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Feldenkrais Research Journal • volume 7 (2025) 
 
Original Research 
 
 

Group Exercise for Improvement in Urinary Incontinence using Motor 
Learning and Sensory Awareness based on the Feldenkrais Method® 
of Somatic Education  

 
Deborah Bowes 
Doctor of Physical Therapy (DPT), Feldenkrais Teacher and Trainer 
Feldenkrais Movement and Awareness, San Francisco; Saybrook University 
 
Contact: deborahjbowes@gmail.com 
 

Abstract 
Background: Purpose and Rationale 
The pelvic floor functions as an integrated neuromuscular system. Dysfunction and motor control 
problems in the pelvic floor system cause various kinds of pelvic distress, including urinary incontinence 
(UI) and dyscoordination. Many women have pelvic floor dysfunction and do not know it or have UI and 
do not seek physical therapy. There is a need for effective group treatment programs to reduce and 
prevent incontinence and promote pelvic health. The purpose of this report is to present a group exercise 
model that used a sensory motor learning method drawing from the Feldenkrais Method® of Somatic 
Education, health education and group support. The Feldenkrais Method is a sensory motor learning 
educational process. The program’s goal was to improve sensory motor coordination in order to reduce 
symptoms of UI and pelvic distress. 

Case Description 
This mixed method case report describes a five-week group treatment program for 12 self-referred 
women with UI. There were five weekly two-hour classes, for a total of 10 hours. The program included, 
(1) Feldenkrais Method Awareness Through Movement® lessons, (2) relevant health education 
information about the bony, muscular and organ anatomy of the pelvis, (3) bladder training, including the 
reflex relationship between the bladder and pelvic floor, and healthy voiding habits, (4) the role of the 
parasympathetic and sympathetic nervous systems, and (5) how the pelvic floor works as an integrated 
system. Each class included group support and discussion. Home practice was with provided 
pre-recorded Awareness Through Movement audio lessons on CD.  

Outcomes 
The measures used were the Urogenital Distress Inventory 6 (UDI-6) and Incontinence Impact 
Questionnaire 7- short form (IIQ-7). The results from these scales demonstrated the effectiveness of the 
program for reducing mild to moderate UI and symptoms of pelvic distress, such as pelvic pain, in 
women. As measured by the UDI-6, 66% of the women had reduced distress.  

Conclusion 
This pelvic floor program using Feldenkrais Method Awareness through Movement lessons, health 
education including bladder training and group support is an effective option for reducing mild-moderate 

 
Published by the International Feldenkrais® Federation (IFF) https://feldenkrais-method.org 
Available online at https://feldenkraisresearchjournal.org 
 

 
 

mailto:deborahjbowes@gmail.com
https://feldenkrais-method.org/
https://feldenkraisresearchjournal.org


 

urinary incontinence and improving quality of life. Further research would be valuable to expand on this 
approach. 

Keywords 
Urinary incontinence, pelvic floor, Feldenkrais Method, motor control, sensory awareness, group exercise, 
women’s health 

Copyright ©: The copyright for this paper remains with the author(s). 

Please cite: (First published in the) Feldenkrais Research Journal, volume 7; 2025. 

Service marks: The terms Feldenkrais®, Feldenkrais Method®, Awareness Through Movement®, ATM®, 
Functional Integration®, and FI® are service marked terms of the International Feldenkrais® Federation 
(IFF) and Feldenkrais professional guilds and associations in many countries. In keeping with academic 
conventions, they will not be service marked in the entire text as may be required in nonacademic use, 
but only for the first and most prominent use of the terms. In recognition that these phrases are formal 
terms referring to specific practices within the Method, and to the Method as a whole, capitalization of all 
the words in each term has been retained.  

 
Bowes • Feldenkrais Research Journal, volume 7 (2025) 2 
 



 

Original Research 
 
 

Group Exercise for Improvement in Urinary Incontinence using Motor 
Learning and Sensory Awareness based on the Feldenkrais Method® 
of Somatic Education  

 
Deborah Bowes 
Doctor of Physical Therapy (DPT), Feldenkrais Teacher and Trainer 
Feldenkrais Movement and Awareness, San Francisco; Saybrook University 

 
Impact of Urinary Incontinence 

The quality of a woman’s life is adversely affected by urinary incontinence (Shumaker et al. 
1994). Urinary incontinence (UI) affects a person’s health status, quality of life, including 
productivity, and healthcare expenses (Tang et al. 2014). In addition, Ge et al. (2017) reported 
significant disruption of sleep and an increase in fatigue with UI. Pereira et al. (2019) studied 80 
women who were in physical therapy treatment and had a co-morbidity of UI, found that sexual 
satisfaction, expression and self-image had been negatively impacted, and this was part of a 
reduction in their quality of life.  

The impact on caregivers has also been studied. Talley et al. (2021) described an increase in 
caregiver burden, and an increase in institutionalization for elderly people with UI. These 
impacts have social consequences: they reported ‘physical, financial, and social consequences, 
changes in family roles and support, and a need for training on incontinence management 
strategies’ (2021: 2).  

In 2008, Nygaard et al. reported that 15.7% of non-pregnant women over 20 years of age had 
moderate-severe urinary incontinence. This percentage increases with aging (Nygard et al. 
2008). Depending on how UI is defined, the method of measurement, the age of women, 
whether community dwelling or in an institutional facility, then the percentage can range from 
5% to 66% (Choi et al. 2007). This figure may be even higher as many women do not discuss 
UI with any healthcare provider. UI affects the physical, social, and psychological well-being of 
women whether living in the community or in an institutional facility. There is also a high financial 
cost, somewhere in the range of USD $16 to $26 billion annually, with 37% of the money spent 
on absorbent products and laundry (Choi et al. 2007; Koch 2006). One only needs to look at the 
volume of incontinent products on display for sale at the local pharmacy to see that dealing with 
UI costs money for the consumer and seems hugely profitable for the companies who make the 
products. 

The environmental impact of increased adult diaper disposal is a significant problem and 

 
Bowes • Feldenkrais Research Journal, volume 7 (2025) 3 
 



 

growing. Adult diapers now exceed the amount of baby diapers in the waste stream, as shown 
by a recent Australian study by (Brewster et al. 2022). In one rehabilitation hospital in Japan, 
eight out of 10 residents wear diapers and 400 pounds of diaper waste is produced daily by 200 
residents (Rich and Inoue 2021). 

Rationale for Group Exercise 

Many patients are seeking greater control of their health and are looking for affordable self-care 
options. Health education classes offer a self-care model that appeals to many consumers and 
its affordability makes them an attractive choice. Pelvic floor dysfunction leading to mild to 
moderate UI can be addressed in small group exercise classes using Awareness Through 
Movement® lessons. Literature supports inclusion of pelvic floor exercise in a general exercise 
program for women to improve pelvic floor function (Kim et al. 2011). 

Research reports found that five is the median treatment visits for UI treatment reported in a 
multicentre observational study in Australia (Neumann et al. 2005). For group pelvic floor 
training and treatment, groups of 8 to 10 students were reported in the Netherlands (Janssen et 
al. 2001). 

Pelvic floor muscle training is often called Kegel exercises. Dr Arnold Kegel promoted the idea 
that stress UI resulted from a lack of awareness of function and coordination of pelvic floor 
muscles (Kegel 1948; and also Cho and Kim 2021). Dr Kegel drew on midwives’ traditional 
methods used to restore a mother’s bladder and pelvic floor function after giving birth. These 
traditional methods included instructions for a woman to use her own finger to sense the 
contraction of the pelvic floor musculature. Dr Kegel invented a device, called a perineometer, 
used internally in the vagina, which recorded the force of the contractions of the pelvic floor 
muscles (Kegel 1948). The use of the perineometer is a Kegel exercise, and a type of 
biofeedback device. Currently, any pelvic floor exercise is commonly called a Kegel, but without 
the use of the perineometer biofeedback device, it is a different exercise. A woman may not 
have the awareness or sensory feedback to exercise these muscles properly. This may lead to a 
lack of confidence in whether-or-not they are doing the PFME correctly. It may also result in a 
lack of improvement in symptom reduction. This can lead to women not doing pelvic floor 
muscle exercises (PFME). In addition, many women are not comfortable physically or 
psychologically using an internal device. They may not be able to or want to purchase a device 
or use the device with a therapist. Some women may prefer a self-directed awareness based 
program that can be done independently and non-invasively, or they may not have access to a 
trained pelvic floor therapist.  

A 2013 study by Fan et al. used measures UDI-6 and IIQ-7 and found significant improvement 
in quality of life for women with UI from PFMT (pelvic floor muscle training). Pelvic floor training 
can have a progression of phases. Gödel-Purrer suggests that Phase 1 is “development of the 
ability to become aware of the region” (2006: 253). 

 
Bowes • Feldenkrais Research Journal, volume 7 (2025) 4 
 



 

This case report describes a treatment approach unique in the literature. It is a group exercise 
program, offered as a self-referred public wellness program, with a semi-standardized protocol, 
using the Feldenkrais Method, a sensory-motor learning process (Feldenkrais 1991; Hillier and 
Worley 2015; Stephens and Hillier 2020). A successful program to improve continence will 
develop awareness of the muscular system of the pelvic floor. As the pelvic floor is functionally 
integrated with other deep muscles of the body, one can make use of concrete, observable 
feedback in the form of one’s own whole body movements, including the spine, pelvis, shoulder 
girdle, hips and breathing. It has been proposed that this process of directing one’s attention 
and noticing changes to many aspects of sensory motor learning causes a change in how the 
nervous system manages or organizes the whole self to perform the action. The theory of 
neuroplasticity may explain how changes in efficiency, coordination, musculoskeletal 
configuration, timing and ease can occur relatively quickly. In Awareness Through Movement 
lessons clarification of the image of the movement as connected to one’s sensation is 
emphasized (Doidge 2007; Stephens and Hillier 2020). 

Pelvic Floor exercise has been shown to improve or even cure UI symptoms (Bø and Sherburn 
2005; Liebergall-Wischnitzer et al. 2009). In addition, specific bladder training also is an 
important part of a UI treatment program (Choi et al. 2007, UCSF 2022-2024). Women with UI 
benefit from education that explains the reciprocal relationship between the bladder and the 
pelvic floor. Effective full contractions of the pelvic floor can inhibit bladder contraction and stop 
urination, the urge to urinate, and involuntary urine leakage. Bladder training requires 
awareness of the sensations of urination, the urge to urinate and the skill to use the pelvic floor 
muscles to manage urination. Pelvic floor exercise is recommended by medical doctors and 
physical therapists as the initial intervention for incontinence (Koch 2006).  

A 2018 systematic review of 31 research trials, concluded  

Based on the data available, we can be confident that pelvic floor muscle training can 
cure or improve systems of SUI [stress urinary incontinence] and all other types of UI 
[urinary incontinence]. It may reduce the number of leakage episodes, the quantity of 
leakage…, and symptoms on UI specific questionnaires….The findings of the review 
suggest that PFMT could be included in first-line conservative management programs for 
women with UI. (Dumoulin et al. 2018) 

Bladder retraining is a valuable element to be included in programs for improving UI symptoms. 
A systematic review of 15 trials published in 2023 (Funada et al.) showed mild to moderate 
evidence of its value in UI treatment. Bladder training was included in the health education 
aspect of this study. 

Most often UI treatment is provided on an individual basis and in a medical setting from a 
physical therapist or nurse with special training (Choi et al. 2007). There are limitations to this 
model in the United States, as the cost of individual treatment is expensive and prohibitive for 
many women. Without health insurance coverage, many women would pay out of pocket for 

 
Bowes • Feldenkrais Research Journal, volume 7 (2025) 5 
 



 

individual treatment. In addition, health insurance may not cover physical therapy, a medical 
referral may be needed from the primary care provider to receive services, and there may be 
high co-payments to make. Even in the best situation, the woman must first ask for help with this 
condition. Yet less than 38% of women have ever discussed urinary incontinence with their 
health care provider (Koch 2006). 

The reasons for not seeking treatment for UI include the belief that UI is a normal process of 
aging, or they were embarrassed or ashamed. Some women thought the problem could not be 
solved or that their doctor would treat their problem lightly or they were afraid that the physician 
would suggest surgery. Women who did not find surgery an acceptable solution were less likely 
to seek help (Koch 2006). 

A pelvic floor training program offered as a wellness or pelvic health program can address some 
barriers to treatment. Group classes are cost effective. The educational component can address 
misconceptions about UI. Group discussion can provide support and motivation. Advertisements 
for group classes bring the issue out in the open and could help educate the public about the 
prevalence of the problem and that there are solutions. In one study (Koch 2006), 16% of 
women said they sought help for UI due to a public health campaign. If the class has a wellness 
component, women who feel embarrassment may be encouraged to attend. Each pelvic health 
educator could positively affect the lives of more women. Group treatment with pelvic floor 
exercise and bladder training is as effective as individual treatment (Janssen et al. 2001). 

Research describes effective pelvic floor muscle training programs. However, there are a range 
of parameters for the type of PFME to be performed, the repetitions needed to decrease 
symptoms, and the duration of the exercise program (Koch 2006). There are differences shown 
in effective programs in type of (1) exercise, (2) duration, (3) repetitions, (4) intensity, and (5) 
length of time needed to show improvement. According to Cho and Kim (2021), “Specific 
exercise regimens vary considerably in frequency and intensity, and the ideal exercise regimen 
has not yet been determined” (2021: 383). 

Women with UI have difficulties with pelvic floor motor control and also with coordination of the 
pelvic floor system (Madill et al. 2009; Sapsford 2004). Borello-France et al. 2006 found that the 
prognosis for improvement of stress UI symptoms is very good with at least 65% of women 
improving and 16% having a complete cure. Similar results are seen in individual and group 
exercise pelvic floor training programs that prescribe a set number of exercises and repetitions 
(Choi et al. 2007; Janssen et al. 2001). 

The identified literature at the time of the research study emphasized pelvic floor exercises to be 
done for a particular number of repetitions. This number varied, ranging from one to dozens of 
contractions per day. This study was designed to explore if a sensory-motor learning approach 
that did not emphasize the number of repetitions could be effective. Rather than a preset 
number of repetitions, in this study, repetitions of exercises were determined by an individual’s 
comfort with moving and the ability to move with focused attention. Another important 

 
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characteristic was the use of exploratory movement. Stephens and Hillier (2020), citing Corbetta 
et al. (2018) note that they “confirmed the effectiveness of the exploratory learning process in 
their study of infant skill acquisition” (2018: 230). 

A sensory motor approach to exercise, as found in the theory and practice of the Feldenkrais 
Method, suggests that the ability to sense movement is essential for learning new movement 
patterns, such as pelvic floor contractions and the activation of the pelvic floor system. The 
ability to maintain attention to the sensation of the contractions is an important part of the 
learning. In addition, comfortable movement reinforces engagement with the learning process, 
and enhances motivation and a sense of success. In this context, a proscribed number of 
repetitions is less important, and may be less effective, than a sensory motor approach. 

The literature indicates that there was a wide range of treatment variables possible and this 
program was consistent with other pelvic floor programs in (1) the size of the group, (2) 
symptom history of participants, (3) the number of sessions offered, and (4) the health education 
provided (Choi et al. 2007; Janssen et al. 2001). The author anticipated the program would be 
effective for improving UI, but it was important to discover if the program was effective for (1) 
women with mild or moderate UI, (2) with what type of risk factors, and (3) to identify any 
unanticipated benefits or barriers to participation in the program and (4) the use of a home 
exercise component.  

Students participated in novel movement explorations, called Awareness Through Movement 
lessons. Instead of emphasizing the number of repetitions, the emphasis is for students to 
develop increased kinesthetic ability to sense and feel the pelvic floor working as a coordinated 
system. In this program, Awareness Through Movement lessons were combined with education 
relevant to reducing urinary incontinence.  

Sensory-motor learning may be the foundational process for women with UI and other pelvic 
floor conditions. Women with UI have difficulties with pelvic floor motor control and also with 
coordination of the pelvic floor system (Madill et al. 2009; Sapsford 2004). Borello-France et al. 
2006 found that the prognosis for improvement of stress UI symptoms is very good with at least 
65% of women improving and 16% having a complete cure. Similar results are seen in 
individual and group exercise pelvic floor training programs that prescribe a set number of 
exercises and repetitions (Choi et al. 2006; Janssen et al. 2001). 

Cho and Kim (2021) have noted that “Patients have better outcomes with regular PFME [Pelvic 
Floor Muscle Exercise] and proper technique. The first step in PFME is to instruct the patient 
how to identify the pelvic floor muscles and to contract and relax them” (2021: 381). 

One of the problems for learning to use the pelvic floor is that the sensory and kinesthetic 
component is not easily perceived. There is no clear joint movement to sense and in contrast to 
moving a limb and following external feedback cues, such as changes in pressure on supporting 
surfaces, or the trajectory of the limb through space, a person is required to sense muscular 

 
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work on its own. In cases of trauma and abuse, there may be diminished sensation or other 
psychosocial aspects that can reduce the ability to perceive muscular sensations of the pelvic 
floor area.  

If one cannot feel or see what is happening as a result of muscle contraction, it is difficult to 
know what is actually occurring. Women who are given written or verbal instructions to do 
‘Kegels’ may not be doing what they think they are doing and may be using a technique that 
could promote incontinence, such as pushing the abdomen out and bearing down (Bump et al. 
1991).  

Why Feldenkrais Method was Utilized 

A key concept of the Feldenkrais Method is the proposal “that if a person can attend to 
kinesthetic processes and the bodily organization underlying any movement, they would be 
bringing the biological feedback that regulated optimal movement coordination in the perceptual 
threshold” (Russell 2020: 223) In their discussion of possible mechanisms of action for the 
Feldenkrais Method, Stephens and Hillier (2020) draw on the work of Vereijken and Whiting 
(1990), suggesting “the use of intrinsic feedback has been shown to be especially valuable to 
learning” (1990: 230). 

As the function of pelvic floor muscles is integrated with other muscles as a 
neuro-musculoskeletal functional unit (Sapsford 2004), sensory motor learning using full body 
movement patterns can offer a solution to improving the function of the pelvic floor system. This 
is suggested by the work of Sapsford (2004) describing muscle synergies between the pelvic 
floor muscles, the diaphragm, and the abdominal muscles. The pelvic floor is synergistic with 
the abdominals responding together to manage any changes in intra-abdominal pressure (Madill 
et al. 2009; Sapsford 2004). To address all components of the pelvic floor system in both its 
support and movement functions requires using movements that integrate the use of the legs, 
abdomen, arms and spine. In movement, the nervous system uses synergies and patterns to 
organize function (Berthoz 2000). Other researched functional components of the system 
include the deep muscles of the back and the respiratory diaphragm (Richardson et al. 2004). 

Feldenkrais Method is congruent with principles of motor control postural control retraining 
(Connors et al. 2010). Feldenkrais Method group Awareness Through Movement lessons use 
components of motor learning to improve action. The ability to perform functional tasks requires 
the use of coordinated muscle action; so that stability and motion are in optimal balance, with 
appropriate timing, organization of breathing, imagery, and specific sequencing of muscle 
activation (Lee 2004; Sapsford et al. 2013). Women with SUI have altered motor control 
patterns, specifically in the timing of the pelvic floor muscles with the abdominals (Madill et al. 
2009). Awareness Through Movement lessons emphasize awareness of timing to improve 
function. 

 
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Outcome Measures for Urinary Incontinence 

At the time of this study there were several scales for measuring improvement in UI symptoms 
and to assess quality of life related to those symptoms. The Urogenital Distress Inventory-UDI-6 
Short form and the Incontinence Impact Questionnaire-IIQ-7 were used as both pre and post 
measures. (Shumaker et al. 1994; Ubersax et al. 1995). Subsequent studies have also 
confirmed the value of these measures (Fan et al. 2013). The measures, validated by research, 
are simple to administer and score and have been used in other research studies for the 
treatment of UI. The type of UI for each person is not differentiated by the measures. The 
measures have been validated and are reliable (Uebersax et al. 1995). The World Health 
Organization’s Second International Consultation on Incontinence rated the UDI and the IDI-6 
among the five highly recommended questionnaires to assess symptoms of incontinence, and 
the IIQ and the IIQ-7 among the five highly recommended questionnaires for assessing the 
impact of incontinence on (Shumaker et al. 1994; Uebersax et al. 1995). 

The scale for Urogenital Distress Inventory-UDI-6 Short form and the Incontinence Impact 
Questionnaire-IIQ-7 have scores from 0-100. Skorupska et al. 2021 categorized scores lower 
than 33 on the UDI-6 as having a mild impact and scores higher than 33 as causing greater 
distress (Shumaker et al. 1994; Uebersax et al. 1995). Skorupska et al. (2021) found, “The 
higher impact of UI on health-related quality of life is seen in women who scored 9 or more in 
the IIQ7 questionnaire, and such women felt impaired quality of life” (Abstract). 

The goals of the program were to (a) reduce symptoms of stress, urge and mixed UI; (b) to 
improve motor control in movement that included pelvic floor muscles, (c) to improve the 
coordination of breathing with exercise, (d) to improve sensory awareness of the pelvic floor 
muscles, (e) to include the pelvic floor system in functional movements such as moving from sit 
to stand, and (f) to provide relevant health education for healthy pelvic and bladder function.  

Methods 

Student Selection 

An opportunity sample of twelve women was selected for the group class from a pool of 
approximately thirty women who responded to the researcher’s Practice newsletter announcing 
the program and asking for volunteer participants. Many women received the newsletter directly 
from the author, others heard about the program from a friend or healthcare provider. 

Each respondent was screened by phone to determine her suitability for the group classes and 
if she met the requirements for participation. Requirements included (1) having symptoms of UI, 
stress, urge or mixed, (2) English proficiency, (3) ability to lie supine on a floor exercise mat, (4) 
ability to sit for thirty minutes, (5) access to a CD player in order to use the recorded home 
program Awareness Through Movement lessons on CD, and (6) the ability to attend all five 
classes. Reasons for exclusion from participation were (1) recent history of injury, serious illness 

 
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or surgery, (2) severe pain, or (3) certification as a Feldenkrais Method Teacher. No medical 
prescription was required as the exercise program was considered a self-improvement or 
wellness type of program offered on a self-referral basis. 

A longer history of UI symptoms was gathered from the women who passed through the initial 
screening. A range of risk factors for developing UI were identified in the screening (Seshan et 
al. 2016). 

Women reporting symptoms consistent with stress, urge, and/or mixed urinary incontinence 
were admitted into the study.  

Group Size and Duration 

The two-hour classes met on a Saturday morning for five consecutive weeks at the author’s 
private movement studio. The number of weeks was set at five. This decision was based on the 
need for consecutive weeks of treatment and that the literature reported that five was the 
median number of treatment visits (Neumann et al. 2005). The class size was limited to 12 by 
several factors: recommended group size from the literature (Janssen et al. 2001), as well as 
the space requirements at the author’s private practice, the need for the teacher to visually 
observe the quality of each student’s movement, especially the movement of the abdomen, and 
to allow for group discussion. The author also expected that 1-3 students would drop out, 
however, 100% enrollment and class participation remained throughout the study.  

The Guide for Physical Therapist Practice (APTA 2003), recommends people with findings of 
pelvic floor dysfunction are classified into the pattern 4C Impaired Muscle Performance. The 
recommended intervention plan for pattern 4C includes therapeutic exercise, breathing and 
relaxation, health education, group support, and a home program of exercise and journal 
writing. Reviewing each woman’s history, as well as the results of the participants initial UD-6 
and IIQ-7 measures, suggested that these women likely had pelvic floor muscle dysfunction. 
Women with UI have difficulties with pelvic floor motor control and also with coordination of the 
pelvic floor system (Madill et al. 2009; Sapsford 2004). Consideration of all these factors led to 
the design for the intervention.  

Intervention 

The intervention included weekly sensory-motor learning processes called Awareness Through 
Movement Lessons from the Feldenkrais Method, as well as health education for pelvic floor 
function, bladder training, group support, and journal writing. The health education included 
information on, for example, voiding habits, relevant anatomy and physiology, emotional aspects 
of UI, and included group discussion. In the first meeting, participants were given, (1) journals to 
record observations, insights, questions and home practice activities, (2) an audio CD program 
of six Awareness Through Movement lessons to use for the home exercise program (Bowes 
2006), (3) a handout including health education information about the pelvic floor system and 

 
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healthy voiding habits, and (4) UDI-6 and the IIQ-7 was given and collected. Participants signed 
an informed consent. In weeks two through five, participants received additional written 
materials designed to develop participants’ knowledge of their pelvic floor, what bodily 
sensations are associated with voiding, and voiding hygiene. In each week there was 30 
minutes for sharing of experience, discussion, and questions and answers.  

Bladder training included information on the reflex relationship between the pelvic floor muscles 
and the bladder, how to urinate in a way that reduces strain on the pelvic floor, frequency of 
urination, body position for urinating, fluid intake, using pelvic floor muscles to appropriately 
inhibit urination. Many women have been told to stop the flow of urine during each urination 
event and it was important to communicate that this is misinformation in that it disrupts healthy 
voiding patterns. 

Awareness Through Movement Lessons: Somatic Education 

Awareness Through Movement, the group exercise component of the Feldenkrais Method is 
verbally directed, with no demonstration of the movements. Students are guided by the teacher 
to explore movement sequences, to self-organize to perform the task and to attend to sensory 
cues such as pressure response on the floor or breathing pattern.  

The Awareness Through Movement lesson began with a body scan. In the body scan, the 
teacher directs the student’s attention to contact with the floor, the sense of length of the spine 
and relationships of body parts, the quality of the breathing and various other physical 
sensations related to the intent of the lesson. In lessons for improving the pelvic floor, attention 
is given to (1) the sense of the spine, pelvis, hip joints and legs, (2) breathing in the lower 
abdomen and lower back, (3) the movement of the ribcage with the breath, and (4) the overall 
feeling of relaxation that is possible in the moment. After the scan, the teacher gives a verbal 
direction for a movement. While the student explores this movement, further directions are given 
to focus the student’s attention to various aspects of the movement. A non-judgmental attitude is 
fostered toward a student’s experience of movement and bodily experience. The movements 
gradually link together promoting full body participation in an easy and coordinated manner. 
Movement variables are introduced in a structured way congruent with the intention of the 
learning possibilities in the lesson. Changes felt in pressure against the floor give feedback as to 
the use of ground forces and to how the whole body is moving. Verbal guidance brings attention 
to the change between internal and external focus. Noticing the relationship of the breathing 
cycle to the movement, i.e. whether one is inhaling or exhaling, ensures that the student does 
not hold the breath and can also be used to calibrate the intensity and quality of the movement. 
In Awareness Through Movement lessons, the student is asked to move in an easy and relaxed 
manner while continuing to breathe. Attention is given to the quality of the movement, i.e. is it 
smooth throughout the range, or jerky; is the movement reversible, i.e. can one stop and start at 
any point in the trajectory; and what is the timing of the movements of different body parts with 
breathing. The student is asked to develop a coherent sense of the movement pattern (Berthoz 

 
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2000). This sense is reported by students as a pleasant whole body feeling of a movement 
pattern that is harmonious, integrated, and coordinated (Berthoz 2000; Feldenkrais 1991; Smyth 
2018; Stephens and Hillier 2020). 

Other attentional aspects and movement variables can be included in an Awareness Through 
Movement lesson depending on the teacher’s perceived needs of the student.  

Motor control may be improved by noticing one’s speed, initiation of movement, planes of 
action, orientation, the effort used or the sequence of the movement of parts of the body, and 
timing. The Awareness Through Movement teacher does not demonstrate a movement, but 
continues to give kinesthetically based verbal cues (questions, suggestions, directions) or 
images to promote independent motor learning and awareness. Throughout the lesson students 
are asked to move in a comfortable and pain-free range. At the end of the lesson, the body scan 
is repeated to foster the student’s learning through the noticing of change in elements such as 
differences in body organization, breathing, and mood as compared to the start of the lesson. 

Pelvic Health and Awareness Lessons Brief Description 

Lessons are done in different exercise positions for both novelty and to activate the full 
musculature of the pelvic floor system. Body positions used were supine with legs long or knees 
bent, sitting on the floor, and standing. It is interesting that a study by Borello-France et al. 
(2006) demonstrated that position for performing exercises did not affect outcomes. 

The reader is directed to Appendix B for a brief description of each Awareness Through 
Movement lesson. The brief description of the six basic lessons does not convey the 
sensory-motor richness of each lesson, as directed attention to different parts of the body 
makes the movements progressively more complex. All lessons emphasize breathing, and 
sensing movement through the whole spine. The movement instructions include resting and 
relaxing in between contractions of the pelvic floor. Slowness and ease are qualities that are 
emphasized in the Awareness Through Movement lessons. Two lessons were taught each week 
and were similar to lessons on the audio CDs for home use. 

Health Education 

Health education included anatomy topics: (1) bones of the pelvis, hips, and vertebral column, 
including their shape, muscles and joints; (2) respiratory diaphragm; (3) bladder system; (4) 
uterus and rectum, specifically their position and relationship to each other and the pelvic floor. 
The physiology topics included the micturition–pelvic floor reflex, physiology of elimination, and 
the relationship of breathing to the sympathetic and parasympathetic nervous system. Health 
topics included (1) definitions of types of UI, (2) healthy voiding habits, (3) aligning student’s 
images of their body parts closer to reality. For example, one woman thought the excursion of 
the respiratory diaphragm was much greater than it was, another did not know that the ribs 

 
Bowes • Feldenkrais Research Journal, volume 7 (2025) 12 
 



 

moved. An anatomical musculo-skeletal model of the pelvic floor was demonstrated and 
illustrations from The Female Pelvis by Blandine Calais-Germain (2003) were used. 

Group Support 

Confidentiality was requested for the program from all participants. During the discussion, 
students asked questions or shared their experiences. The time allotted for discussion could 
have been longer as the participants requested this. Most participants reported that they had 
never discussed these issues with others who shared similar experiences. The Awareness 
Through Movement lessons seemed to stimulate deep reflection and responses in many of the 
participants. Many students reported an increased awareness of the pelvic floor, and gained 
insights into their life, their habits of voiding, and how their self-image was changing with the 
improvement in sensation and control of the pelvic floor. 

Table 1: Interventions weekly  

Week  Movement Lessons Health Education Group Support 
    
One Breathing, Leg Tilts (ATM 

lessons 1, 2) 
Healthy voiding habits, 
pelvic floor system, pelvic 
floor illustrations 

Introductions, Use of 
journal 

Two Breathing, Leg Tilts with 
head raise (ATM lessons 1, 
3) 

Incontinence definitions, 
Demonstration with pelvic 
floor model, 
Urge incontinence 
strategies. 

Q & A of first week, 
homework, imagery 
in lessons, confusion 
about breathing 

Three Buttocks awareness (ATM 
lesson 7. This lesson is not 
in the recorded home 
program), Pelvic tilting 
(ATM lesson 4, handout #3) 

Constipation, nighttime 
urination strategies, ‘jic’, 
breathing, role of 
sympathetic and 
parasympathetic nervous 
system 

Talk about digestion, 
sleeping, self-image, 
awareness and how 
one changes 

Four Breathing, Sitting lifting R/L 
sides of pelvis (ATM lesson 
1, 5) 
Self-mobilization of pelvis 
(handout #2) 

Skeletal system-pelvis, 
sacrum, hip and spine 
relationships, Q & A 

Role of practice in 
improvement, 
reports of improved 
symptoms, sexual 
response changes 

Five Breathing, Sitting tilting 
pelvis (ATM lesson 6) 
Review of all movements. 
How to change movement 
patterns and continue to 
breathe. 

Q & A, review of all 
course material 

How to continue in 
future, personal 
changes noticed, 
awareness  

 

 
Bowes • Feldenkrais Research Journal, volume 7 (2025) 13 
 



 

Home Exercise Program 

Home exercises provided choice for each student. The resources were (1) six recorded 
Awareness Through Movement lessons on CD (Bowes 2006), (2) written instructions for an 
additional lesson exploring the use of the buttocks, (3) written instructions for self-mobilization of 
the sacrum and pelvis. Students were oriented to these exercises during the program. Students 
were asked to select a practice daily, either using the CDs, or the handouts or doing what they 
remembered from the class. They were encouraged to do something that was interesting to 
them. Instructions included a suggested routine: (1) initial breathing Awareness Through 
Movement lesson, (2) any other lesson, rotating what they chose each day, and (3) using 
healthy voiding habits. Novelty is an important characteristic to employ with motor learning 
(Berthoz 2000; Doidge 2007). The number of repetitions of each variation is determined by each 
student’s comfort level and ability to maintain attention to how they are moving. Generally, the 
number of repetitions will be less than 15. 

Results 

Student Characteristics and Demographics 

Participant ages ranged from 46-68, with an average age of 52, and all were non–Hispanic 
White with diverse work histories and occupations. All reported exercising 2-3 hours per week, 
doing a combination of walking and other forms of exercise including martial arts, ballet, yoga, 
and gym-based weight training. 

Half of the participants (n=6) had discussed UI and sought help from a medical provider. One 
person had received surgical treatment with a bladder suspension, five were given verbal 
instructions or a written handout of Kegel type exercises. Eleven participants (91%) had not 
received therapy or treatment for UI, yet 83% (n=10) had utilized Kegel type exercises 
independently, however they had discontinued Kegel type exercises when their symptoms did 
not improve. Participants had symptoms of UI from 2-32 years. A history of sexual trauma was 
reported by 25% (n=3). Of the group, 58% (n=7) had borne 1-2 children, with 42% (n=5) having 
had no history of giving birth. One woman reported two C-section births; 6 had vaginal births.  

Characteristics of study group participants are summarized in Tables 2 and 3.  

Table 2: Duration of UI symptoms 

Length of time having UI 
symptoms  

2, 4, 5, 5, 10, 10, 11, 20, 20, 
25, 30, 32 years 

Average 14.5 years 

 

 
Bowes • Feldenkrais Research Journal, volume 7 (2025) 14 
 



 

 
Table 3: Other Characteristics 

Did student ever discuss UI 
with medical provider 

6 yes 6 no 

Childbirth history 7 yes 5 no 
Birth type  6 vaginal 1 c-section 
Prior treatment for UI 1 yes (bladder suspension) 11 no 
Kegel exercises experience 10 yes 2 no 
Sexual Trauma History 3 yes 9 no 
Abdominal surgeries 7 yes 5 no 
Total Hip Replacement 1 bilateral 11 no 
Other Medical conditions 
such as BMI>26, 
Hypertension, cancer 
history, chronic pain 

11 yes 1 no 

 

There were other medical conditions present in 91% (n=11) of the women. These included 
hypertension (n=2), low blood pressure (n=1), high cholesterol (n=2), chronic low back pain 
(n=3), migraine (n=2), scoliosis (n=2), gastric reflux (n=3), bipolar disorder (n=1), depression 
(n=1), diabetes (n=1), arthritis (n=1), low blood sugar (n=1) and cancer treatment for non 
Hodgkin’s lymphoma (n=1).  

In terms of surgical history, 58% (n=7) had a history of abdominal surgery including 
hysterectomy, appendectomy, oophorectomy, bladder prolapse repair, laparoscopic tubal 
exploration, cholecystectomy, and bladder neck obstruction repair with endometrioma excision 
and laparoscopic tubal exploration. One woman had posterior approach bilateral total hip 
replacements.  

The 10 self-referred participants had urinary leakage, symptoms consistent with, either stress, 
urge or mixed incontinence or both. The information about other health conditions showed that 
each woman had one or more risk factors for developing UI (Seshan et al. 2016). 

Data Collection 

The UDI-6 and the IIQ-7 were administered at the beginning of the first class and at the end of 
the last class. The journals were for the participants’ personal reference and not reviewed by the 
researcher. The Qualitative Assessment Questions post intervention, Appendix A, were 
administered at the end of the final session.  

Outcomes 

The students’ scores on the UDI-6, initially ranged from 54-16.6 and post intervention, the range 
was 33-8.3. Scores from 1-33 were considered mild, 34-66 were moderate and 67-100 as 

 
Bowes • Feldenkrais Research Journal, volume 7 (2025) 15 
 



 

severe. Initially seven students had moderate UI, and five had mild. After the program, 11 had 
mild symptoms and 1 had moderate. 66% (n=8) students’ scores improved, 16% (n=2) no 
improvement, 16% (n=2) students worsened. The largest change in score occurred in the group 
with moderate symptoms. 

Pre and Post UDI-6 and the IIQ-7 Scores 

The pre-intervention scores on the UDI-6 ranged from 16.6–54 and for the IIQ-7 from 4.7 – 54. 
On the UDI-6, that translates to 42% (n=5) with mild UI and 58% (n=7) with moderate severity of 
UI. The impact on the quality of life (QOL), the IIQ-7 showed 92% (n=11) of the women were 
mildly impacted and 8% (n=1) moderately impacted. 

Table 4: Initial Scores on the UDI-6 and the IIQ-7  

Student UDI-6 pre Severity of UI 
symptoms 

IIQ-7 pre QOL impact 

     
A 54 moderate 42.8 moderate 
L 54 moderate 19 mild 
H 54 moderate 19 mild 
G  54 moderate 9.5 mild 
C 45.8 moderate 28.5 mild 
B 37.5 moderate 4.7 mild 
I 37.5 moderate 9.5 mild 
J 33 mild 19 mild 
F 29 mild 33.3 mild 
D 25 mild 4.7 mild 
E  25 mild 9.5 mild 
K 16.6 mild 14.2 mild 
 

That 66% percent of the women showed improvement via a lower score on the UDI-6, is within 
the range of improvement reported in other pelvic floor training programs (Choi et al. 2007; 
Koch 2006). 

The IIQ-7 scores initially were from 42.8-14.2 and post intervention went from 28.5-0. Initially the 
QOL of 11 women was mildly impacted and 1 was moderate. Post intervention, 10 were mildly 
impacted with 75% (n=9) showing improvement and less impact, and 2 showed that their QOL 
was no longer affected by UI.  

The IIQ-7 scores shows that 16% (n=2) worsened and .8% (n=1) showed no improvement. The 
largest gains were seen in the women whose QOL was more impacted by UI having IIQ-7 
scores initially above 19.  

 
Bowes • Feldenkrais Research Journal, volume 7 (2025) 16 
 



 

Table 5: Pre and post Intervention Scores on the UDI-6 and the IIQ-7 correlated with attendance 
and completion of homework journal 

Student UDI-6 
pre 

UDI-6  
post 

 Change: (-) = 
improvement 

IIQ-7 
 pre 

IIQ-7  
post 

 Change: (-) = 
improvement 

Attend- 
ence 

Homework 
journal 

A 54 33  - 21 42.8 23  - 19.8 100% Yes 
L 54 33  - 21 19 0  - 19 100% Yes 
H 54 12.5  - 41.5 19 14.2  - 4.8 100% Yes 
G * 54 54  No change 9.5 23  +13.5 80% No 
C 45.8 16.6  - 29.2 28.5 4.7  - 23.8 100% Yes 
B 37.5 33  - 4.5 4.7 4.7  No change 100% Yes 
I 37.5 20.8  - 16.7 9.5 4.7  - 4.8 100% Yes 
J 33 33  No change 19 4.7  -14.3 100% Yes 
F 29 20.8  - 8.2 33.3 28.5  - 4.8 100% Yes 
D 25 33  + 8 4.7 0  - 4.7 100% Yes 
E * 25 33  + 8 9.5 14.2  + 4.7 80% No 
K 16.6 8.3  - 8.3 14.2 4.7  - 9.5 100% Yes 
 

*(Student E missed the 5th class and mailed in her post intervention questionnaire. Student G 
missed the 3rd class) 

Qualitative Results 

The UDI-6 and the IIQ-7 did not measure some of the benefits and experiences as reported by 
the students during the course. A qualitative questionnaire was used post intervention to 
attempt to draw out the non-measurable benefits (Mehling et al. 2005). For example, one 
student reported her constipation problem was gone. Constipation is another pelvic floor issue 
that has been addressed by pelvic floor exercises, however neither of the measures were 
sensitive to measuring constipation (Harrington et al. 2006). Two students reported being able 
to have sexual intercourse without pain for the first time in several years. One student reported 
her long-standing plantar fasciitis disappeared during the course. This points to using different 
assessment tools for this kind of program that would be sensitive to other whole body or pelvic 
floor improvements (Barber et al. 2005), or quality of life changes. 

Answering the question, “Was there some experience you are really glad you had?” nine 
students cited group support and discussion. For example: 

Listening to others. 

Meeting and being with the other women. 

Sharing experiences verbally and hearing others’ experiences. 

 
Bowes • Feldenkrais Research Journal, volume 7 (2025) 17 
 



 

I learned an enormous amount from other women’s experiences. This was an important part of 
the experience. 

The program was different from other group classes I’ve taken because we were all allowed 
time during and after the sessions to hear other’s comments and observations which was useful 
because it prompted further comment and info from the instructor. 

Being part of a group of articulate and caring women. 

It is great to be able to talk to and listen to other women’s experiences and improvements.  

I like having the support of other women in the group. 

This selection of students’ qualitative statements represents other non-measurable findings of 
the program. These statements were made on the qualitative questionnaire administered after 
the last class.  

I’m more aware of the pelvic floor. I feel the interconnectedness of the skeleton and muscles 
and how they interact and affect one another. 

My sexual sensations are now felt physically and emotionally. 

The best part was learning that I can control my body once I have the body awareness. 

I had become fearful of becoming more debilitated. This fear is now lessened. 

I feel increased self-efficacy being proactive and taking care of myself.  

It was important to be in a group and hear other people’s experiences. 

The program helped resolve my back pain. 

It made me more receptive to sex, which has been remote and painful and unattractive for 
years. 

I am glad to find out I still have feeling and sensations in the genital area, inside and out. 

I learned an enormous amount from other women’s experiences. Astonishing actually! 

The most dramatic result is not having to get up so many times during the night.  

The biggest impact was on my feet. The pain in my heels decreased noticeably. 

I feel it is opening my curiosity and I’m more hopeful. 

 

 
Bowes • Feldenkrais Research Journal, volume 7 (2025) 18 
 



 

Discussion 

Improvement was shown for 66% of the women on both measures, i.e. a lessening of UI 
symptoms and less impact on their QOL. The percentage of improvement is consistent with 
other studies which measured improvement in QOL following individual PFM treatment and a 
group exercise program where 60% of women reported improvement (Janssen et al. 2001). 

The two students whose scores worsened on both measures had missed one class and did not 
complete a homework journal. This could mean that attendance at all of the classes was 
important either for the exercise, information or motivation, or perhaps that they did not utilize 
the home program. In future programs having a private individual session with the instructor to 
review the exercises, discuss any barriers to engage with the content, and answering any 
individual questions could enhance the outcomes. 

There was 100% retention in the program, which is different from the other research studies. For 
example, in Australia, 25% of women dropped out of a 4-6 visit outpatient UI treatment program 
(Neumann et al. 2005). In the Netherlands, a group exercise program reported a 7.9% drop out 
or no start rate (Janssen et al. 2001). The Australian program involved individual treatment and 
did not include the dynamic of group support. The time frame for the Netherlands was longer, 
and although a group program, the duration was 3 months of classes and then a follow up 9 
months later. Perhaps a shorter time for the intervention was important for retention as well as 
the component of group support. More research on retention of participants in group exercise 
programs is warranted.  

This style of teaching and learning in this case report was very different from all other methods 
for pelvic floor muscle training (Choi et al. 2007). The instructions given to the student in an 
Awareness Through Movement lesson emphasize a non-linear approach that uses multiple 
strategies such as variability and constraints to accomplish any task (Harbourne and Stergiou 
2009; Lafe and Pacheco 2019). Human movement variability includes variations for motor skill 
and performance (Harbourne and Stergiou 2009). Rather than training the student to ‘do it this 
way’, the student explores movement variables in different positions that lead to a healthy 
dynamic state. Variability is an inherent property of movement regulation (Corbetta 2009). The 
students were trained to use their kinesthetic sense to move and sense in different positions and 
explore each action with different movement variables. The number of repetitions was 
determined by the individual based on their sensation of ease, comfort, and the ability to 
maintain easy breathing while moving, as well as attention to their action. The role of inner and 
outer focus of attention was important and students were asked to stop a movement when they 
were tired and could not pay attention any longer. A brief rest refreshed the ability to attend 
when the student resumed moving. 

The length of the course being only five weeks was a limitation even though some successful 
interventions report a median number of five individual treatment sessions (Neumann et al. 

 
Bowes • Feldenkrais Research Journal, volume 7 (2025) 19 
 



 

2005). There is literature to suggest 9-12 weeks as being optimal for group pelvic floor muscle 
training programs (Borello-France et al. 2006; Janssen et al. 2001; Koch 2006). 

A limitation of this case report was that the students were self-referred. There may have been a 
context effect and perhaps the expectation for improvement was high.  

Students completed journals with open-ended entries, writing their thoughts, sensations and 
experiences. The students seemed to like the journals and everyone brought them to each 
class. One written comment on the qualitative questionnaire: 

I think the notebook is a crucial part of the program. Just having the shiny thing on the table as a 
reminder, and then thinking about what I have done.  

Journal writing was included to encourage the women to take notes during the educational 
component of class. From years of teaching Feldenkrais Method classes, I have learned that 
people can have deep personal responses, insights and experiences from Awareness Through 
Movement classes. From my clinical experience, I have learned that pelvic floor work goes 
beyond the physical and can stimulate deeply personal experiences for reflection. The journal 
was also a practical place to keep a record of homework done. I would use the journal again, 
but separate out the homework records, to allow for easier data collection and analysis and to 
encourage compliance. 

Completion of a homework journal was assumed to demonstrate that the student was compliant 
with home exercises. Homework was not recorded in an organized form. This was a limitation of 
the case report. It would be useful to have data regarding what was done for the home program, 
how often and how much. In analyzing the data, the two students whose scores did not improve, 
also did not complete homework journals. In a future program, standardized forms for recording 
homework and one’s response to it would be better. It would then be easier to know what was 
useful and perhaps delineate criteria for student selection for greater success. 

Another limitation of the study was that the students had only mild to moderate symptoms. The 
short form of the UDI-6 and IIQ-7 may not have been sensitive enough for this group. Several 
students also had problems answering the questionnaires at the last class. Some students 
appeared rushed, or unable to focus on the questions. In the future, other measures that ask 
more questions may be useful to detect changes in other pelvic floor functions or quality of life, 
such as improvement in sexual response, constipation, or sleep. The full Pelvic Floor Distress 
Inventory PFDI-20) (de Arruda et al. 2022) could be useful for this. Setting aside enough time in 
the last class for completion of the questions should be considered in the structure of the 
program.  

The UDI-6 and the IIQ-7 did not measure all of the qualitative benefits and experiences of the 
program as reported verbally by the students during the course. A qualitative questionnaire was 
developed by the author to use post intervention to attempt to draw out the non-measurable 

 
Bowes • Feldenkrais Research Journal, volume 7 (2025) 20 
 



 

benefits (Mehling et al. 2005). In the future, the use of systematic data collection process may 
be useful. Measuring changes in body awareness and the effects that may have on pelvic floor 
dysfunction would be interesting. There may be different tools for this kind of program that would 
be sensitive to other whole body or pelvic floor improvements (Barber et al. 2005). 

The intervention in this case report was based on an original program developed by the author 
called Pelvic Health and Awareness. It was multi-faceted including breathing and relaxation, 
Awareness Through Movement lessons, health education, bladder training, journal writing and 
group support. Discussion and group support brought out some of the qualitative statements 
that touched not only on UI, but sexuality, empowerment, hopefulness, and self-image.  

This program appealed to women who were proactive in their healthcare, enjoyed the 
camaraderie of being in a group with other women and could reflect on their experience. It 
would be useful to know for whom this program does not work. That could be a question for 
future research. 

Other questions suggested for future study include: What are the best measures to use for a 
sensory-motor based PFM exercise program? How does an increase in pelvic floor and/or body 
awareness contribute to improvement in quality of life? What changes in self-image are helpful 
for improving UI? Can Awareness Through Movement lessons affect long-term improvement in 
UI symptoms? Can a sensory-motor approach help women with moderate-severe UI? 

Conclusion 

Urinary incontinence can be addressed in group classes for women with mild to moderate 
symptoms using Feldenkrais Method Awareness Through Movement lessons, combined with 
health education, group support, and journal writing. This group program had other benefits 
beyond improvement of UI. For example, the qualitative statements revealed improvement in 
sexual function and sensitivity to sexual sensations, less pain with intercourse, less fear of 
losing function in the future, awareness of felt bodily connections, reduced back pain, and value 
of sharing experiences specific to a woman’s identity and life. Discussion time for women to 
learn from each other’s experiences proved to be a valuable addition to a group pelvic floor 
training program. 

This program was successful in mitigating the suffering from mild to moderate urinary 
incontinence. In this study 66% of the women improved in their symptoms of UI. Most of the 
participants had improvement in UI related QOL scores, with greater improvement in those who 
were more impacted by UI.  

They felt greater control over this aspect of their function and valued the feeling of support from 
other women to discuss what is often an embarrassing aspect of many women’s lives. The use 
of the comprehensive Pelvic Floor Distress Inventory PFDI-20) (de Arruda et al. 2022) could be 
included and useful for future studies, along with a systematic collection of qualitative first 

 
Bowes • Feldenkrais Research Journal, volume 7 (2025) 21 
 



 

person data. This study points to the value of future research for this approach to relieve the 
burden of UI.  

Thank You 

Thank you to Karol Connors, co-editor for this volume of the Feldenkrais Research Journal and 
to the anonymous reviewers for their valuable assistance and suggestions that contributed to 
bringing this paper to fruition.  

Biography 

Deborah Bowes, Doctor of Physical Therapy (DPT), Feldenkrais Method Teacher and Trainer 
Feldenkrais Movement and Awareness, San Francisco; Saybrook University 

Deborah graduated from Columbia University, NYC, in Physical Therapy and later earned a 
Doctorate in Physical Therapy from Shenandoah University. She is Guild Certified Trainer of the 
Feldenkrais Method and has taught in over 35 Feldenkrais Method training programs around the 
world. She is Adjunct Faculty in the Department of Mind-Body Medicine at Saybrook University. 
Her mind body practices include Tai Chi Chuan, Qigong, yoga, Vipassana meditation, and 
several dance forms. She is the creator of the Pelvic Health and Awareness audio program and 
offers online courses through movementandcreativity.com. 

 

 

 
Bowes • Feldenkrais Research Journal, volume 7 (2025) 22 
 



 

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Appendices 

 
Appendix A: Qualitative questions for post intervention 

Qualitative assessment questions post intervention 
(Mehling, et al., 2005) 

1. What was important for you? Please feel free to share in your own words and comments 
about your experience. I’d like to know some of your thoughts, feelings, responses to the 
program. Whether you think or feel any differently about your body, your pelvic floor, your 
discomfort or difficulty, or life in general. 
2. Was there some information that was particularly useful? 
3. Was there some experience that you’re really glad you had? 
4. Do you have any suggestions for improving any aspect of the classes or the program? 

 
Appendix B: Brief Descriptions of Feldenkrais Awareness Through Movement 
Lessons Used in the Program 

1. Breathing to relax and balance the nervous system. This lesson is done in supine with knees 
bent. The lesson explores making three different sounds: sss, shh, haa, sound with exhalation 
while feeling the movement of the ribs and abdomen. It is designed to relax and calm the 
sympathetic nervous system. It is done before any of the other exercises as a type of warm-up, 
not of the muscles, but of the nervous system. 

2. Activating the right and left sides of the pelvic floor. This lesson is done in supine with knees 
bent. The student is asked to move the knees from side to side and allow the movement to 
travel through the whole spine all the way up to the head, sensing the spine as a kinetic chain. 
After sensing the full skeletal movement, the lesson progresses using the pelvic floor to help 
move the legs individually or at the same time. The student is asked to coordinate breathing 
with the movement pattern. This lesson is designed to help balance the strength and control of 
each side of the pelvic floor. The main movement strategy is the use of the auxiliary muscles, 
the adductors of the legs and the abdominal obliques. 

3. Engaging the abdominals. This lesson is done in supine with knees bent. It uses the 
movement pattern learned in lesson #2 with the addition of lifting the head with the help of the 
hands as the knees are moved. Breathing is coordinated with the legs. Once, the movement is 
felt as a coherent body pattern, the use of the pelvic floor is added with lifting and lowering the 
head. This lesson is designed to engage all of the abdominal muscles, and to improve the 
coordination of the pelvic floor with the respiratory diaphragm. 

 
Bowes • Feldenkrais Research Journal, volume 7 (2025) 28 
 



 

4. Activating the front and back of the pelvic floor. This lesson is done supine with knees bent. 
The student is asked to gently tilt the pelvis forward and back and sense the response or 
connection in the spine and head. After there is the full skeletal movement of gentle flexion and 
extension, the student explores habits of using the front and back of the pelvic floor. Through 
the use of simple imagery with different combinations of tilting the pelvis and including the pelvic 
floor, this lesson is designed to improve the ability to sense and coordinate the pelvic floor with 
functional movement. The student can sense her habit of use of either front or back triangle of 
the pelvic floor. The lesson includes differentiating a pelvic floor contraction, with movement of 
pelvis and without it. 

5. Dynamic sitting with the right and left sides of the pelvic floor. This lesson is done in sitting on 
a flat-bottomed chair. It uses a small folded towel placed under one ischial tuberosity. The 
student is asked to lift and lower the ischial tuberosity that is not sitting on the towel. Attention is 
directed to how shifting weight from one side to the other affects the whole spine. After there is 
full skeletal movement, the student is asked to engage the right and left sides of the pelvic floor 
with slower and faster movements. This lesson is designed to help learn how to use the pelvic 
floor dynamically in sitting. 

6. Dynamic sitting with the front and back of the pelvic floor. This lesson is done sitting on a 
flat-bottomed chair. The student is asked to tilt the pelvis slowly forward and back and notice 
how the posture changes. Gentle, complete spinal flexion and extension is matched to forward 
and backward tilting of the pelvis. Students explore using the front or back of the pelvic floor 
with different directions of tilting the pelvis. At the end of the lesson there is directed attention in 
standing to sense how the pelvic floor is involved in supporting the hips, legs and spine. This 
lesson is designed to help learn how to use the pelvic floor dynamically in sitting. 

7. Buttocks awareness. This lesson is done in supine, prone, side lying and sitting on the floor 
and in standing. The student is asked to contract the buttocks in different ways and sense the 
relationship to breathing, external rotation of the legs, decreasing lumbar extension and raising 
the arches of the feet. This lesson allows students to feel relaxation of the buttocks and the 
pelvic floor. The lesson is designed to improve buttocks use and decrease extraneous work in 
the buttocks. 

 
Bowes • Feldenkrais Research Journal, volume 7 (2025) 29 
 


	​Original Research 
	​ 
	Group Exercise for Improvement in Urinary Incontinence using Motor Learning and Sensory Awareness based on the Feldenkrais Method® of Somatic Education  
	Abstract 
	Keywords 

	Original Research 
	​ 
	Group Exercise for Improvement in Urinary Incontinence using Motor Learning and Sensory Awareness based on the Feldenkrais Method® of Somatic Education  
	​Impact of Urinary Incontinence 
	Rationale for Group Exercise 
	Why Feldenkrais Method was Utilized 
	Outcome Measures for Urinary Incontinence 
	Methods 
	Student Selection 
	Group Size and Duration 
	Intervention 
	Awareness Through Movement Lessons: Somatic Education 
	Pelvic Health and Awareness Lessons Brief Description 
	Health Education 
	Group Support 
	Home Exercise Program 

	Results 
	Student Characteristics and Demographics 
	Data Collection 
	Outcomes 
	Pre and Post UDI-6 and the IIQ-7 Scores 
	Qualitative Results 

	Discussion 
	Conclusion 
	Thank You 
	Biography 
	 
	References 
	Appendices 
	​Appendix A: Qualitative questions for post intervention 
	​Appendix B: Brief Descriptions of Feldenkrais Awareness Through Movement Lessons Used in the Program 


