Activation patterns of pelvic floor muscles in women with incontinence while running: a randomized controlled trial


Introduction and hypothesis

Running is known to cause urinary leakage in women with stress urinary incontinence (SUI). Task-specific fiber-type recruitment while running can be estimated using wavelets. The aim of this study was to compare the effect of a new physiotherapy program including involuntary, reflexive training with a standard physiotherapy program on pelvic floor muscle (PFM) activation patterns and fiber-type recruitment behavior while running.


In this triple-blinded randomized controlled trial, women with SUI were randomly allocated to the control group (CON), which performed a standard physiotherapy program, or the experimental group (EXP), which received additional involuntary, reflexive training. PFM electromyography (EMG) was recorded during 10 s at three running speeds and analyzed using Morse wavelets. The relative distribution of power (%) over the frequencies from 20 to 200 Hz was extracted and analyzed within six-time intervals of 30 ms. Statistical nonparametric mapping was performed to identify power spectra differences.


Thirty-nine (CON) and 38 (EXP) women were included. The power spectra showed no statistically significant group differences. The time intervals from 30 ms before to 30 ms after initial contact showed significantly lower intensities than the intervals from 30 to 150 ms after initial contact in the lowest and higher intensities in the highest frequencies for all running speeds and both groups.


Power spectra shifts toward higher frequency bands in the pre-initial contact phase could indicate a feed-forward anticipation and a muscle tuning for the expected impact of initial contact event in order to maintain continence.

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Authors’ contribution to the manuscript

All listed authors have made the required substantive intellectual contributions and meet the criteria for authorship. I. Koenig: project development, conception, and design, data extraction and analyses, manuscript writing, article revision, final approval; P. Eichelberger: data analyses, article revision, final approval; H. Luginbuehl: project development, data collection, article revision, final approval; A. Kuhn: project development, data collection, article revision, and final approval; C. Lehmann: project development, article revision, and final approval; J. Taeymans: manuscript writing, article revision, and final approval; L. Radlinger: project development, conception, and design, data analyses, manuscript writing, article revision, and final approval.


The RCT was funded by the Swiss National Science Foundation, Division III (Medicine & Biology; 320030_153424/1). The granting organization was not involved in the development and conduction of the present study.

The protocol was registered at Clinical (NCT02318251).

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Correspondence to Irene Koenig.

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Ethics committee approval (Ethics Committee of the Canton of Bern, reference number 249/14), in accordance with the Declaration of Helsinki and the Swiss Human Research Act, and written informed consent.

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Koenig, I., Eichelberger, P., Luginbuehl, H. et al. Activation patterns of pelvic floor muscles in women with incontinence while running: a randomized controlled trial. Int Urogynecol J 32, 335–343 (2021).

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  • Electromyography
  • Urinary stress incontinence
  • Wavelet analysis