Effects of Paula Exercises and Tibial Nerve Stimulation in Stress Urinary Incontinence

Combine Effects of Paula Exercises and Tibial Nerve Stimulation on Incontinence, Pelvic Floor Muscles Strength, Sexual Function and Quality of Life in Stress Urinary Incontinence

The aim of this study is to compare the combined effects of Paula method & tibial nerve stimulation on incontinence, pelvic floor muscles strength, sexual function and quality of life in stress urinary incontinence

This study will be randomized controlled trial and will be conducted in Arshian Hussnain Medical Clinic and at Marie Stopes Society. Non probability convenience sampling technique will be used and 56 participants will be recruited in study after randomization. Inclusion criteria will be females aged 30-45 years, multiparous women (≥2 full-term vaginal delivery). Exclusion criteria will be Neurological disorders, pregnancy and dermatological conditions .The subjects will be divided into two groups. Group A will receive Paula exercise and Tibial nerve stimulation. Group B will receive only Paula exercises. Both groups will receive baseline treatment which will include pelvic floor muscle contractions. The total duration of treatment will be 8 weeks and there will be 2 sessions each week. Outcomes assessed will be urinary function, pelvic floor muscles strength, sexual function & quality of life. Outcomes will be assessed using validated tools such as the IIQ-7, Modified Oxford Scale, FSFI, and SF-36. After data collection, it will be analyzed by using SPSS version 21.

Inclusion Criteria:

• Multiparous women (≥2 full-term vaginal deliveries)
• Clinical diagnosis of stress urinary incontinence (confirmed by cough stress test)
• Duration of symptoms ≥3 months
• Ability to correctly perform pelvic floor contractions (confirmed by digital examination)

Exclusion Criteria:

• Neurological disorders (e.g., multiple sclerosis, spinal cord injury)
• Mixed or urge urinary incontinence as the predominant type
• Previous pelvic surgery or incontinence-related procedures within the past year
• Current pregnancy or <6 months postpartum
• Pelvic organ prolapse beyond stage II (POP-Q system)
• Current use of other incontinence therapies (e.g., medication, PTNS, PFMT)
• Diagnosed malignancy
• Diagnosed psychiatric disorder
• Pregnancy
• Diagnosed dermatological condition
• Participants who are currently enrolled in other clinical trials to avoid potential confounding factors.