Pelvic Floor Muscle Exercise Program Research Articles

Pelvic floor muscle training program for women in the puerperal period: clinical progress after intervention.

To evaluate the sexual function of women in the puerperal period after a postpartum pelvic floor musculature training program. We also sought to evaluate correlations between sexual dysfunction in the women and their delivery type and compare the frequency of sexual dysfunction and the quality of resumed sexual function following vaginal and cesarean deliveries. This clinical study included an intervention, carried out between July and December 2019, in which data were collected about 28 rooming-in women at a Maternity School. Data were divided into vaginal delivery and cesarean delivery. Sexual function was evaluated by the Female Sexual Function Index and the International Consultation on Incontinence Questionnaire-Short Form to assess the Incontinence Urinary and qualifies urinary loss. The intervention consisted of a muscle training exercise program. ANOVA tests were used to establish differences between groups. There was an improvement in all outcomes, but there was no time versus group interaction. Improvement in sexual function was observed (p<0.001), the impact of urinary incontinence on quality of life (p<0.001), and pressure of the muscles of pelvic floor muscles (p<0.001) over time. There was no time versus group interaction for sexual function (p=0.87), the impact of urinary incontinence on quality of life (p=0.88), and pressure of the pelvic floor muscles (p=0.66). Pelvic floor muscle exercise programs seem to be a very promising strategy concerning improving sexual activity among puerperal patients.

The Effects of Pelvic Floor Muscle Training and Behavioral Training on Sexual Dysfunction, Incontinence, Physical Activity Level and Quality of Life in the Elderly

Alterations in hormonal balance, especially with ageing, cause many pelvic floor problems such as urinary incontinence, lack of interest in or desire for sex and inactivity. The aim of this study was to explore the effects of pelvic floor muscle exercise and behavioral training programs on sexual function, incontinence, quality of life and physical activity level in the elderly. A total of 94 elderly subjects were separated into two groups as the pelvic floor muscle training (PFMT) group and the behavioral training for pelvic floor dysfunctions (BT) group. A (1-h program was applied twice a week for 8 weeks). Evaluations pre and post-training were made using the Female Sexual Function Inventory, the International Index of Erectile Function, International Consultation on Incontinence Questionnaire-Short Form, SEAPI quality of life scale, and Physical Activity Scale for the Elderly. In the post-treatment comparisons, the PFMT group was superior to the BT group in all parameters (z: − 4.21–0.00, p:0.00–0.02). The results of this study suggest that pelvic floor muscle training could be beneficial if added to rehabilitation programs for the elderly to obtain less sexual dysfunction and, incontinence, and better incontinence-related quality of life and physical activity levels.

The Development and Effectiveness of a Care Protocol Using the Stevens Star Model of Knowledge Transformation in Female Patients With Stress Incontinence: An Experimental Study

Nurse-led pelvic floor muscle exercise and lifestyle education programs are effective first-line interventions for women with stress incontinence (SI). To develop an evidence-based stress incontinence care protocol (SICP) using the Stevens Star Model of Knowledge Transformation and evaluate its effect on the frequency and quantity of urinary incontinence, quality of life, pelvic muscle self-efficacy levels, and lifestyle variables of women with SI. An SICP was developed on the basis of the Star model. The views of an expert were consulted for testing the content validity of the protocol. Using a pretest-posttest experimental design, 68 women with SI who visited an outpatient clinical at a hospital in Turkey were prospectively enrolled in the intervention (n = 34) and control (n = 34) groups. After obtaining baseline demographic and health history information, participants completed the King's Health Questionnaire, the Broome Pelvic Muscle Exercise Self-Efficacy Scale, a 3-day voiding diary, and a 1-hour pad test. The intervention group received an 8-week program of care according to the Star model-derived SICP, and follow-up assessments were completed by both groups after 8 and 12 weeks. The content validity index for the SICP was 91.9%. The intervention group had a reduced quantity and frequency of urinary leakage, reduced King's Health Questionnaire scores, and increased Broome Pelvic Muscle Exercise Self-Efficacy Scale scores (P < .05). Care provided according to the Star model-derived SICP reduced the quantity and frequency of SI and improved the perceived pelvic muscle exercise self-efficacy and quality of life of the participants.

Effect of low level laser on pelvic floor muscles and fascia in cases of stress urinary incontinence: a randomized controlled trial

IntroductionThe aim of the study was to determine the effect of low level laser applied for 3 months, 2 sessions per week, on pelvic floor muscles and fascia compared with a pelvic floor exercise program in patients with stress urinary incontinence.MethodsThe randomized controlled trial involved 30 patients with stress urinary incontinence and with pelvic floor muscle strength not less than grade 1 on the Oxford scale. They were assigned to 2 equal groups. The experimental group received low level laser for 15 minutes and a pelvic floor muscle exercise program for 30 minutes, 2 sessions per week, for 12 weeks; the control group only received the pelvic floor muscle exercise program for 30 minutes, 2 sessions per week, for 12 weeks. The pelvic floor muscles were evaluated before and after treatment with a Neen Peritone perineometer and the Modified Oxford Grading Scale. The Revised Urinary Incontinence Scale served to assess incontinence severity before and after treatment.ResultsThe statistical analysis indicated a significant increase in pelvic floor muscle strength (&lt;i&gt;p&lt;/i&gt; &lt; 0.05), a significant improvement of the grade muscle test of pelvic floor muscles (&lt;i&gt;p&lt;/i&gt; &lt; 0.05), and a significant reduction of Revised Urinary Incontinence Scale score (&lt;i&gt;p&lt;/i&gt; &lt; 0.05) after treatment compared with pre-treatment status in both groups. Also, there was a significant improvement in all dependent variables in favour of the experimental group.ConclusionsLow level laser may be an effective intervention in treating stress urinary incontinence and improving pelvic floor muscle strength and fascia.

Effectiveness of the pelvic floor muscle training on muscular dysfunction and pregnancy specific urinary incontinence in pregnant women with gestational diabetes mellitus: A systematic review protocol

There is ample evidence that gestational diabetes mellitus has a direct influence on urinary incontinence and pelvic floor muscles. There are no standardized pelvic floor muscle exercise programs in the literature for the physiotherapy and differ in the type of exercise, intensity, type and duration of application, and the frequency and duration of treatment sessions. The aim of this systematic review will be to investigate that Pelvic Floor Muscle Training can prevent and/or decrease the pregnancy specific urinary incontinence in women with gestational diabetes mellitus or gestational hyperglycemia. We will perform a systematic review according to the Cochrane methodology of Randomized Controlled Trials. An overall search strategy will be developed and adapted for Embase, MEDLINE, LILACS, and CENTRAL databases, with the date of consultation until June 2020. The MeSH terms used will be "Pregnancy", "Hyperglycemia", "Diabetes Mellitus, Type 2", "Diabetes Mellitus, Type 1", "Pregnancy in Diabetics", "Diabetes, Gestational", "Urinary Incontinence", "Pelvic Floor Muscle Strength". Primary outcomes: improvement or cure of pregnancy specific urinary incontinence (which can be assessed by questionnaires, and tools such as tampon test, voiding diary, urodynamic study). Secondary outcomes: improvement of pelvic floor muscle strength (pelvic floor functional assessment, perineometer, electromyography, functional ultrasonography), improved quality of life (questionnaires), presence or absence of postpartum Urinary Incontinence and adverse effects. Quality assessment by Cochrane instrument. Metanalysis if plausible, will be performed by the software Review Manager 5.3. The present study will be the first to analyze the effectiveness of pelvic floor exercises in pregnant women with Gestational Diabetes Mellitus or Hyperglycemia, who suffer from pregnancy specific urinary incontinence. Randomized Controlled Trials design will be chosen because they present the highest level of evidence. It is expected to obtain robust and conclusive evidence to support clinical practice, in addition to promoting studies on the theme and contributing to new studies. Systematic review registration: PROSPERO CRD42017065281.

Pelvic floor muscle exercise with biofeedback helps regain urinary continence after robot-assisted radical prostatectomy.

BackgroundTo determine the benefit of pelvic floor muscle exercise (PFME) with visual biofeedback on promoting patient recovery from incontinence, we investigated variables associated with the early restoration of continence for patients who robot-assisted radical prostatectomy (RARP).MethodsOf the 83 patients enrolled, 41 consecutive patients completed PFME (the exercise group), and the other 42 consecutive patients just before the PFME program commenced (the control group). The primary outcome was whether PFME engagement was associated with zero pad continence restoration within 3 months of surgery.ResultsContinence restoration percentages (defined as zero pads used per day) at 1, 3, and 6 months after surgery were 49.4%, 77.1%, and 94.0%, respectively. The exercise group achieved significantly higher recovery rates at 1 month (p=0.037), 3 months (p<0.001), and 6 months (p=0.023). Cox regression analysis demonstrated that a lower Gleason score (<8; hazard ratio [HR], 2.167), lower prostate specific antigen (<20 ng/dL; HR, 2.909), and engagement in PFME (HR, 3.731) were independent predictors of early recovery from postprostatectomy incontinence. Stratification by age showed that those younger than 65 years did not benefit significantly from exercise (log-rank test, p=0.08), but that their elderly counterparts, aged 65–70 years (p=0.007) and >70 years old (p=0.002) benefited significantly.ConclusionThis study suggests that postoperative engagement in PFME with biofeedback speeds up the recovery of continence in elderly patients (≥65 years old) that undergo RARP.

Device-assisted pelvic floor muscle postpartum exercise programme for the management of pelvic floor dysfunction after delivery

Background Pelvic floor dysfunction (PFD) is a multifactorial condition that clinically manifests as the pelvic prolapse, urinary and/or rectal incontinence, and sexual dysfunction. Aim We aimed to evaluate the efficacy of two pelvic floor trainers for the prevention of PFD in women during the postpartum period. Materials and methods This was a prospective, randomized, open-label study in 70 women in the postpartum period. Participants were randomized to complete a daily, 20-min set of pelvic floor muscle exercises using the EmbaGYN (UK; Group 1, n = 40) or the Magic Kegel Master device (China; Group 2, n = 40) for 4 weeks. All participants anonymously completed the PFDI-20 questionnaire and FSFI form at baseline and last visit. Pelvic floor muscle strength was measured using the XFT-0010 device. Results After the completion of the 4-week pelvic floor muscle exercise program, there was a significant decrease in the rates of all PFD symptoms including pelvic organ prolapse and urinary and/or fecal incontinence in both groups. The rates of sexual dysfunction after the exercise program decreased significantly only in Group II (69.4 versus 25.0%; р =.001). After the program, Group I showed a significant reduction in the number of women with symptoms of urgent urinary incontinence versus baseline (35.3 versus 8.8% p = .009). Similarly, the rates of urine loss associated with coughing, sneezing or laughing in Group I decreased from 41.2% at baseline to 11.8% after the program (р =.006) and the rates of urine leakage independent of physical activity from 23.5 to 5.9% (p = .040), respectively. Conclusion The 4-week postpartum pelvic floor muscle exercise program utilizing the EmbaGYN or Magic Kegel Master device has significantly increased the pelvic floor muscle strength and decreased the symptoms of pelvic organ prolapse, urinary and fecal incontinence. The use of the Magic Kegel Master device significantly reduced the symptoms of sexual dysfunction. The use of the EmbaGYN device was effective in addressing the individual symptoms of urinary incontinence.

Pelvic floor muscle training in radical prostatectomy: a randomized controlled trial of the impacts on pelvic floor muscle function and urinary incontinence

BackgroundPelvic floor muscle training (PFM) training for post-prostatectomy incontinence (PPI) is an important rehabilitative approach, but the evidence base is still evolving. We developed a novel PFM training program focussed on activating fast and slow twitch muscle fibres. We hypothesized that this training, which commenced pre-operatively, would improve PFM function and reduce PPI, when compared to a control group.MethodsThis randomized trial allocated 97 men (63 ± 7y, BMI = 25.4, Gleason 7) undergoing radical prostatectomy (RP) to either a control group (n = 47) performing low-volume rehabilitation, or an intervention group (n = 50). Both interventions commenced 5 weeks prior to surgery and continued for 12 weeks post-RP. Participants were assessed pre-operatively and at 2, 6 and 12 weeks post-RP using 24 h pad weights, International Prostate Symptom Score (IPSS), Expanded Prostate Cancer Index Composite for Clinical Practice (EPIC-CP) and real time ultrasound (RTUS) measurements of PFM function.ResultsFollowing RP, participants in the control group demonstrated a slower return to continence and experienced significantly more leakage (p < 0.05), measured by 24 h pad weight, compared to the intervention group, suggesting an impact of the prehabilitation protocol. PFM function measures were enhanced following RP in the intervention group. Secondary measures (IPSS, EPIC-CP and RTUS PFM function tests) demonstrated improvement across all time points, with the intervention group displaying consistently lower “bothersome” scores.ConclusionsA pelvic floor muscle exercise program commenced prior to prostate surgery enhanced post-surgical measures of pelvic floor muscle function, reduced PPI and improved QoL outcomes related to incontinence.Trial registrationThe trial was registered in the Australia New Zealand Clinical Trials Registry and allocated as ACTRN12617001400358. The trial was registered on 4/10/2017 and this was a retrospective registration.

Improvement of Urinary Incontinence, Life Impact, and Depression and Anxiety With Modified Pelvic Floor Muscle Training After Radical Prostatectomy

Prostate cancer ranks second among male cancers in the United States in terms of death rate. Robot-assisted surgery (RAS) is now offered as the standard surgical procedure performed for radical prostatectomy. Urinary incontinence and erectile dysfunction were common complications after RAS prostatectomy. Patients felt ill-prepared after surgery, resulting in negative impacts on their quality of life. Pelvic floor muscle exercise is prioritized for patients with mild-to-moderate incontinence. The purpose of this study was to examine the effects of using resistance band pelvic floor muscle exercise for patients after RAS prostatectomy. A preexperimental single-group study was conducted for this study. A total of 43 patients completed the program. Urinary incontinence scale, Incontinence Impact Questionnaire, and Hospital Anxiety and Depression Scale were assessed at 0.5 months, 1 month, 2 months, and 3 months after urinary catheter removal. The results revealed that urinary incontinence, life impact, and depression and anxiety improved significantly as time went on. This study suggests that using simple and easy-to-learn resistance band pelvic floor muscle exercise program at home can benefit patients financially and reduce travel time.

Is a 6-week supervised pelvic floor muscle exercise program effective in preventing stress urinary incontinence in late pregnancy in primigravid women?: a randomized controlled trial

ObjectiveThe study investigated the effect of a 6-week supervised pelvic floor muscle exercise (PFME) program to prevent stress urinary incontinence (SUI) at 38 weeks’ gestation. Study designWe conducted a randomized controlled trial into two arms design: one intervention group and one control group, using the randomly computer-generated numbers. A research assistant, who was not involved with care of the participants, randomly drawn up and opened the envelope for each participant to allocate into the intervention group and the control group. The investigators could not be blinded to allocation. Seventy primigravid women who had continent with gestational ages of 20–30 weeks were randomly assigned to participate in the intervention (n=35) and control groups (n=35). The intervention was a supervised 6-week PFME program with verbal instruction and a handbook, three training sessions of 45min with the main researcher (at 1st, 3rd and 5th week of the program) and self-daily training at home for an overall period of 6 weeks. The control condition was the PFME and the stop test had been trained by the main researcher to all of the participants in the intervention group. OutcomesThe primary outcome was self-reported of SUI, and the secondary outcome was the severity of SUI in pregnant women which comprises of frequency, volume of urine leakage and score of perceived severity of SUI in late pregnancy at 38th weeks of pregnancy. Statistical analysis was performed using Chi-square test, Independent-sample t-test, and Mann–Whitney U-test. Significance P-value was <0.05. ResultsAt the end of the intervention, 2 of 35 women in the intervention group and 5 of 35 women in the control group dropped out of the study. Therefore, the total of the study participants consisted of 63 pregnant women (33 in the intervention group and 30 in the control group). Fewer women in the intervention group reported SUI than the control group: 9 of 33 (27.3%) versus 16 of 30 (53.3%) at 38 weeks’ gestational age (OR 3.05, 95% CI 1.07–8.70, P=0.018). ConclusionsThe 6-week supervised PFME program was effective in preventing SUI and decreasing the SUI severity in pregnant women who reported SUI at late pregnancy. The women who performed PFME program under the training sessions once every two weeks found that the program demands less time, incurs lower costs and possibly offers more motivation to exercise. This 6-week supervised PFME program may be suitable in real clinical situation.

Investigation of Pelvic Floor Muscle Strength of the Women Admitted to the Gynecology Clinics and the Evaluation of Affecting Factors [Malatya Il Merkezinde Jinekoloji Polikliniklerine Basvuran Kadinlarin Pelvik Taban Kas Kuvvetinin Degerlendirilmesi ve Etkileyen Faktorlerin Incelenmesi

The aim of this study is to investigate the factors affecting pelvic floor muscle strength of the women admitted to the gynecology clinics in Malatya by evaluating their pelvic floor muscle strengths with perineometry device. This study is of a cross-sectional type. In the sample selection, stratified cluster sampling method was used. 430 women between the ages of 20-50 were included in the study. In the analysis process; Chi-square and logistic regression were used. In our study, the mean value of pelvic floor muscle strength has been found to be 31.4±9.6 cmH2O. According to results of this research, it has been found out that there are primary relational factors between having a normal or mixed births (OR=5.546, CI=2.58611.895), being at the age of 40 years and older (OR=3.484, CI=1.982-6.125) and pelvic floor muscle strength weakness (p<0.05). Conclusion: Pelvic floor muscle strength values have been found to be quite low. According to the results of this study, it can be suggested that primary health care staff should make informative studies to the individuals about risk factors negatively affecting pelvic floor muscle strength and exercise programs about pelvic floor muscles strength.

Comparison of abdominal muscle thickness with vaginal pressure changes in healthy women.

[Purpose] The purpose of this study was to verify the efficacy of a pelvic floor muscle exercise program by comparing subjects’ muscle thickness with changes in vaginal pressure. [Subjects] Two groups of female participants without a medical history of pelvic floor muscle dysfunction were evaluated. The mean age of Group I was 33.5 years and that of Group II was 49.69 years. [Methods] The participants were instructed to perform a pelvic floor muscle contraction. While measuring the vaginal pressure of the pelvic floor muscle, biofeedback was given on five levels, and the thicknesses of the transversus abdominis, external oblique, and internal oblique muscles were measured with ultrasound. [Results] The thickness of the transversus abdominis muscle was significantly increased at 30 cmH2O in Group I, and at 20 cmH2O in Group II. The thickness of the internal oblique abdominal muscle significantly increased at maximum contraction in Group II. [Conclusion] Different abdominal muscles contracted depending on vaginal pressure. The result may be used to create and implement an exercise program that effectively strengthens the pelvic floor muscles.

Chinese women's experiences of stress incontinence: a descriptive qualitative study

This study explored the perceptions of 35 Chinese women on the impact of stress urinary incontinence on their life and their adherence to pelvic floor muscle exercise program. Audiotaped interviews were conducted at a time and place convenient to them. Content analysis was used to extract significant categories that described their experience. The five major categories that emerged were: (i) perceptions of stress urinary incontinence; (ii) living with urinary incontinence; (iii) emotions and feelings; (iv) factors facilitating pelvic floor muscle exercise and (v) factors inhibiting pelvic floor muscle exercise program. The women who adhered and those who did not adhere to pelvic floor muscle exercised were similar in the two categories of living with urinary incontinence, and emotions and feelings. However, there were great differences between the perceptions of the two groups in three categories on perceptions of urinary incontinence, factors facilitating and inhibiting the performance of pelvic floor muscle exercise.

Comparison of Abdominal Muscle Activities with Vaginal Pressure Changes in Healthy Women

[Purpose] The purpose of this study was to verify the effect of a Pelvic Floor Muscle exercise program by comparing muscle activities at different ages, using biofeedback to regulate vaginal pressure. [Subjects] Two groups of female participants without medical history of pelvic floor muscle dysfunction were evaluated. The mean age of Group I was 33.5 years and that of Group II 49.69 years. [Methods] Participants were instructed to perform the pelvic floor muscle exercise. Biofeedback was given for vaginal pressure of the pelvic floor muscles, and we measured the activities of the rectus abdominis, external oblique, and internal oblique muscles by electromyogram at 5 different levels of vaginal pressure. [Results] In Group II, as the vaginal pressure increased, the internal oblique values showed significant differences. When the vaginal pressure was 20 cmH2O, 30 cmH2O, and Maximum, the muscle activities of Group II increased significantly more than in Group I. [Conclusion] When the pelvic floor muscles were contracted, Group I showed greater differences in the internal oblique muscle activity than Group II.

Nursing intervention to enhance efficacy of home practice of pelvic floor muscle exercises in treating mixed urinary incontinence

This study was conducted to evaluate nursing intervention to enhance the efficacy of a home-based pelvic floor muscle exercise (PFME) in treating mixed urinary incontinence among a community-based population. Eighty-eight women with mixed incontinence were recruited for this study and were asked to practice PFME at home as instructed. A registered nurse monitored the study group via telephone checkups twice a week. The Symptoms (LUTS) Questionnaire and a disease-specific questionnaire of impact index were used for repeat measurements before intervention, at 3 and 6 months after PFME. Symptoms such as frequency, nocturia, urge incontinence, and urinary stress incontinence improved significantly in the study group at 6 months. Quality of life with regard to worry about pads/towels leakage and getting wet also improved in the study group at 6 months. Nursing intervention can significantly improve the efficacy of a home-based PFME program in community women with mixed storage symptoms.

Incontinent Women Have Altered Pelvic Floor Muscle Contraction Patterns

Pelvic floor exercises are invaluable for regaining continence but mechanisms are not fully understood. To contribute to the understanding of these mechanisms we investigated the contraction sequence of superficial vs deep pelvic floor muscles in 6 positions in continent and incontinent women. The onset of contraction of the superficial and deep pelvic floor muscles was recorded by perineal and intravaginal surface electromyography in 32 continent and 50 incontinent women. The agreement between perineal and intravaginal recordings was calculated with the kappa statistic and the percent of agreement. Differences in onset between superficial and deep pelvic floor muscle contractions are reported as the median and IQR. Perineal and intravaginal electromyography recordings used to define the onset of muscle activity showed a high level of agreement. In the continent group the superficial muscles almost always contracted before the deep muscles in all 6 positions. In the incontinent group the reverse sequence was observed in 3 of 6 positions. Higher and less consistent time differences in the onset of contraction of the 2 muscle layers were found in incontinent vs continent women. Contractions of the superficial and deep pelvic floor muscles can be recorded by intravaginal or perineal electrodes. A consistent contraction sequence can be found in continent women but it is lacking in incontinent women. This might be a possible explanation for incontinence. Including differentiated muscle contraction exercises in pelvic floor muscle exercise programs may further optimize treatment outcomes.

Management of Stress Urinary Incontinence With Surface Electromyography–Assisted Biofeedback in Women of Reproductive Age

Although surgery has been widely accepted as the treatment of choice for stress urinary incontinence (SUI), there has recently been an increased interest in the conservative management of this condition. The aims of this study were to test the ability of a biofeedback-assisted pelvic-floor muscle exercise (PFME) program to affect symptoms of SUI in premenopausal women and to evaluate a training program that might lead to successful outcomes in a relatively limited number of sessions. Twenty-six women with SUI were treated with PFME with surface electromyography (sEMG)-assisted biofeedback. All participants were of reproductive age and were treated individually for 12 sessions. results were evaluated with a 7-day voiding diary, a 1-hour pad test, pelvic-floor muscle strength measurements, sEMG amplitudes, a leakage index, and a quality-of-life questionnaire. These variables were compared before and after the intervention. The frequency of urine loss, the occurrence of nocturia, and the number of pads required decreased significantly after the intervention. Objective cure was found in 61.5% of women. There was a significant improvement in the quality of life, in pelvic-floor muscle strength, and in the sEMG amplitudes of all contractions throughout the intervention. A relatively short-term intervention of PFME with sEMG-assisted biofeedback appeared to be helpful in relieving symptoms of SUI in premenopausal women and represents a reasonable conservative management option.

A pelvic floor muscle exercise programme for urinary incontinence following childbirth

This information on best practice is based on a systematic review conducted by the Western Australian Centre for Evidence Based Nursing and Midwifery, a collaborating centre of the Joanna Briggs Institute. Full details of the studies included in the systematic review are in the report The Effectiveness of a Pelvic Floor Muscle Exercise Program on Urinary Incontinence Following Childbirth (Haddow et al 2005) available online via Blackwell Synergy: www.blackwell-synergy.com and to members of the institute via the web site: www.joannabriggs.edu.au This information sheet discusses the following: > Antenatal and postnatal pelvic floor muscle exercises (PFME). > Timing and types of PFME programme. > Implications for practice. > Recommendations.

Effectiveness of a pelvic floor muscle exercise program on urinary incontinence following childbirth

Effectiveness of a pelvic floor muscle exercise program on urinary incontinence following childbirth

Effectiveness of a pelvic floor muscle exercise program on urinary incontinence following childbirth

Effectiveness of a pelvic floor muscle exercise program on urinary incontinence following childbirth