Postpartum Pelvic Floor Muscle Training in Women With and Without Injured Pelvic Floor Muscles
Condition: Urinary Incontinence
MeSH terms: Urinary Incontinence; Enuresis
Study type: Interventional

Summary: 
      Although pregnancy and childbirth are associated with happiness and a positive life change
      for most women, it can also be considered as risk periods for injuries to the pelvic floor
      and development of pelvic floor dysfunction. This may leed to devastating loss of function
      and quality of life (Ashton-Miller & DeLancey 2007).

      The aim of this study is to evaluate the effect of postpartum pelvic floor muscle training
      for primiparous women with and without pelvic floor muscle injury.
    

Detailed description: 
      Injuries to the pelvic floor muscles (PFM) and fascias may lead to urinary incontinence (UI),
      fecal incontinence, pelvic organ prolapse (POP), sensory and emptying abnormalities of the
      lower urinary tract, defecatory dysfunction, sexual dysfunction and chronic pain syndromes
      (Bump & Norton 1998, MacLennan et al 2009, Turner et al 2000). Prevalence rates of the most
      common pelvic floor disorders are generally high in the fertile female population

      To date many randomized controlled trials (RCT) have demonstrated significant effect of
      pelvic floor muscle training (PFMT) in treatment of stress and mixed urinary incontinence,
      and it is recommended as first line treatment for stress and mixed UI in women (Level I,
      Grade A) (Abrams 2010). The effect of postpartum PFMT in prevention and treatment of urinary
      incontinence is investigated in only four RCTs (Sleep 1987, Meyer 2001, Chiarelli 2001,
      Ewings 2005) and one matched controlled trial (Mørkved 1997). The results are conflicting.
      The matched controlled trial by Mørkved (1997) shows the far most effective intervention so
      far, with 50% less prevalence of UI in the training group. Similar results were found for the
      same long term effect with 50% less prevalence of UI in the training group with the same long
      term effect (Mørkved 2000). The high effect size may be explained by the close follow-up and
      relative high training dosage. However, as this was not a RCT, the effect may be
      overestimated and the trial is often not included in systematic reviews (Hay-Smith 2008).

      Only few research groups have measured PFM function and strength, and there are no studies
      evaluating possible effects of PFMT on PFM injuries and morphology following pregnancy and
      childbirth. DeLancey (1996) have suggested that the effect of PFMT would be much higher if we
      knew the causes of incontinence and were able to include only those with intact pelvic floor
      muscles. This may be true, but the statement also reflects a belief that muscle injury of the
      PFM cannot be treated with exercise. However, this is in contrast to common practice in
      treatment of other skeletal muscles e.g. after sport injuries, where all injuries are treated
      and it is believed that early mobilization and training is important in speeding up tissue
      healing (Järvinen 2007). Hence, there is a need to conduct a RCT with high methodological and
      interventional quality (Herbert 2005) to investigate the effect of postpartum PFMT.
    

Intervention name(s): Postpartum pelvic floor muscle training
Intervention type(s): Other
Intervention description(s): Beyond a customary leaflet and thorough initial instruction on how to contract the PFM correctly, the training participants will attend one weekly supervised exercise class led by an experienced physiotherapist, and perform daily training at home. The intervention starts 6-8 weeks postpartum and last for 4 months. General principles for strength training are followed: 3 sets of 8-12 contractions close to maximum (Bø 1990, Haskell 2007). Emphasis will be on progression in force development. The participants are provided with a DVD of the program (www.corewellness.co.uk). At week 4 during the intervention, the PFM strength will be assessed for each participant. Training adherence at home will be recorded in a training diary, whereas the physical therapist will record group session adherence.
Other intervention name(s): Postpartum PFMT
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Outcomes Assessor)
Primary purpose: Prevention
Keywords: Randomized controlled trial; Post partum pelvic floor muscle training; Urinary incontinence; Pelvic floor dysfunction; Pelvic floor muscle injury; Pelvic floor muscle strength; Pelvic floor muscle morphology