Regular antenatal exercise including pelvic floor muscle training reduces urinary incontinence 3 months postpartum—Follow up of a randomized controlled trial

Abstract

Introduction Urinary incontinence is a frequently reported condition among women with pregnancy and delivery as established risk factors. The aims of this study were to evaluate the effect of an antenatal exercise program including pelvic floor muscle training on postpartum urinary incontinence, and to explore factors associated with urinary incontinence three months postpartum. Material and methods This is a short‐term follow‐up and secondary analysis of a randomized controlled trial conducted at two Norwegian University Hospitals including healthy, pregnant women aged >18 years with a singleton live fetus. Women in the exercise group received a 12‐week standardized exercise program including pelvic floor muscle training, with once weekly group exercise classes led by a physiotherapist and twice weekly home exercise sessions. The controls received standard antenatal care. Data were obtained from questionnaires answered in pregnancy weeks 18–22, and three months postpartum. Urinary incontinence prevalence in the exercise and control groups was compared, and multivariable logistic regression analyses were applied. Urinary incontinence prevalence three months postpartum was assessed by the Sandvik severity index. Results Among the 722 (84%) women who responded three months postpartum, significantly fewer women in the exercise group (29%) reported urinary incontinence compared with the standard antenatal care group (38%, P = .01). Among women who were incontinent at baseline, 44% and 59% (P = .014) were incontinent at three months postpartum in the exercise and control groups, respectively. Urinary incontinence three months postpartum was associated with age (OR 1.1, 95% CI 1.0‐1.1), experiencing urinary incontinence in late pregnancy (OR 3.6, 95% CI 2.3‐5.9), birthweight ≥4000 g (OR 1.8, 95% CI 1.2‐2.8), and obstetric anal sphincter injuries (OR 2.6, 95% CI 1.1‐6.1). Cesarean section significantly reduced the risk of urinary incontinence three months postpartum compared with spontaneous vaginal delivery (OR 0.2, 95% CI 0.1‐0.5). Conclusions A moderate‐intensity exercise program including pelvic floor muscle training reduced prevalence of urinary incontinence 3 months postpartum in women who were incontinent at baseline.

Can pelvic floor muscle training prevent perineal laceration? A systematic review and meta‐analysis

“…Only one study did not report the degree of laceration found 19 . Four studies 18,20–22 reported prevalence related only to the third‐ and fourth‐degree lacerations, and one 17 reported prevalence related only to first‐ and second‐degree lacerations. One study 2 showed laceration rates related only to the first‐degree and one 16 showed laceration rates related only to the third‐degree.…”

“…Only one study did not report the degree of laceration found. 19 Four studies 18,[20][21][22] reported prevalence related only to the third-and fourth-degree lacerations, and…”

“…A total of nine studies were included in the final sample. They were all RCT carried out in Spain (n = 1), 15 the UK (n = 1), 16 Brazil (n = 2), 2,17 China (n = 2), 18,19 and Norway (n = 3) [20][21][22] and published between 2004 and 2020. Most studies were conducted to identify the effect of PFMT on perinatal outcomes with sample sizes that ranged from 42 to 722 women.…”

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

“…As our short-term results show that including PFMT in an antenatal exercise programme reduced UI in late pregnancy [10] and 3 months postpartum [11], we intended to assess the long-term effects of the intervention. No group differences after 7 years are in concurrence with the only study assessing the effect of antenatal PFMT beyond 6 months postpartum [9].…”

“…In a randomized controlled trial including 855 pregnant women, we have previously shown that including PFMT in a general antenatal exercise programme had preventive and therapeutic effects on UI in late pregnancy [10] and 3 months postpartum [11]. Since pregnancy may be a "golden opportunity" for sustainable lifestyle changes, our hypothesis was that the effect of PFMT during pregnancy may have long-term effects.…”