Postpartum Pelvic Floor Muscle Training Research Articles

Antepartum pelvic floor muscle training (PFMT) plus perineal massage vs. postpartum PFMT alone: analysis of pelvic floor disorders, Quality of Life and sexual function.

The aim of this study was to analyze how antepartum pelvic floor muscle training (PFMT) plus perineal massage associated with postpartum PFMT have a significant impact on pelvic floor health during pregnancy and after delivery. One thousand two hundred thirty-three women were enrolled from January 2019 to December 2021. They were divided into two groups: 786 women underwent postpartum PFMT only, 447 women experienced both prepartum perineal massage and PFMT and postpartum PFMT. The primary endpoint was to evaluate prepartum perineal massage and PFMT's impact on delivery. The second endpoint was the evaluation of Quality of Life and sexual function at 3- and 12-months follow-up after delivery. Women who underwent prepartum PFMT experienced significantly lower percentage of episiotomy, high-grade obstetric tear or instrumental delivery and higher percentage of intact perineum. Furthermore, prepartum PFMT appeared to improve sexual function at 3 months follow-up, and it was associated with an earlier first sexual intercourse after childbirth. The incidence of stress urinary incontinence was significantly higher in women who experienced PFMT only in postpartum, both at 3- and 12-months follow-up, while the other examined clinical parameters did not show a significant difference. Prepartum PFMT has a role in preventing obstetric traumas and on improving Sexual Function and Quality of Live in the immediate postpartum. Moreover, prepartum PFMT in association with postpartum PFMT reduces the incidence of stress urinary incontinence in a higher percentage than postpartum PFMT only.

The Effect of Postpartum Pelvic Floor Muscle Training on Female Sexual Function: A Randomized Controlled Clinical Trial

According to the high prevalence of sexual disorders, this study was performed to determine the effects of pelvic floor muscle training on sexual function in postpartum women. A pragmatic, multi-center, single-blind, non-inferiority randomized controlled trial (RCT), women with sexual dysfunction at 3 to 6 months postpartum were divided into two groups: the pelvic floor muscle training intervention for two sessions, once a week for two hours (n = 40), and the postpartum usual care (PUC) group (n = 40), who was referred to healthcare centers in Babol from December 2020 to May 2021. They were randomly assigned to the two groups. Demographic information and the Female Sexual Function Index (FSFI) were used. After 8 weeks, all participants completed the FSFI again. Data were analyzed using an analysis of covariance (ANCOVA), with p ≤ 0.05 considered significant. There were no significant differences in baseline characteristics and pre-intervention FSFI scores. But after 8 weeks, the FSFI total scores (p = 0.001) and the scores of subscales such as desire (p = 0.001), arousal (p < 0.001), orgasm (p = 0.009), and satisfaction (p = 0.004) were significantly higher in the intervention group than in the PUC group. Pelvic floor muscle training can improve a woman’s sexual function after childbirth.

Postpartum Pelvic Floor Muscle Training for Reducing Urinary Incontinence: A Systematic Review of Randomized Control Trials

Postpartum urinary incontinence is an increasingly prevalent problem for women, as it affects about one-third of women. The clinical significance of urine incontinence in relation to deficiencies in the active and passive pelvic floor structures is well recognized. Hence, pelvic floor muscle training (PMFT) treatment for urine incontinence is recommended. Several research studies suggest that PFMT prevents and treats pregnancy- and delivery-related urine incontinence. This study aimed to determine the effectiveness of postpartum PFMT for the treatment of urinary incontinence. Randomized control trials reporting the efficiency of PFMT among postpartum women from 2003–2023 were included. Studies including pregnant women or women who underwent any surgical intervention, along with studies describing pharmacological interventions and others apart from PFMT or PFMT with electrostimulation or biofeedback, were excluded. Additionally, studies with insufficient or unclear data regarding pregnancy outcomes were excluded. A Cochrane bias risk assessment tool was utilized to assess the quality of the studies. Final inclusion resulted in 7 studies that recruited 1398 patients. Four of the included trials assessed the endurance and strength of PFMT, and various rates of strength and endurance were observed among participants in both the intervention and control groups. The prevalence of urinary incontinence in comparison to the control group was observed to be lower in the intervention group, which demonstrates the beneficial role of PFMT in the management of urinary incontinence postpartum. There is strong evidence to suggest the effectiveness of PFMT in the management of postpartum urinary incontinence. However, this beneficial role of PFMT is often overlooked or under-described in clinical practice, for which awareness among clinicians and patients is vital. Additionally, awareness and planning for PFMT execution during antenatal visits can also help prevent urinary incontinence postpartum.

Antenatal, Intrapartum and Postpartum Interventions for Preventing Postpartum Urinary and Faecal Incontinence: An Umbrella Overview of Cochrane Systematic Reviews.

Post-partum, women can suffer from urinary and faecal incontinence. It is important to assess interventions to prevent this problem. Cochrane systematic reviews summarize the data available from systematic reviews of randomized trials assessing interventions. We conducted an umbrella overview of Cochrane systematic reviews encompassing antenatal, intrapartum and postpartum interventions for preventing postpartum urinary and faecal incontinence. We searched the Cochrane Database of Systematic Reviews on the 9 May 2023. Results: Our search identified nine Cochrane reviews providing results. Data for urinary and faecal incontinence were available from 77 (72%) trials and included 51,113 women. The reviews assessed antenatal digital perineal massage, pelvic floor muscle training, techniques for repairing anal sphincter tears, routine use of episiotomy, use of endoanal ultrasound prior to repairing perineal tears, caesarean versus vaginal delivery (overall, for breech and for twins), and vaginal delivery with forceps or vacuum. Only the use of a vacuum instead of forceps if an assisted vaginal delivery is needed, the use of an endo-anal ultrasound prior to repairing perineal tears and postpartum pelvic floor muscle training suggest a reduction in postpartum incontinence. Due to the small number of relevant reviews, a consequence of the relatively small number of primary studies, the effect of almost all the tested interventions was found to be imprecise.

Postpartum pelvic floor muscle training, levator ani avulsion and levator hiatus area: a randomized trial

Introduction and hypothesisVaginal delivery may lead to tearing of the levator ani (LA) muscle from its bony insertions (complete LA avulsion) and increased levator hiatus (LH) area, both risk factors for pelvic floor dysfunctions. Early active rehabilitation is standard treatment after musculo-skeletal injury. We hypothesized that pelvic floor muscle training (PFMT) early postpartum would reduce the presence of LA avulsions and reduce LH area.MethodsWe carried out a planned secondary analysis from a randomized controlled study. Primiparous women (n=175) giving birth vaginally were included 6 weeks postpartum, stratified on complete LA avulsion, and thereafter randomized to PFMT or control. The training participants (n=87) attended a supervised PFMT class once a week and performed home-based PFMT daily for 16 weeks. The control participants (n=88) received no intervention. Presence of complete LA avulsion, LH area at rest, maximal contraction, and maximal Valsalva maneuver were assessed by transperineal ultrasound. Between-group comparisons were analyzed by analysis of covariance for continuous data, and relative risk (RR) for categorical data.ResultsSix months postpartum, the number of women who had complete LA avulsion was reduced from 27 to 14 within the PFMT group (44% reduction) and from 28 to 17 within the control group (39% reduction). The between-group difference was not significant, RR 0.85 (95% CI 0.53 to 1.37). Further, no significant between-group differences were found for LH area at rest, during contraction, or Valsalva.ConclusionsSupervised PFMT class combined with home exercise early postpartum did not reduce the presence of complete LA avulsion or LH area more than natural remission.

Prevention of Stress Urinary Incontinence in Women

Lower urinary tract dysfunction (LUTD), including stress urinary incontinence (SUI), is increasingly recognized as a public health issue due to the prevalence, individual burden, and societal impact. Women are disproportionately affected by UI and are exposed to unique events that affect LUT function including higher rates of LUT infection, childbirth, pelvic floor anatomic changes, and hormonal milieu. The majority of LUTD research and clinical practice has focused on treatment of the most affected subset of women, but there are millions of women living with urinary incontinence that do not seek advice or treatment, and the evidence base for prevention or detection of early symptoms is lacking. Individual factors such as sociodemographic elements, medical history, physical exam, and comorbidities have been well studied; however, the contribution of family and environmental factors is less well understood. Emerging data suggests that some types of high-impact physical activity in adolescence can confer increased UI risk later in life. Prenatal and postpartum pelvic floor muscle training appears to be beneficial in preventing SUI in some women. While certain individual risk factors for SUI have been identified, sociocontextual factors also affect health outcomes and can mediate an individual’s risk of disease. The social ecological model considers factors within the family/peer, community, and societal levels that can affect an individual’s health behaviors. Prevention research that investigates these multiple levels of influence on individual biology and behavior is a fundamental step to better understand the complex factors that impact bladder health and inform LUTS prevention agendas. In addition, strategies to educate girls and women and engage communities in bladder health promotion are essential in order to effectively disseminate scientific findings and implement intervention programs.

Exploring the Impact of a Mobile Health Solution for Postpartum Pelvic Floor Muscle Training: Pilot Randomized Controlled Feasibility Study.

BackgroundThe postpartum period is a vulnerable time for the pelvic floor. Early implementation of pelvic floor muscle exercises, appropriately termed as pelvic floor muscle training (PFMT), in the postpartum period has been advocated because of its established effectiveness. The popularity of mobile health (mHealth) devices highlights their perceived utility. The effectiveness of various mHealth technologies with claims to support pelvic floor health and fitness is yet to be substantiated through systematic inquiry.ObjectiveThe aim of this study was to determine the acceptability, feasibility, and potential effect on outcomes of an mHealth device purposed to facilitate pelvic floor muscle training among postpartum women.MethodsA 16-week mixed methods pilot study was conducted to evaluate outcomes and determine aspects of acceptability and feasibility of an mHealth device. All participants received standardized examination of their pelvic floor muscles and associated instruction on the correct performance of PFMT. Those randomized to the iBall intervention received instructions on its use. Schedules for utilization of the iBall and PFMT were not prescribed, but all participants were informed of the standard established recommendation of PFMT, which includes 3 sets of 10 exercises, 3 to 4 times a week, for the duration of the intervention period. Quantitative data included the measurement of pelvic floor muscle parameters (strength, endurance, and coordination) following the PERFECT assessment scheme: Incontinence Impact Questionnaire scores and the Urogenital Distress Inventory (UDI-6) scores. Aspects of acceptability and feasibility were collected through one-to-one interviews. Interview transcripts were analyzed using Thorne’s interpretive description approach.ResultsA total of 23 women with a mean age of 32.2 years were randomized to an intervention group (n=13) or a control group (n=10). Both groups improved on all measures. The only statistically significant change was the UDI-6 score within both groups at 16 weeks compared with baseline. There was no statistically significant difference between the intervention group and control group on any outcomes. Most participants using the iBall (n=10, 77%) indicated value in the concept of the mHealth solution. Technical difficulties (n=10, 77%), a cumbersome initiation process (n=8, 61%), and discomfort from the device (n=8, 61%) were reasons impeding intervention acceptability. Most participants (n=17, 74%) indicated that the initial assessment and training was more useful than the mHealth solution, a tenet that was echoed by all control group participants.ConclusionsOur pilot study demonstrated the potential for mHealth solution–enhanced PFMT in the early postpartum period. Usability issues in hardware and software hindered feasibility and acceptance by the participants. Our findings can inform the redesign of mHealth solutions that may be of value if acceptability and feasibility issues can be overcome.Trial RegistrationClinicalTrials.gov NCT02865954; https://clinicaltrials.gov/ct2/show/NCT02865954

A feasibility study of the postpartum pelvic floor muscle training program using vaginal palpation by midwives

A feasibility study of the postpartum pelvic floor muscle training program using vaginal palpation by midwives

Pelvic Floor Muscle Training Versus Watchful Waiting and Pelvic Floor Disorders in Postpartum Women: A Systematic Review and Meta-analysis

Pelvic floor muscle training (PFMT) is often recommended to treat postpartum urinary incontinence (UI). However, the role of postpartum PFMT in pelvic organ prolapse (POP), sexual function, and anal incontinence (AI) remains unclear. We therefore aim to assess the efficacy of postpartum PFMT on these pelvic floor disorders. This study is a meta-analysis consisting of randomized controlled trials (RCTs). We searched databases including CENTRAL, MEDLINE, EMBASE, CINAHL, and PEDro. We also sought after grey literature including conference proceedings. We included RCTs comparing PFMT versus watchful waiting in women with stage II or less POP within 1 year postpartum. Two authors independently performed study screening, risk of bias assessments, and data extraction. Fifteen RCTs (3845 patients) were included. Women undergoing PFMT less likely report bothersome POP symptoms (risk ratio [RR], 0.48 [0.30-0.76]; very low-quality evidence). There is no significant difference in the number of women with stage II or greater POP (RR, 0.74 [0.45-1.24]; moderate-quality evidence). Fewer women receiving PFMT report the presence of sexual dysfunction (RR, 0.48 [0.30-0.77]; low-quality evidence). There is no significant difference in AI symptoms (RR, 1.11 [0.82-1.51]), but PFMT may be more beneficial for women with anal sphincter injuries (standardized mean differencein AI scores, -0.57 [-1.12 to -0.02]; low-quality evidence). Women receiving PFMT less likely report UI (RR, 0.44 [0.25-0.75]; moderate-quality evidence) with a more pronounced effect on stress UI (SUI). At present, it remains uncertain whether postpartum PFMT improves POP symptoms because of very low-quality evidence, and more high-quality RCTs are needed in this area. The POP staging will likely not change with postpartum PFMT. The PFMT may result in improved postpartum sexual function compared to watchful waiting, and may provide benefit for AI in women with anal sphincter injuries. Postpartum PFMT likely reduces the risk of UI, particularly stress urinary incontinence symptoms. There is currently little evidence about postpartum PFMT and long-term pelvic floor function.

Effect of postpartum pelvic floor muscle training on vaginal symptoms and sexual dysfunction-secondary analysis of a randomised trial.

Evaluate effect of pelvic floor muscle training (PFMT) on vaginal symptoms and sexual matters, dyspareunia and coital incontinence in primiparous women stratified by major or no defects of the levator ani muscle. Randomised controlled trial (RCT). Akershus University Hospital, Norway. About 175 primiparous women with a singleton vaginal delivery. Two-armed assessor blinded parallel group RCT from 6 weeks to 6 months postpartum comparing effect of PFMT versus control. International Consultation on Incontinence Modular Questionnaire-vaginal symptoms questionnaire (ICIQ-VS) and ICIQ sexual matters module (ICIQ-FLUTSsex). Overall, analysis (n = 175) showed no difference between training and control groups in women having vaginal symptoms or symptoms related to sexual dysfunction 6 months postpartum. The majority of women (88%) had intercourse and there was no difference between groups. Unadjusted subgroup analysis of women with a major defect of the levator ani muscle (n = 55) showed that women in the training group had 45% less risk of having the symptom 'vagina feels loose or lax' compared with the control group (relative risk 0.55, 95% confidence interval 0.31, 0.95; P = 0.03). Unadjusted analysis showed that in women with major defect of the levator ani muscle, significantly fewer in the training group had the symptom 'vagina feels loose or lax' compared with the control group. No difference was found between groups for symptoms related to sexual dysfunction. More studies are needed to explore effect of PFMT on vaginal symptoms and sexual dysfunction. Unadjusted analysis shows that PFMT might prevent symptoms of 'vagina feels loose or lax'.

Postpartum pelvic floor muscle training and pelvic organ prolapse—a randomized trial of primiparous women

Pelvic organ prolapse (POP) is a common and distressing condition. The aim of the present study was to evaluate the effect ofpelvic floor muscle training (PFMT) on prevention and treatment ofsymptoms and signs of POP in primiparous postpartum women. This was a parallel group assessor blind randomized controlled trial. One hundred seventy-five primiparous postpartum women, mean age 29.8 years (standard deviation 4.1), stratified on major levator ani defects or no defect diagnosed by 3-/4-dimensional ultrasound, participated in a 4-month PFMT starting at 6-8 weeks' postpartum or control. All participants had thorough individual instruction and assessment of ability to perform correct pelvic floor muscle contractions. The PFMT group followed a supervised, weekly group training program and performed 3 sets of 8-12 daily maximal contractions at home. Main outcome was POP stage II or greater assessed by POP quantification and bladder neck position assessed by 3-/4- dimensional transperineal ultrasonography. Secondary outcome was symptoms of vaginal bulge using International Consultation on Incontinence Vaginal Symptoms questionnaire. Ninety-six percent of the intervention group adhered to ≥80% of both group and home training sessions. At postintervention, there was no significant risk difference in POP (rational ratio, 1.62; 95% confidence interval, 0.55-4.75), bladder neck position or symptoms of vaginal bulging. No effect was found of postpartum PFMT on POP in primiparous women. More randomized controlled trials are needed before strong conclusions can be drawn on the effect of PFMT on POP in the particular population.

Postpartum Pelvic Floor Muscle Training and Urinary Incontinence: A Randomized Controlled Trial

Postpartum Pelvic Floor Muscle Training and Urinary Incontinence: A Randomized Controlled Trial

Postpartum Pelvic Floor Muscle Training and Urinary Incontinence

To evaluate whether postpartum pelvic floor muscle training decrease prevalence of any urinary incontinence (UI) in primiparous women with and without UI at inclusion (mixed population) and further to perform stratified analyses on women with and without major levator ani muscle defects. A two-armed assessor-blinded randomized controlled trial including primiparous women 6 weeks after vaginal delivery was conducted. Participants were stratified on major levator ani muscle defects, verified by transperineal ultrasonography, and thereafter randomly allocated to training or control. All participants were taught to contract the pelvic floor muscles. The control participants received no further intervention, whereas training participants attended a weekly supervised pelvic floor muscle training class and performed daily home exercise for 16 weeks. Primary outcome was self-reported UI analyzed by relative risk. We included 175 women, 55 with major levator ani muscle defects and 120 without. Prevalence of UI at baseline was 39.1% in the training group (n=87) and 50% among those in the control group (n=88). Fifteen women (8.6%) were lost to follow-up. At 6 months after delivery (postintervention), 34.5% and 38.6% reported UI in the training and control groups, respectively. Relative risk analysis of UI gave a nonsignificant effect size of 0.89 (95% confidence interval [CI] 0.60-1.32). Results were similar for the stratum with and without major levator ani muscle defects, 0.89 (95% CI 0.51-1.56) and 0.90 (95% CI 0.53-1.52), respectively. Postpartum pelvic floor training did not decrease UI prevalence 6 months after delivery in primiparous women. Stratified analysis on women with and without major levator ani muscle defects showed similar nonsignificant results. ClinicalTrials.gov, www.clinicaltrials.gov, NCT01069484. : I.

Which women do pelvic floor muscle exercises six months’ postpartum?

This study was undertaken to estimate the association between pelvic floor muscle training and demographic and health related factors that may influence pelvic floor muscle training postpartum. This analysis includes the first 17,978 women enrolled in the Norwegian Mother and Child Cohort Study who answered questions about pelvic floor muscle training (n = 17,744). We used logistic regression analyses, and the results are presented as crude and adjusted odds ratios with 95% CI. Women doing regular pelvic floor muscle training were more educated, likely to participate in general fitness activities, and had more children. Women experiencing urinary leakage and pelvic girdle pain postpartum were also more likely to do pelvic floor muscle training (adjusted odds ratio = 1.26, 95% CI 1.18-1.35; adjusted odds ratio = 1.31, 95% CI 1.23-1.39). Those who smoked daily or were delivered by cesarean were less likely to do pelvic floor muscle training (adjusted odds ratio = 0.81, 95% CI 0.72-0.91; adjusted odds ratio = 0.56, 95% CI 0.51-0.61). There is a need for more research concerning effective strategies to enhance postpartum pelvic floor muscle training.