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

Abstract

Objective To evaluate the effect of pelvic floor muscle exercises (PFME) for postpartum anal incontinence (AI).Design A parallel two-armed randomised controlled trial stratified on obstetrical anal sphincter injury with primary sphincter repair and hospital affinity.Setting Ano-rectal specialist out-patient clinics at two hospitals in Norway.Population One hundred and nine postpartum women with AI at baseline. MethodsThe intervention group received 6 months of individual physiotherapy-led PFME and the control group written information on PFME. Changes in St. Mark's scores and predictors of post-intervention AI were assessed by independent samples t-tests and multiple linear regression analyses, respectively. The study was not blind.Main outcome measures The primary outcome measure was change in AI symptoms on the St. Mark's score from baseline to post-intervention. Secondary outcome measures were manometry measures of anal sphincter length and strength, endoanal ultrasound (EAUS) defect score and voluntary pelvic floor muscle contraction.Results There was a significant difference in the reduction of St. Mark's scores from baseline to post-intervention in favour of the PFME group (À2.1 versus À0.8 points, P = 0.040). No differences in secondary outcome measures were found between groups. Baseline St. Mark's, PFME group affinity and EAUS defect score predicted post-intervention St. Mark's score in the imputed intention-to-treat analyses. The analysis on unimputed data showed that women performing weekly PFME improved their AI scores more than women in the control group did.Conclusions Our results indicate that individually adapted PFME reduces postpartum AI symptoms.

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

“…1 We agree that GWG and obesity in pregnancy are important, partly overlapping factors in adverse pregnancy outcomes, and that a significant amount of research has focused on methods to reduce GWG. We note that in meta-analysis, dietary interventions appear to be most successful at reducing GWG, compared with exercise or other interventions, but studies have shown mixed results in reducing the incidence of other important adverse maternal and neonatal outcomes.…”

“…2 Our study and others' results have led us to revise our initial hypothesis: we now feel that serial self-weighing alone is unlikely to alter GWG or health outcomes for overweight and obese women and their children in any predictable way. 1,3 Nevertheless, it is extremely reassuring to know that women do not suffer anxiety or diminished quality of life when they participate in research aimed at controlling GWG. 1,4 We anticipate that serial self-weighing will remain in research and clinical practice.…”

“…1,3 Nevertheless, it is extremely reassuring to know that women do not suffer anxiety or diminished quality of life when they participate in research aimed at controlling GWG. 1,4 We anticipate that serial self-weighing will remain in research and clinical practice. For example, we await results from a low-cost, woman centred, mobile-health (mhealth) intervention for overweight and obese pregnant women in which serial self-weighing is one component.…”

Análise da distribuição multivetorial de cargas do assoalho pélvico feminino em diferentes populações

“…PFM training is the first line of conservative management for women with different symptoms of pelvic floor dysfunction Beji et al 2003;Dean et al 2008;Hagen and Stark 2011;Braekken et al 2015;Hagen et al 2017;Johannessen et al 2017), promoting pelvic organ support and control of the continence mechanism, along with better awareness of the pelvic floor structures, self-confidence and libido. Pompoir practice is not particularly focused on treating or preventing pelvic floor symptoms, but on improving coordination capacities of the PFM, being reported by practitioners to promote benefits on sexual function and self-awareness.…”

“…Some studies also indicated that PFM training have a positive impact on sexual functions by increasing self-confidence, desire, lubrication, orgasm, and satisfaction Beji et al 2003;Dean et al 2008;, although it has been suggested that more high quality clinical trials would be necessary to confirm these findings (Bø 2012;Ferreira et al 2015). Most recently, benefits of PFM training were reported for anal incontinence (Johannessen et al 2017), and for the prevention and reduction of symptoms and severity of pelvic organ prolapse (Hagen and Stark 2011;Hagen et al 2017), pointing out that intervention for treatment and prevention of these dysfunctions should be encouraged on the basis of it being safe and done easily by most women.…”