Pelvic floor muscle training may reduce postpartum stress urinary incontinence

1. Pelvic floor workout reduced the incidence of stress urinary incontinence at 6 weeks postpartum.

Evidence Rating Level: 1 (Excellent)

Study Rundown: Stress urinary incontinence (SUI) is defined as involuntary leakage of urine during increased abdominal pressure, which adversely affects women’s quality of life. Although pelvic floor muscle training (PFMT) is recommended as the first-line treatment for SUI, the effectiveness of prenatal PFMT is inconclusive. Global postural exercise, which involves correcting postural misalignments by stretching muscle chains, is more effective than PFMT for treating SUI. This study thus examined the effectiveness of a training program with PFMT integrated into global postural exercise called pelvic floor workout (PEFLOW) in preventing postpartum SUI. This multicenter randomized clinical trial included primiparous women aged 20-40 years in China with singleton pregnancy of less than 16 weeks’ gestation. Participants were randomly assigned 1:1 to the exercise group or the control group. The exercise group practiced PEFLOW while the control group was provided with usual medical care. The primary outcome was the incidence of SUI at 6 weeks postpartum. SUI was defined as a positive stress test for involuntary urinary leakage and/or a positive response to a screening question. Pelvic floor muscle strength during contraction was assessed using the Modified Oxford Scale (MOS). In total, 764 women were included in the study, with 382 in each group. The incidence of SUI at 6 weeks postpartum was 5.2% lower in the exercise group than the control group (8.7% vs 13.9). The proportion of women with a MOS score of 4 or higher (indicating good and strong contraction) at 6 weeks postpartum was 10% higher in the exercise group than the control group (17.8% vs 7.9%). Overall, PEFLOW reduced SUI incidence at 6 weeks postpartum.

Click to read the study in JAMA Network Open 

Relevant reading: Global Postural Re-education: an alternative approach for stress urinary incontinence?

In-Depth [Randomized Clinical Trial]:

This trial included primiparous women aged 20-40 years in China with singleton pregnancy of less than 16 weeks’ gestation, who visited the outpatient obstetric department of 1 of the 9 hospitals from August 1st, 2020, to June 6th, 2022. Participants were randomly assigned 1:1 to the exercise group or the control group. The exercise group practiced PEFLOW from 28 weeks’ gestation to delivery, with checkups and guidance provided every 2 weeks. PEFLOW consisted of daily PFMT following a video guide and application available for download to mobile devices, and 2 sessions of global postural exercises per week. The control group was provided with usual medical care and received an obstetric examination every 2 weeks from 28 weeks’ gestation to delivery. The primary outcome was the incidence of SUI at 6 weeks postpartum. SUI was defined as a positive stress test for involuntary urinary leakage and/or if the response to the question “When does urine leak?” was urinary leakage during coughing, sneezing, and/or physical exercise. Pelvic floor muscle strength during contraction by digital vaginal examination using the Modified Oxford Scale (MOS) (score 0-5; 0 = no contraction, 5 = strong contraction). In total, 764 women were included in the study (median [IQR] age, 29 [27-32] years), with 382 in each group. Intent-to-treat analysis found that the incidence of SUI at 6 weeks postpartum was 5.2% lower in the exercise group than the control group (8.7% [32 of 367] vs 13.9% [50 of 360]; risk difference, 5.17 [95% CI, 0.36-10.03] percentage points). The proportion of women with an MOS score of 4 or higher (indicating good and strong contraction) at 6 weeks postpartum was 10% higher in the exercise group than the control group (17.8% [68 of 382] vs 7.9% [30 of 382]; risk difference, 9.95 [95% CI, 5.05-14.870] percentage points). There were no PEFLOW-related adverse events reported. Overall, this study found that PEFLOW reduced SUI incidence at 6 weeks postpartum, suggesting that PEFLOW is effective in preventing SUI in pregnancy. A limitation of this study was the unfeasibility of blinding participants in each group. Future studies are needed to confirm the study findings and examine the outcomes of postpartum PEFLOW. 

Image: PD

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