Original ResearchGynecologyCan postpartum pelvic floor muscle training reduce urinary and anal incontinence?: An assessor-blinded randomized controlled trial
Section snippets
Study design
This was an assessor-blinded, parallel-group RCT with the allocation ratio 1:1 examining the effects of postpartum PFMT on the rate of UI and AI in primiparous women. The trial was carried out at Tap, Physical Therapy Clinic, Kopavogur, Iceland, from March 2016 to January 2018. Information and baseline assessment of participants were obtained at recruitment 9 weeks postpartum (range, 6–13 weeks), after completed treatment 6 months postpartum (endpoint, range, 5–7 months), and finally 12 months
Results
In all, 84 women, all of white ethnicity, were included, 41 in the intervention group and 43 in the control group. The initial appointment was on average 9 weeks postpartum (range, 6–13 weeks). Participant characteristics at recruitment/baseline are shown in Table 1. At baseline, 16 participants (19%) had difficulties activating their PFMs, but all were able to do this after verbal instruction and facilitation through vaginal palpation. Four women (3 from the intervention group) withdrew
Principal findings
Among women with urinary incontinence after childbirth, we showed that regular pelvic floor muscle training substantially reduced the rate of UI and related bother. Pelvic floor muscle strength and endurance were also improved. However, no differences were observed for anal incontinence and bowel-related bother between groups. At the 1-year follow-up, similar prevalences of urinary and anal incontinence were observed, whereas improvements in PFM and anal sphincter strength and endurance
Acknowledgments
The authors thank secretary Hulda Magnusdottir for her work in registering and administering all clinical appointments for the participants of the study, and physical therapists Fanney Magnusdottir and Gudrun Magnusdottir for carrying out the intervention. We express our gratitude for the permission given by Dr Kaven Baessler and coauthors to translate and use the Australian Pelvic Floor Questionnaire.
References (26)
- et al.
Degree of bother from pelvic floor dysfunction in women one year after first delivery
Eur J Obstet Gynecol Reprod Biol
(2015) - et al.
‘A worse nightmare than expected'–a Swedish qualitative study of women's experiences two months after obstetric anal sphincter muscle injury
Midwifery
(2018) - et al.
Pelvic floor muscle training for prevention and treatment of urinary and faecal incontinence in antenatal and postnatal women
Cochrane Database Syst Rev
(2017) - et al.
Psychological consequences of pelvic floor trauma following vaginal birth: a qualitative study from two Australian tertiary maternity units
Arch Womens Ment Health
(2018) - et al.
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) - et al.
The effect of postpartum pelvic floor muscle exercise in the prevention and treatment of urinary incontinence
Int Urogynecol J Pelvic Floor Dysfunct
(1997) - et al.
Postpartum pelvic floor muscle training and urinary incontinence: a randomized controlled trial
Obstet Gynecol
(2013) - et al.
Vaginal palpation of pelvic floor muscle strength: inter-test reproducibility and comparison between palpation and vaginal squeeze pressure
Acta Obstet Gynecol Scand
(2001) - et al.
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) Stress incontinence and genital relaxation
Ciba Clin Symp
(1952)
Test-retest intra-rater reliability of vaginal measurement of pelvic floor muscle strength using Myomed 932
Acta Obstet Gynecol Scand
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
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
Cited by (49)
Pelvic exam in gynecology and obstetrics: Guidelines for clinical practice
2023, Gynecologie Obstetrique Fertilite et SenologieAssessing the robustness of results from clinical trials and meta-analyses with the fragility index
2023, American Journal of Obstetrics and GynecologyCitation Excerpt :In addition, the FI should be interpreted in the context of the clinical question of the trial. For example, in the study by Sigurdardottir et al19 that had FI of 2, we should think about whether it is clinically likely that 2 women, who were labeled as being continent based on a questionnaire, could have been mislabeled, and they were, in fact, incontinent. The outcome misclassification of 2 women is quite likely in this case.
Sexually Induced Orgasm to Improve Postpartum Pelvic Floor Muscle Strength and Sexual Function in Primiparous Women After Vaginal Delivery: A Prospective Randomized Two-Arm Study
2022, Journal of Sexual MedicineCitation Excerpt :The quality of life is adversely affected in women with PFMD.26,27 Postpartum pelvic floor muscle training is known to be beneficial in increasing both pelvic floor muscle strength and sexual function.8–10 Though, sexually induced orgasms are known to be associated with pelvic floor muscle contraction and those with good pelvic floor muscle strength are known to have better orgasmic contraction of the pelvic floor,19 we are the first to use this natural process of orgasm for enhancing postpartum pelvic floor muscle strength and sexual function.
Care needs and self-induced measures of women with postpartum pelvic floor disorder- Results of a social media-based survey of 2930 women
2024, Archives of Gynecology and Obstetrics
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.