Comparison between the Significant of Antenatal Pelvic Floor Exercises and Non-Intervention in Preventing Urinary Incontinence: A Systematic Literature Review

Abstract

IntroductionUrinary incontinence as defined by the International Continence Society is the complain of any involuntary leakage of urine [1][2][3]. The world Health Organization (WHO) has classified UI as one of the ten major health problems of present times among women [4]. Causes of UI can be divided into: dysfunction of the bladder or urethra, and neurological or gynecological causes. Gynecological components include: the weakening of pelvic floor muscles, gynecological and obstetrical operations and pelvic organ prolapse [5]. Existing evidence indicates that both natural delivery, as well as the pregnancy itself [6] has a prominent impact on the functioning of pelvic floor muscles and the occurrence of urinary incontinence. SUI occurs when intra-vesical pressure exceeds urethral closure pressure in the absence of a detrusor contraction. SUI may be due to bladder neck hyper-mobility or poor urethral closure pressure [7]. The pelvic floor muscles (PFM) function to elevate the bladder, preventing descent of the bladder neck during rises in intra-abdominal pressure and to occlude the urethra. The theoretical basis for physical therapy to treat SUI is to improve PFM function by increasing strength, coordination, speed and endurance [5] in order to maintain an elevated position of bladder neck during raised intra-abdominal pressure with adequate urethral closure force [8]. Since 1992, conservative management of SUI has been promoted by the US Department of Health and Human Services (AHCPER) as first -line treatment for SUI for its efficacy, low cost and low risk [9].According to Boyle [10], up to a third of women have urinary incontinence while about a 10 th of them have stool incontinence after delivery. Urinary incontinence is a major clinical problem with profound effects on the quality of life and day-to-day activities of the affected women. It's physically debilitating and socially incapacitating, with loss of self-confidence, helplessness, depression and anxiety all related to its occurrence. Affected women suffer social stigma and are withdrawn socially. As a result their productivity is significantly reduced and may lose interest in life.Chiarelli P [11] indicates that the prevalence of urinary incontinence among women increases during young adult life: a study with over 40000 women estimated a prevalence of 12.8% in women aged 18-22 years, 36.1% in women aged 40-49, and 35% in women aged 70-74 years.The severity of urinary incontinence varies in severity ranging from mild, moderate to severe forms. These levels of incontinence require different approaches in management in terms of duration and intensity. AbstractBackground: Urinary incontinence is a common symptom observed in modern times, which may affect 7-37% of women aged 20-39 and 9-39% after the age of 60. Pregnancy and natural delivery are important risk factors increasing the likelihood of incontinence. Conservative intervention such as pelvic floor muscle training (PFMT) is superior in preventing and treating urinary incontinence.