Pelvic floor muscle training for prevention and treatment of urinary and faecal incontinence in antenatal and postnatal women [Meta-Analysis Review]

Rehabilitation Teaching and Research Unit, Department of Medicine, Wellington School of Medicine and Health Sciences, University of Otago, PO Box 7343, Wellington South, Wellington, New Zealand.
Cochrane database of systematic reviews (Online) (Impact Factor: 6.03). 02/2008; 10(4):CD007471. DOI: 10.1002/14651858.CD007471
Source: PubMed


About a third of women have urine leakage, and up to a tenth of women leak stool (faeces), after childbirth. Pelvic floor muscle training is commonly recommended during pregnancy and after birth for prevention and treatment of incontinence. This is a programme of exercises that women can do several times a day to strengthen their pelvic floor muscles. They are usually taught by a health professional such as a physiotherapist. The review of trials showed that women who do not leak urine while pregnant can reduce urine leakage for the first six months after childbirth by doing the exercises during and after pregnancy. Exercises can also help women who do leak urine after the birth and they may help them leak less stool. They may be helpful for women who are at higher risk of urine leakage, such as after having a large baby or a forceps delivery. However, there was not enough evidence to say if these effects last after the first year.

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    • "In relation to the prevention and control of UI during pregnancy, these findings are in agreement with the results of a systematic review [10] that showed that nulliparous women are able to avoid UI in pregnancy by performing PFMT. Maybe, the fact that women in the BPP group had received information regarding pelvic floor muscle and PFMT resulted in increased awareness and consequently in reduced urinary leakage [25]. "
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    ABSTRACT: Antenatal preparation programmes are recommended worldwide to promote a healthy pregnancy and greater autonomy during labor and delivery, prevent physical discomfort and high levels of anxiety. The objective of this study was to evaluate effectiveness and safety of a birth preparation programme to minimize lumbopelvic pain, urinary incontinence, anxiety, and increase physical activity during pregnancy as well as to compare its effects on perinatal outcomes comparing two groups of nulliparous women. Method: A randomized controlled trial was conducted with 197 low risk nulliparous women aged 16 to 40 years, with gestational age [greater than or equal to] 18 weeks. Participants were randomly allocated to participate in a birth preparation programme (BPP; n=97) or a control group (CG; n=100). The intervention was performed on the days of prenatal visits, and consisted of physical exercises, educational activities and instructions on exercises to be performed at home. The control group followed a routine of prenatal care. Primary outcomes were urinary incontinence, lumbopelvic pain, physical activity, and anxiety. Secondary outcomes were perinatal variables. Results: The risk of urinary incontinence in BPP participants was significantly lower at 30 weeks of pregnancy (BPP 42.7%, CG 62.2%; relative risk [RR] 0.69; 95% confidence interval [CI] 0.51-0.93) and at 36 weeks of pregnancy (BPP 41.2%, CG 68.4%; RR 0.60; 95%CI 0.45-0.81). Participation in the BPP encouraged women to exercise during pregnancy (p=0.009). No difference was found between the groups regarding to anxiety level, lumbopelvic pain, type or duration of delivery and weight or vitality of the newborn infant. Conclusions: The BPP was effective in controlling urinary incontinence and to encourage the women to exercise during pregnancy with no adverse effects to pregnant women or the fetuses.
    BMC Pregnancy and Childbirth 07/2013; 13(1):154. DOI:10.1186/1471-2393-13-154 · 2.19 Impact Factor
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    • "Worldwide, the World Health Organisation (WHO) report that one third of women have urinary incontinence after childbirth 3. Supervised pelvic floor muscle training (PFMT) or ‘pelvic floor exercise’ aims to strengthen these muscles to help treat and prevent UI. Evidence suggests the more the pelvic floor is exercised the better the result 3. "
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    ABSTRACT: Background: We aim to evaluate if Pelvic Floor Muscle Training (PFMT) delivered in primary care results in fewer referrals to secondary care for urinary incontinence (UI), thereby reducing the number and associated costs of surgical procedures for UI. Methods / design: The study will consist of two populations – a prevention group and a treatment group who will both be offered PFMT in primary care. The prevention group will consist of parous women aged 25-64 attending for a routine cervical smear. Their pelvic floor will be assessed using the Modified Oxford Scale (MOS) and a baseline data form will be completed that asks about the frequency and associated bother of urine leakage. From the answers given, the group will be subdivided into two groups. The first (prevention) group will be subdivided into a primary prevention arm (no symptoms of urinary incontinence and pelvic floor strength ≤2 on MOS) and a secondary prevention arm (women reporting symptoms of urine leakage irrespective of MOS). The second (treatment) group will be women of any age who may or may not have had a vaginal birth presenting to their GP with UI. Semi-structured, in-depth interviews will be conducted with a subset of patients and staff with the aim of identifying barriers and facilitators in delivering PFMT in primary care. Discussion: A recently completed community study showed good outcomes with practice nurse delivery of PFMT. We suggest if this were to be implemented more widely it would reduce the need for referral to secondary care. We believe that this study will show whether implementing a package of PFMT delivered in primary care can treat as well as prevent UI and will also be helpful in exploring the benefits / drawbacks of such implementation, thus providing lessons for implementation in other Primary Care Trusts (PCTs).
    F1000 Research 02/2013; 2. DOI:10.12688/f1000research.2-47.v1
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    • "is condition has been found to be a barrier to participation in physical activity due to embarrassment , feeling of discomfort, and possible increased leakage [48]. It is strong evidence that pelvic �oor muscle training can prevent and treat urinary continence, and this should be taken into account when designing exercise program for women in all age groups, with extra emphasis during pregnancy [49] "
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    ABSTRACT: Background: The transtheoretical model (TTM) has been successful in promoting health behavioral change in the general population. However, there is a scant knowledge about physical activity in relation to the TTM during pregnancy. Hence, the aims of the present study were (1) to assess readiness to become or stay physically active according to the TTM and (2) to compare background and health variables across the TTM. Methods: Healthy pregnant women (n = 467) were allocated to the study from Oslo University Hospital, Norway. The participants filled in a validated self-administered questionnaire, physical activity pregnancy questionnaire (PAPQ) in gestation, weeks 32-36. The questionnaire contained 53 questions with one particular question addressing the TTM and the five stages: (1) precontemplation stage, (2) contemplation stage, (3) preparation stage, (4) action stage, and (5) maintenance stage. Results: More than half of the participants (53%) were involved in regular exercise (stages 4-5); however, only six specified that they had recently started an exercise program (stage 4). About 33% reported engaging in some physical activity, but not regularly (stage 3). The results showed that receiving advice from health professionals to exercise during pregnancy increased the likeliness of being in stages 4-5, while higher age, multiparity, pregravid overweight, unhealthy eating habits, pelvic girdle pain, and urinary incontinence were more prevalent with low readiness to change exercise habits (stages 1-3). Conclusion: According to the TTM, more than half of the participants reported to be physically active. Moreover, most of the participants classified as inactive showed a high motivational readiness or intention to increase their physical activity level. Hence, pregnancy may be a window of opportunity for the establishment of long-term physical activity habits.
    Journal of pregnancy 02/2013; 2013(2):193170. DOI:10.1155/2013/193170
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