Effect of pelvic floor muscle training during pregnancy and after childbirth on prevention and treatment of urinary incontinence: a systematic review

Abstract

This file was dowloaded from the institutional repository Brage NIH -brage.bibsys.no/nih Mørkved, S., Bø, K. (2014). Effect of pelvic floor muscle training during pregnancy and after childbirth on prevention and treatment of urinary incontinence: A systematic review. British Journal of Sports Medicine,48,.Dette er siste tekst-versjon av artikkelen, og den kan inneholde små forskjeller fra forlagets pdf-versjon. Forlagets pdf-versjon finner du på bjsm.bmj.com: http://dx.doi. org/10.1136/bjsports-2012-091758 This is the final text version of the article, and it may contain minor differences from the journal's pdf version. Results: Twenty-two randomized or quasi experimental trials were found. There is a very large heterogeneity in the populations studied, inclusion and exclusion criteria, outcome measures and content of PFMT interventions. Based on the studies with relevant sample size, high adherence to a strength training protocol and close follow up, we found that PFMT during pregnancy and after delivery can prevent and treat UI. A supervised training protocol following strength training principles, emphasizing close to maximum contractions and lasting at least eight weeks is recommended. Conclusions: PFMT is effective when supervised training is conducted. Further high quality RCTs are needed especially after delivery. Given the prevalence of female UI and its impact on exercise participation, PFMT should be incorporated as a routine part of women's exercise programs in general. INTRODUCTIONCurrent exercise guidelines recommend all pregnant women to be physically active on preferably all weekdays throughout pregnancy and to conduct both cardiovascular and strength training exercise (1,2,3). The prescription for exercise is more detailed for the cardiovascular component of training than the strength training component. This may, to some extent, be explained by the fact that there are fewer published clinical trials on strength training programs for pregnancy and birth outcomes than endurance training (4,5) Pregnancy and childbirth are known risk factors for weakening and injury to the perineum and pelvic floor. Stretch and rupture of peripheral nerves, connective tissue and muscles may cause urinary and faecal incontinence, pelvic organ prolapse, sensory and emptying abnormalities of the lower urinary tract, defecation dysfunction, sexual dysfunction and chronic pain syndromes (6). About 50% of women lose some of the supporting function of the pelvic floor due to childbirth (7), and recent research using ultrasound and MRI report prevalence of major injuries to the pelvic floor muscles of 20-26% % following vaginal delivery (8,9,10). Hence, vaginal childbirth can be considered equivalent to a major sport injury, but has not been given the same attention concerning prevention or treatment. Urinary incontinence is the most prevalent symptom of pelvic floor dysfunction; prevalence rates varying between 32-64% (11). Stress urinary incontinence is defined as "complaint of involuntary loss of urine during on effor...

Priporočila za telesno dejavnost nosečnic

“…Priporočila jasno in praktično opredeljujejo pojem zmerne telesne dejavnosti. Izvajanje vaj za moč v nosečnosti je varno, vendar se svetuje uporaba lažjih bremen in večjega števila ponovitev (15)(16)(17)(18)(19)(20). Posebno mesto pri vajah za moč pripada vadbi za mišice medeničnega dna.…”

“…American Congress of Obstetricians and Gynecologists, ACOG).6 Nosečnice, ki so telesno dejavne, imajo boljšo telesno pripravljenost, manj nosečniških težav, v nosečnosti pridobijo manj telesne mase, imajo manj težav med porodom in po porodu se hitreje vrnejo v prvotno formo.7-11 Telesna dejavnost dokazano zmanjša tveganje za nastanek bolezni, povezanih z nosečnostjo (gestacijska hipertenzija in nosečnostna sladkorna bolezen).12,13 Prav tako je tudi dokazan pozitiven vpliv zmerne telesne dejavnosti na rast ploda.14 Pregled literature je pokazal, da imajo nosečnice, ki so telesno dejavne, manj pogosto bolečine v medeničnem obroču in ledvenem delu hrbtenice ter urinsko inkontinenco. 15,16 Čeprav so nekateri avtorji izrazili bojazen, da lahko vadba mišic medeničnega dna, ki ima za posledico večjo zmogljivost mišic, vodi do obstrukcije porodnega kanala zaradi mišične hipertrofije,17 pa so drugi mnenja, da lahko vadba mišic medeničnega dna v nosečnosti izboljša gibčnost, mišično jakost in motorični nadzor, kar pospešuje drugo porodno dobo in zmanjša potrebo pa instrumentalnih porodih.18 Iz rezultatov dveh randomiziranih kontroliranih raziskav je razvidno, da vadba mišic medeničnega dna ni imela vpliva na trajanje prve in druge porodne dobe, število zapletov ali potrebo po instrumentalnem porodu.19,20 Salvesen in Mørkved21 pa navajata, da so ženske, ki so v nosečnosti izvajale vadbo mišic medenične-ga dna, imele krajšo drugo porodno dobro v primerjavi s kontrolno skupino. Podobno so dokazale tudi nekatere druge raziskave.…”

The perinatal period: A literature review from the biopsychosocial perspective

“…While these statistics illustrate high rates of poor physical health postpartum, for many physical conditions such as tiredness and backaches, postpartum women do not seek assistance from health care professionals [35] . Using the example of pelvic floor muscle training, evidence clearly shows that high adherence to a strength-training protocol and close follow-up can prevent and treat this condition [36] , however the optimal dosage for effective PFMT is still not known and further research is required using high-quality randomised controlled trials.…”

Do pelvic floor muscle exercises reduce postpartum anal incontinence? A randomised controlled trial

“…The individually adapted home PFME program followed principles for increasing muscle strength 16 and was based on exercise programs with previously documented effect in reducing postpartum UI. 17 Women were encouraged to perform three sets of 8-10 close to maximum PFM contractions daily and to hold the contractions for more than 3 seconds. Progression of the PFME included holding the VPFMC for up to 10 or 12 seconds, adding three fast contractions at the end of the VPFMC, and using progressively more challenging starting positions from supine lying, sitting, standing, and standing with legs apart to walking, jumping, etc.…”