PROJECT ABSTRACT/SUMMARY
Urinary incontinence (UI) is a highly prevalent (up to 50% of community-living older women) condition
associated with profound morbidity and psychosocial consequences. Treatment options of UI are limited for
older women due to adverse effects related to medications or surgery, thus conservative management,
including pelvic floor muscle (PFM) exercises, are often the only available option. Despite the unique
physiologic changes associated with aging, traditional PFM exercises use the same protocol for women across
all ages, failing to address aging-related physical and functional decline. There is growing evidence that the
surrounding anatomic structures of the pelvic floor play an important role in maintaining PFM function and
strength through dynamic muscle coactivation. The obturator internus (involved in hip external rotation) shares
facial attachment with PFMs. Previous studies have demonstrated that strengthening the hip external rotator
muscles improved intravaginal squeeze pressures (a validated measurement for voluntary PFM contraction
involved in PFM training) in both young and postmenopausal women. However, the impact on UI symptoms
was not examined in these studies. Thus, the effect of hip muscle exercises on older women with UI remains
unknown. The current preliminary data further demonstrated that older women with UI had significantly lower
baseline hip strength compared to those without UI, and hip external rotation had the highest correlation with
pelvic floor strength. Thus, the overarching goal of this project is to assess the impact of hip external rotation
exercises on pelvic floor strength and function (contributing to the continence mechanism), specifically
targeting older women with UI. The proposed study will include 30 older women (ages 65 or older) with UI,
aiming to 1) investigate changes in PFM strength from pre- to post-standardized 12-week hip muscle
exercises, progressively increasing resistance over time (an evidence-based exercise strategy for aging
associated muscle weakness), 2) examine the impact of hip muscle exercises on UI symptoms, and 3) assess
barriers in hip muscle exercises, specifically cognitive function, physical function, and self-efficacy. Results
from this study will provide insight into the dynamic interaction of anatomic support structures on pelvic floor
strength and function and will be utilized to design a future randomized controlled trial comparing the traditional
PFM training versus a novel exercise regimen including hip muscle exercises in older women with UI. The
long-term goal is to develop an innovative intervention incorporating the potential synergistic effect of
intermuscular interactions between hip and pelvic floor muscles as a non-surgical treatment of UI in older
women.
