Effectiveness of pelvic floor exercises in treating Urinary Incontinence following childbirth

Abstract

Objectives The objective of this review is to determine from the available evidence the effectiveness of pelvic floor muscle exercises (PFME) in treating urinary incontinence following childbirth. Questions The specific questions being asked are: • Do antenatal PFME prevent or reduce urinary incontinence following childbirth? • Do PFME following childbirth resolve or reduce subsequent urinary incontinence? • What is the most effective type of instruction of PFME in treating urinary incontinence? Criteria for considering studies for this review Types of participants Women who have delivered at more than 20 weeks gestation and who have experienced a spontaneous onset of labour. The labour may proceed to a caesarean section. Exclusions: Women who have had an elective caesarean section. Studies have demonstrated that there is a lower prevalence of incontinence in women who have undergone an elective caesarean section as no stress has been placed on the pelvic floor muscles Types of interventions a) Pelvic floor exercises b) Type of instruction of PFME e.g. timing, method, content. Exclusion: Electrical stimulation of pelvic floor muscles or other adjunct therapies. These have been excluded as they are not normally performed by midwives, but rather are part of the physiotherapist’s role. Types of outcome measures Outcomes that are of interest include but are not confined to: Resolution or reduction in (as appropriate) amount, length, or severity of urinary incontinence up to twelve months following childbirth. In relation to types of instruction: • effectiveness of pelvic floor contraction • period of time PFME continued after initial instruction • frequency of PFME undertaken • woman’s awareness of importance of PFME • satisfaction with instruction