AbstractAimsThe purpose of this study was to examine the effect of a pelvic floor muscle (PFM) rehabilitation program on incontinence symptoms, PFM function, and morphology in older women with SUI.MethodsWomen 60 years old and older with at least weekly episodes of SUI were recruited. Participants were evaluated before and after a 12‐week group PFM rehabilitation intervention. The evaluations included 3‐day bladder diaries, symptom, and quality of life questionnaires, PFM function testing with dynamometry (force) and electromyography (activation) during seven tasks: rest, PFM maximum voluntary contraction (MVC), straining, rapid‐repeated PFM contractions, a 60 sec sustained PFM contraction, a single cough and three repeated coughs, and sagittal MRI recorded at rest, during PFM MVCs and during straining to assess PFM morphology.ResultsSeventeen women (68.9 ± 5.5 years) participated. Following the intervention the frequency of urine leakage decreased and disease‐specific quality of life improved significantly. PFM function improved significantly: the participants were able to perform more rapid‐repeated PFM contractions; they activated their PFMs sooner when coughing and they were better able to maintain a PFM contraction between repeated coughs. Pelvic organ support improved significantly: the anorectal angle was decreased and the urethrovescial junction was higher at rest, during contraction and while straining.ConclusionsThis study indicated that improvements in urine leakage were produced along with improvements in PFM co‐ordination (demonstrated by the increased number of rapid PFM contractions and the earlier PFM activation when coughing), motor‐control, pelvic organ support. Neurourol. Urodynam. 32:1086–1095, 2013. © 2013 Wiley Periodicals, Inc.