Background: Women living with UI have been shown to have a significantly lower quality of life compared with those who are continent (TOG 2009). In Malaysia, the estimated prevalence of UI in the elderly population was found to be about 10% with this figure increasing up to 50% amongst residents living in nursing homes (Poi 1995, Sidik 2010). PFE remains the main primary intervention for the management of stress and mixed UI (NICE guideline, November 2015).

Objectives: To determine whether Hyacinth exercises (Alternative Slow and Moderate Exercises) was more effective than conventional PFE alone for the treatment of female with UI.

Methods: This was a prospective, randomized, single-blind study performed at University Malaya Medical Centre from July 2015 to May 2017 with ethics approval. Women aged 55 years and above with complaints of UI were recruited once they were counselled with written consents obtained. Women were randomized to either PFE alone or Hyacinth exercises which were taught by a trained physiotherapist. All patients were asked to complete an exercise diary. Primary outcome was evaluated via a validated questionnaire (Australian pelvic floor questionnaire) which was completed at recruitment, 2 and 6 months after enrollment. Secondary outcome was assessed by measuring pelvic floor strength with the use of Femiscan, a intravaginal biofeedback device.

Results: Seventy five women were recruited into this study which included ten drop outs. Both groups showed significant improvement in both questionnaire scores and Femiscan measurements from baseline to follow up visits.

Mean score of improvement is higher in the Hyacinth group when compared to the PFE group at second (2.97 vs 1.65) and third visit (6.00 vs 5.26). However, this was not statistically different with p values of 0.27 and 0.56 respectively.

Mean improvement of pelvic floor strength by Femiscan measurement was higher in the Hyacinth group when compared to the PFE group at second visit (39.27 vs 36.76), as well as at third visit (117.52 vs 81.47). Again, however, this was not statistically different with p values of 0.61 and 0.50 respectively.

When comparing stress incontinence alone, there was significant score improvement in Hyacinth group when compared to PFE group (P= 0.06 vs 0.13) at second visit.

Conclusions: Although there is no statistical difference between the two groups for our primary and secondary outcome, this study shows that Hyacinth group demonstrates earlier improvement in urinary stress incontinence at two months when compared to PFE group.