Comparative Effectiveness of Pelvic Floor Muscle Training and Pharmacological Therapy in Women With Urinary Incontinence: An Observational Study.

Background Urinary incontinence is a common and underreported condition in women that significantly impairs quality of life. Pelvic floor muscle training (PFMT) and pharmacological therapy are both widely used treatment options, but comparative real-world evidence on their effectiveness and tolerability remains limited, particularly in routine clinical practice settings. Methods This prospective comparative observational study included women aged ≥18 years with clinically diagnosed stress, urge, or mixed urinary incontinence attending outpatient clinics in Saudi Arabia. Participants were allocated to either PFMT or pharmacological therapy based on routine clinical decision-making. Baseline demographic and clinical characteristics were recorded, including urinary incontinence severity assessed using the International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form (ICIQ-UI SF). Outcomes were assessed after a treatment period of approximately 10-12 weeks. The primary outcome was the change in ICIQ-UI SF score. Secondary outcomes included reduction in weekly incontinence episodes, pad usage, patient-reported global improvement, achievement of ≥50% symptom reduction, complete continence, and adverse events. Results A total of 102 women were included (PFMT: n=52; pharmacotherapy: n=50). Baseline characteristics were comparable between groups. Both groups demonstrated improvement in urinary incontinence symptoms. The reduction in ICIQ-UI SF score was greater in the PFMT group compared with the pharmacotherapy group (-7.2 ± 3.1 vs -6.1 ± 3.4; p=0.048). Reduction in weekly incontinence episodes showed a non-significant trend favoring PFMT (-5.8 ± 3.0 vs -4.6 ± 3.3; p=0.06). Clinical improvement of ≥50% was observed in 38/52 (73.1%) in the PFMT group and 32/50 (64.0%) in the pharmacotherapy group. Complete continence was achieved in 11/52 (21.2%) and 8/50 (16.0%), respectively. Adverse events were significantly more frequent in the pharmacotherapy group (14/50 (28.0%) vs 3/52 (5.8%); p<0.01). Conclusions Both PFMT and pharmacological therapy were effective in improving urinary incontinence symptoms in women. PFMT demonstrated slightly greater improvement in symptom severity and a significantly lower rate of adverse effects. These findings support PFMT as a preferred first-line treatment option in routine clinical practice, while pharmacological therapy remains an important alternative for selected patients.