Motor Imagery-Assisted Pelvic Floor Muscle Training for Stress Urinary Incontinence in Postmenopausal Women

This study will evaluate whether adding mental rehearsal of pelvic floor muscle contractions to pelvic floor muscle training improves stress urinary incontinence in postmenopausal women. Stress urinary incontinence is urine leakage during activities such as coughing, sneezing, or physical exertion. Mental rehearsal involves imagining the sensation of a movement without physically performing it. The study will include 60 women aged 45 to 65 years who have completed natural menopause and have stress urinary incontinence. Participants will be randomly assigned to one of two groups. Both groups will receive the same supervised pelvic floor muscle training twice a week for 12 weeks. Before performing the pelvic floor exercises, one group will imagine contracting and relaxing the pelvic floor muscles. The other group will imagine making and opening a fist with their dominant hand. Assessments will take place before treatment and at the end of 12 weeks. The main outcome will be urinary incontinence symptom severity. Additional assessments will examine urine leakage frequency and amount, incontinence-related quality of life, and pelvic floor muscle electrical activity.

Inclusion Criteria: * Women aged 45 to 60 years. * Natural postmenopause, defined as the absence of menstruation for at least 12 consecutive months without a pathological, pharmacological, or surgical cause. * Physician-diagnosed stress urinary incontinence. * Sufficient cognitive and communication abilities to understand instructions in Turkish and complete the questionnaires and a three-day bladder/leakage diary. * A score of at least 30 on each of the visual and kinesthetic imagery subscales of the Kinesthetic and Visual Imagery Questionnaire-20 (KVIQ-20), assessed before randomization. Exclusion Criteria: * Urgency, mixed, overflow, or neurogenic urinary incontinence. * Stage III or IV pelvic organ prolapse according to the Pelvic Organ Prolapse Quantification (POP-Q) system. * Inability to correctly and voluntarily contract the pelvic floor muscles. * Active urinary tract or vaginal infection, unexplained hematuria, or postmenopausal vaginal bleeding. * Severe vaginal atrophy, vaginismus, genital lesions, or pelvic pain that prevents intravaginal assessment. * Previous surgery for stress urinary incontinence or previous pelvic radiotherapy. * Pelvic floor rehabilitation for urinary incontinence within the previous 12 months. * Neurological or cognitive disorders, or uncontrolled psychiatric illness, that could affect pelvic floor control, continence, or motor imagery ability. * Serious or uncontrolled systemic or musculoskeletal conditions that prevent safe participation in the exercise program. * Changes in hormone therapy within the previous six months or changes in medications affecting urinary system function within the previous three months.