BACKGROUND AND PURPOSE:

• Sigurdarottir et al. (AJOG, 2020) examined the effects of individualized physical therapist-guided pelvic floor muscle training in the early postpartum period on
  • Urinary and anal incontinence
  • Pelvic floor muscle strength and endurance

METHODS:

• Assessor-blinded, parallel-group, randomized controlled trial
• Participants
  • Primiparous
  • Urinary incontinence 6 to 10 weeks after childbirth | Anal incontinence also considered primary outcome if present
• Intervention
  • 12 weekly sessions with a physical therapist
  • Control (no instructions after initial assessment)
• Study design
  • Physical therapy intervention began at approximately 9 weeks postpartum
  • Outcomes were assessed at 6 months postpartum | Additional follow-up at 12 months postpartum
• Statistical analysis
  • Fisher exact test was used to test differences in the proportion of women with urinary and anal incontinence between groups
  • Independent-sample t tests were used for mean differences in muscle strength and endurance
• Primary outcomes
  • Rate of urinary and/or anal leakage
• Secondary outcomes
  • Bother from bladder and bowel symptoms: Bother absent if participant answered “not at all” to the questions “How much does your bladder problem bother you?” and “How much does your bowel problem bother you? | Bother present if patient responded “slightly”, “moderately” and “greatly”
  • Changes in pelvic floor muscle and anal strength and endurance: Measured using manometer

RESULTS:

• 80 women included
  • Intervention: 38 women
  • Control: 42 women
  • Anal incontinence: 21 (58%) in the intervention group and 27 (71%) in the control group experiencing anal incontinence at endpoint (P=0.33)
• At 6 months postpartum, urinary incontinence was less frequent in the intervention group
  • Urinary incontinence (P=0.03)
    • Intervention: 57%
    • Control: 82%
  • Related bother (P=.005)
    • Intervention: 27%
    • Control: 60%
• No difference in anal incontinence was demonstrated
  • Anal incontinence: P=0.33
  • Bowel-related bother: P=0.82
• The intervention group had greater
  • Pelvic floor muscle strength (P=0.003)
    • Mean difference 5 hPa (95% CI, 2 to 8)
  • Pelvic floor muscle endurance (P=0.001)
    • Mean difference 50 hPa/s (95% CI, 23 to 77)
  • Anal sphincter strength (P=0.01)
    • Mean difference 10 hPa (95% CI, 2 to 18)
  • Anal sphincter endurance (P=0.02)
    • Mean difference 95 hPa/s (95% CI, 16 to 173)
• At 12 months postpartum, there were no differences between the groups for rates of urinary and anal incontinence
  • However, pelvic floor- and anal muscle strength and endurance differences were maintained

CONCLUSION:

• Physical therapist led postpartum pelvic floor muscle training led to decreased urinary incontinence at 6 months and increased muscle strength and endurance persisted through to 1 year follow-up
• No difference was found for anal incontinence
  • This finding may have resulted due to inclusion of women with major levator ani defects | Study powered based on previous urinary incontinence studies and therefore may have been underpowered for anal incontinence
• The authors state

Our results show benefits from PFMT, in which the treatment aiming at enhancing muscle function in the pelvic floor had a positive effect on bothersome symptoms of urinary incontinence 

Learn More – Primary Sources:

Can postpartum pelvic floor muscle training reduce urinary and anal incontinence?: An assessor-blinded randomized controlled trial

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