group-based yoga program was implemented for women with various types of urinary incontinence and showed a 70 percent reduction in incontinent episodes for participants with stress urinary incontinence (SUI), yet no significant difference for those with UUI or those in the control group (no intervention). All interventions were six to eight weeks in duration and had the expectation of unsupervised practice of yoga and/or mindfulness practices.
These are small and only preliminary studies, yet they are incredibly valuable contributions to our understanding of why people have reported improvement or exacerbation of urinary and pelvic floor symptoms with yoga and how to formulate current recommendations.
- MBSR appears to be a helpful intervention for those with UUI (we’re exploring this in our own clinical practice at Marathon PT), but we cannot conclude that yoga is ineffective for this population. The yoga group was specifically not instructed in breath training (recall the opening quote…), and yet breathing is conclusively linked to the normal range of motion of the pelvic floor and regulation of overall nervous system activity. In other words, breath training is a key component in the treatment of many pelvic floor disorders, including UUI.
- Perhaps different yoga would exert a comparable effect, or even amplified treatment effect, if combined with MBSR. This is certainly what we are seeing clinically. We are typically recommending yoga that emphasizes breath and improved release and range of motion of the pelvic floor before any emphasis on strengthening the pelvic floor.
- This compared a program of eight selected yoga poses to no intervention at all. The yoga postures and techniques were selected “for their potential to improve incontinence and their appropriateness for the target population.” Participants were specifically instructed in how to improve pelvic floor awareness and control with each posture, and mindfulness techniques were also incorporated, though to a lesser degree than in Study 1.
- Such a targeted intervention led to dramatic improvements in SUI, but not UUI.
In other words, while the outcome – urinary leakage – may be the same for UUI vs. SUI, the mechanism is different. As such, we can expect the most beneficial yoga and mindfulness interventions for each type of incontinence would differ, too.
An excellent resource for clinicians and community members is Dustienne Miller of Your Pace Yoga. She is a women’s health and pelvic floor physical therapist and Kripalu yoga instructor who has created DVDs specific to these different needs. Check out “Relieving Pelvic Pain” for UUI and “Optimizing Bladder Control” for SUI.
Published On: May 30, 2014