Background
Pelvic floor dysfunction, including urinary and anal incontinence, is a common postpartum
complaint and likely to reduce quality of life.
Objective
To study the effects of individualized physical therapist–guided pelvic floor muscle
training in the early postpartum period on urinary and anal incontinence and related
bother, as well as pelvic floor muscle strength and endurance.
Materials and Methods
This was an assessor-blinded, parallel-group, randomized controlled trial evaluating
effects of pelvic floor muscle training by a physical therapist on the rate of urinary
and/or anal leakage (primary outcomes); related bother and muscle strength and endurance
in the pelvic floor were secondary outcomes. Between 2016 and 2017, primiparous women
giving birth at Landspitali University Hospital in Reykjavik, Iceland, were screened
for eligibilty 6–10 weeks after childbirth. Of those identified as urinary incontinent,
95 were invited to participate, of whom 84 agreed. The intervention, starting at ∼9
weeks postpartum consisted of 12 weekly sessions with a physical therapist, after
which the main outcomes were assessed (endpoint, ∼6 months postpartum). Additional
follow-up was conducted at ∼12 months postpartum. The control group received no instructions
after the initial assessment. The Fisher exact test was used to test differences in
the proportion of women with urinary and anal incontinence between the intervention
and control groups, and independent-sample t tests were used for mean differences in muscle strength and endurance. Significance
levels were set as α = 0.05.
Results
A total of 41 and 43 women were randomized to the intervention and control groups,
respectively. Three participants and 1 participant withdrew from these respective
groups. Measurement variables and main delivery outcomes were not different at recruitment.
At the endpoint, urinary incontinence was less frequent in the intervention group,
with 21 participants (57%) still symptomatic, compared to 31 controls (82%) (P = .03), as was bladder-related bother with 10 participants (27%) in the intervention
vs 23 (60%) in the control group (P = .005). Anal incontinence was not influenced by pelvic floor muscle training (P = .33), nor was bowel-related bother (P = .82). The mean differences between groups in measured pelvic floor muscle strength
changes at endpoint was 5 hPa (95% confidence interval, 2–8; P = .003), and for pelvic floor muscle endurance changes, 50 hPa/s (95% confidence
interval, 23–77; P = .001), both in favor of the intervention group. The mean between-group differences
for anal sphincter strength changes was 10 hPa (95% confidence interval, 2–18; P = .01) and for anal sphincter endurance changes 95 hPa/s (95% confidence interval,
16–173; P = .02), both in favor of the intervention. At the follow-up visit 12 months postpartum,
no differences were observed between the groups regarding rates of urinary and anal
incontinence and related bother. Pelvic floor- and anal muscle strength and endurance
favoring the intervention group were maintained.
Conclusion
Postpartum pelvic floor mucle training decreased the rate of urinary incontinence
and related bother 6 months postpartum and increased muscle strength and endurance.
Key words
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to American Journal of Obstetrics & GynecologyAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Pelvic floor muscle training for prevention and treatment of urinary and faecal incontinence in antenatal and postnatal women.Cochrane Database Syst Rev. 2017; 12: CD007471
- Degree of bother from pelvic floor dysfunction in women one year after first delivery.Eur J Obstet Gynecol Reprod Biol. 2015; 191: 90-94
- Psychological consequences of pelvic floor trauma following vaginal birth: a qualitative study from two Australian tertiary maternity units.Arch Womens Ment Health. 2018; 21: 341-351
- ‘A worse nightmare than expected'–a Swedish qualitative study of women's experiences two months after obstetric anal sphincter muscle injury.Midwifery. 2018; 61: 22-28
- 6th International Consultation on Incontinence. Recommendations of the International Scientific Committee: Evaluation and treatment of urinary incontinence, pelvic organ prolapse and faecal incontinence.Neurourol Urodyn. 2018; 37: 2271-2272
- The effect of postpartum pelvic floor muscle exercise in the prevention and treatment of urinary incontinence.Int Urogynecol J Pelvic Floor Dysfunct. 1997; 8: 217-222
- Postpartum pelvic floor muscle training and urinary incontinence: a randomized controlled trial.Obstet Gynecol. 2013; 122: 1231-1238
- Vaginal palpation of pelvic floor muscle strength: inter-test reproducibility and comparison between palpation and vaginal squeeze pressure.Acta Obstet Gynecol Scand. 2001; 80: 883-887
- Pelvic floor muscle exercise for the treatment of female stress urinary incontinence: I. Reliability of vaginal pressure measurements of pelvic floor muscle strength.Neurourol Urodyn. 1990; 9: 471-477
- Stress incontinence and genital relaxation.Ciba Clin Symp. 1952; 4: 35-51
- Test-retest intra-rater reliability of vaginal measurement of pelvic floor muscle strength using Myomed 932.Acta Obstet Gynecol Scand. 2009; 88: 939-943
- Pelvic floor muscle exercise for the treatment of female stress urinary incontinence: II. Validity of vaginal pressure measurements of pelvic floor muscle strength and necessity of supplementary methods for control of correct contraction.Neurourol Urodyn. 1990; 9: 479-487
- Are pelvic floor muscle thickness and size of levator hiatus associated with pelvic floor muscle strength, endurance and vaginal resting pressure in women with pelvic organ prolapse stages I-III? A cross sectional 3D ultrasound study.Neurourol Urodyn. 2014; 33: 115-120
- Australian pelvic floor questionnaire: a validated interviewer-administered pelvic floor questionnaire for routine clinic and research.Int Urogynecol J Pelvic Floor Dysfunct. 2009; 20: 149-158
- A validated self-administered female pelvic floor questionnaire.Int Urogynecol J. 2010; 21: 163-172
- Guidelines for the process of cross-cultural adaptation of self-report measures.Spine. 2000; 25: 3186-3191
- Health behavior and health education. Theory, research and practice.Wiley & Sons, San Francisco2002
- Pelvic floor muscle exercise for the treatment of female stress urinary incontinence: III. Effects of two different degrees of pelvic floor muscle exercises.Neurourol Urodyn. 1990; 9: 489-502
- Physiotherapy for persistent postnatal stress urinary incontinence: a randomized controlled trial.Obstet Gynecol. 2004; 104: 504-510
- Pelvic floor muscle exercises utilizing trunk stabilization for treating postpartum urinary incontinence: randomized controlled pilot trial of supervised versus unsupervised training.Clin Rehabil. 2012; 26: 132-141
- Comparisons of approaches to pelvic floor muscle training for urinary incontinence in women.Cochrane Database Syst Rev. 2011; : CD009508
- Postnatal pelvic floor muscle training for preventing and treating urinary incontinence: where do we stand?.Curr Opin Obstet Gynecol. 2006; 18: 538-543
- Conservative management of persistent postnatal urinary and faecal incontinence: randomised controlled trial.BMJ. 2001; 323: 593-596
- A randomized controlled trial of pelvic floor muscle exercises to treat postnatal urinary incontinence.Int Urogynecol J Pelvic Floor Dysfunct. 1998; 9: 257-264
- Do pelvic floor muscle exercises reduce postpartum anal incontinence? A randomised controlled trial.BJOG. 2017; 124: 686-694
- Twelve-year follow-up of conservative management of postnatal urinary and faecal incontinence and prolapse outcomes: randomised controlled trial.BJOG. 2014; 121: 112-120
Article info
Publication history
Published online: September 14, 2019
Accepted:
September 8,
2019
Received in revised form:
August 4,
2019
Received:
May 1,
2019
Footnotes
The authors report no conflict of interest.
This study has received grants from the University of Iceland Research Fund; Public Health Fund, Icelandic Directorate of Health; Icelandic Physiotherapy Association Science Fund; and Landspitali Science Fund.
Cite this article as: Sigurdardottir T, Steingrimsdottir T, Geirsson RT, et al. Can postpartum pelvic floor muscle training reduce urinary and anal incontinence? An assessor-blinded randomized controlled trial. Am J Obstet Gynecol 2020;222:247.e1-8.
This trial was registered March 30, 2015, at https://register.clinicaltrials.gov (NCT02682212). Initial participant enrollment was March 16, 2016, and reported following CONSORT guidelines for RCTs.
Identification
Copyright
© 2019 Elsevier Inc. All rights reserved.
