Prevention of postpartum stress incontinence in primigravidae with increased bladder neck mobility: a randomised controlled trial of antenatal pelvic floor exercises

Abstract

Objective To test whether supervised pelvic floor exercises antenatally will reduce the incidence of postpartum stress incontinence in at-risk primigravidae with bladder neck mobility, ultrasonically proven. Design Single blind, randomised controlled trial.Setting Antenatal clinic in a UK NHS Trust Hospital.Sample Two hundred and sixty-eight primigravidae attending an antenatal clinic at approximately 20 weeks of gestation with bladder neck mobility, on standardised valsalva, of 5mm or more linear movement. The median age was 28, ranging from 16 to 47 years. Intervention Patients randomised to supervised pelvic floor exercises (n ¼ 139) attended a physiotherapist at monthly intervals from 20 weeks until delivery. The exercises comprised three repetitions of eight contractions each held for six seconds, with two minutes rest between repetitions. These were repeated twice daily. At 34 weeks of gestation the number of contractions per repetition was increased to 12. Both the untreated control group and the study group received verbal advice on pelvic floor exercises from their midwives antenatally. Main outcome measures Subjective reporting of stress incontinence at three months postpartum. Pelvic floor strength, using perineometry, and bladder neck mobility measured by perineal ultrasound. Results Of the 268 women enrolled, information on the main outcome variable was available for 110 in the control group and 120 in the study group. Fewer women in the supervised pelvic floor exercise group reported postpartum stress incontinence, 19.2% compared with 32.7% in the control group ). There was no change in bladder neck mobility and no difference in pelvic floor strength between groups after exercise, although all those developing postpartum stress incontinence had significantly poorer perineometry scores than those who were continent. Conclusions The findings suggest that antenatal supervised pelvic floor exercises are effective in reducing the risk of postpartum stress incontinence in primigravidae with bladder neck mobility.

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

“…A specific preventive effect of PFMT was shown in the studies by Reilly et al ,29 Gorbea Chávez et al 26 and in the subgroup of women with no previous UI at inclusion in the trials from Mørkved et al 28 and Stafne et al 23 No adverse effects of the interventions were reported. Sampselle et al 30 found that the short-term effect was not present at 1-year follow-up.…”

“…Sampselle et al 30 found that the short-term effect was not present at 1-year follow-up. Eight years follow-up data from Reilly et al 's29 trial showed no significant difference in UI between the original intervention and control groups 31. Mørkved et al 32 reported that the percentage of continent women in the training group was similar at 3 months and 6 years’ follow-up, while the percentage of continent women in the control group had increased in the period, and the statistically significant differences between groups were no longer present.…”

“…All the trials, except the RCT by Stafne et al ,23 included primigravid/nulliparous women. Three trials were primary prevention trials including only continent women;22 26 29 one trial included only women at risk of developing UI (with increased bladder neck mobility) and no previous UI 29. Seven studies included women who had not been selected on the basis of incontinence or risk factors 17 18 21 23 27 28 30.…”

“…No specific questionnaires/instruments to report adherence were used. Some studies used exercise diaries 23 28 29…”

“…Bø et al 46 emphasised close to maximum contractions, and strength measurements were done throughout the training period. The same protocol has been used in several peripartum studies, and all of these trials show clinically relevant and statistically significant effects 19 21 23 24–26 28 29 37 41. In a recent assessor-blinded RCT of PFMT to reduce pelvic organ prolapse, Brækken et al 50 found that this protocol significantly increased PFM strength and muscle thickness, reduced the muscle length and area of the levator hiatus, in addition to lifting the position of the bladder neck and rectal ampulla.…”