Antenatal pelvic floor muscle training and urinary incontinence: a randomized controlled 7-year follow-up study

Abstract

Introduction and hypothesis Urinary incontinence is common postpartum. Our aims were to assess whether antenatal exercise including pelvic floor muscle training (PFMT) has long-term effects on urinary incontinence (UI) and to explore factors associated with UI 7 years postpartum. Methods A follow-up of a two-centre randomized controlled trial performed at St. Olavs Hospital and Stavanger University Hospital, Norway. In the original trial women were randomized to a 12-week structured exercise protocol including PFMT or standard antenatal care during pregnancy. Link to an electronic questionnaire was sent by postal mail 7 years postpartum. Prevalence of UI was assessed with Sandvik severity index and compared between groups. Factors associated with UI were studied using multivariable logistic regression analysis. Results The response rate was 35% (298/855). UI was reported by 78 (51%) in the intervention group and 63 (57%) in the control group (p = 0.539). In the multivariable logistic regression analyses, women with UI at inclusion had a five-fold increase in odds of UI at 7 years (OR 5.4, 95% CI 2.6, 11.5). Engaging in regular exercise was not significantly associated with UI at 7 years; however, UI was associated with lower exercise intensity (OR 2.4, 95% CI 1.2, 4.6). Conclusions We found no group differences of antenatal exercise including PFMT on UI after 7 years among the responders. UI in pregnancy increased the risk of long-term UI. Regular exercise was not associated with UI at 7 years; however, women with UI were more than twice as likely to exercise at lower intensity than continent women.

Effectiveness of group aerobic and/or resistance exercise programs associated with pelvic floor muscle training during prenatal care for the prevention and treatment of urinary incontinence: A systematic review

“…After the initial screening, duplicate studies were excluded, and the remaining studies were subjected to title and abstract analysis. Five publications [19][20][21][22][23] were considered eligible for full review (Figure 1). However, one of the research groups 20 submitted three publications, 20,22,23 which reported results from different times, therefore these publications was considered as one study.…”

“…Five publications [19][20][21][22][23] were considered eligible for full review (Figure 1). However, one of the research groups 20 submitted three publications, 20,22,23 which reported results from different times, therefore these publications was considered as one study.…”

“…Self-reported absence of UI The results of four clinical trials [19][20][21]23 that measured the self-reported absence of UI using the validated International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form (ICIQ-UI SF) 24 and the Sandvik severity index 25 did not show differences when comparing the group that participated of the aerobic and/or resistance exercise program with usual care, obtaining the following results according to the subgroups for postintervention analysis (RR: 0.57; 95% CI: 0.24−1.34; one study, 762 women, random effects: p = 0.20), based on a very low level of evidence and the subgroup for analysis at 3 months (RR: 0.82; 95% CI: 0.56−1.19, one study, 722 women, random effects: p = 0.30), (Figure 2), based on low level of evidence (Table 5).…”

“…Self-reported UI Three clinical trials 20,22,23 measured self-reported UI using the Sandvik severity index, 14 obtaining the following results according to subgroups analyses. For postintervention analysis (RR: 0.83; 95% CI: 0.74−0.93, one study, 762 women, random effects: p = 0.002), based on a moderate level of evidence; for analysis at 3 months (RR: 0.76; 95% CI: 0.60−0.95, one study, 722 women, random effects: p = 0.02), based on a moderate level of evidence, and the subgroup for analysis at 7 years (RR: 0.90; 95% CI: 0.72−1.12, one study, 262 women, random effects: p = 0.34) (Figure 2), based on a low level of evidence (Table 5).…”

Effects of exercises for strengthening pelvic floor muscles in pregnant women

“…(2021), ispitujući dugoročni efekat prenatalnog vježbanja na urinarnu inkontinenciju i faktore povezane s njom sedam godina nakon porođaja, utvrdili su prevalencu SUI 35% (298/855) kod 78 učesnica (51%) u interventnoj grupi i 63 (57%) u kontrolnoj grupi (p = 0,539). Dugoročno praćenje interventne grupe potvrdilo je da smanjen intenzitet vežbanja pet puta više povećava šansu za razvoj SUI (OR 5,4, 95% CI 2,6, 11,5) (22).…”