Effectiveness of an illustrated home exercise guide on promoting urinary continence during pregnancy: a pragmatic randomized clinical trial

Abstract

ResumoOBJETIVO: Avaliar a efetividade de um manual de orientação de exercícios domiciliares (MOED) para o assoalho pélvico (AP) na promoção da continência urinária em gestantes primigestas. MÉTODOS: Ensaio clínico com 87 participantes, avaliadas 6 vezes durante a gestação e divididas aleatoriamente em 3 grupos: Grupo supervisionado (Gsup), que praticou exercícios com supervisão; Grupo observado (Gobs), que praticou exercícios sem supervisão, e Grupo referência (Gref), que não praticou exercícios. Incontinência urinária (IU) (desfecho primário) e força muscular perineal (FMP) (desfecho secundário) foram avaliadas por intermédio de diário de perdas urinárias e perineometria, respectivamente. Foram utilizados o teste de Kruskal-Wallis, seguido do teste post hoc de Dunn, para variáveis contínuas, e o teste do χ 2 e testes Z, com correções de Bonferroni, para proporções, com nível de significância de 5%. RESULTADOS: O Gsup e o Gobs apresentaram 6,9% de gestantes incontinentes, enquanto o Gref apresentou 96,6% de incontinentes. Quanto à FMP, o Gsup e o Gobs apresentaram valores médios de contração de 10 e 8,9 cmH 2 O, respectivamente, enquanto o Gref apresentou valor de 4,7 cmH 2 O. Ambos os resultados significantes. CONCLUSÃO: A utilização de um MOED é eficaz na promoção da continência urinária e no aumento da FMP em gestantes primigestas, independentemente de supervisão permanente. Registro no clinicaltrials.gov -NCT00740428Abstract PURPOSE: To evaluate the effectiveness of an illustrated home exercise guide targeting the pelvic floor muscles in promoting urinary continence during pregnancy. METHODS: A randomized clinical trial was performed with 87 participants, evaluated six times during pregnancy and divided into three groups: Gsup, supervised; Gobs, not supervised, and Gref, women who did not perform the home exercises program. A miction diary and perineometry were used to evaluate urinary incontinence (primary outcome) and pelvic floor muscle strength (secondary outcome), respectively. The Kruskal-Wallis test with post hoc Dunn's and chi-square and Z tests with Bonferroni correction were used for continuous variables and proportions, respectively, with the level of significance set at 5%. RESULTS: At the end of the study, 6.9% of pregnant women in the Gsup and Gobs had urinary incontinence, while 96.6% of Gref women were incontinent. Regarding pelvic floor muscle function, Gsup and Gobs had mean contractions of 10 and 8.9 cmH 2 O, respectively, while Gref had a value of 4.7 cmH 2 O. Both results were significant. CONCLUSION: An illustrated home exercise guide targeting the pelvic floor muscles is effective in promoting urinary continence during pregnancy, even without permanent supervision. clinicaltrials.gov Registry -NCT00740428

Systematic review of pelvic floor interventions during pregnancy

“…One study compared supervised PFMT with unsupervised PFMT and found no difference in urinary incontinence either during pregnancy or postpartum (12‐month follow‐up). The pelvic floor muscle strength was assessed in five trials, with three studies reporting a strength increase in the intervention group. The studies that analyzed anal incontinence did not demonstrate differences between the groups.…”

“…The strength of the pelvic floor muscles can decrease during pregnancy and after delivery, owing to physiological processes and changes in the anatomical position of the pelvis and in the shape of the pelvic floor muscles. This decrease in muscle strength facilitates the appearance of musculoskeletal alterations, leading to urinary incontinence, perineal laceration, and dyspareunia …”

“…This decrease in muscle strength facilitates the appearance of musculoskeletal alterations, leading to urinary incontinence, perineal laceration, and dyspareunia. 1,2 Perineal laceration during delivery is also associated with considerable postpartum morbidity and raises the incidence of pelvic floor dysfunction. Nulliparous women are at high risk for perineal laceration.…”

Are Home Based Pelvic Floor Muscle Exercises (PFMES) Effective in Prevention of Stress Urinary Incontinence During Pregnancy? A Randomized Controlled Trial

“…Prevalence of UI in Pakistan is estimated to be 45% in pregnant and 10.6% in postpartum women [4,5]. The annual cost in the treatment of UI in United States (US) range from 16-65 billion dollars [6].…”

“…It has no reported side effects, is less time consuming and is cost effective. ICS advises PFMEs as the first line treatment for SUI [6].…”