The effect of pre- and postpartum pelvic floor muscle training versus postpartum training only on the return to urinary continence postpartum

Abstract

Overview: Urinary incontinence (UI) is highly common during pregnancy and postpartum. If neglected, this could potentially become an issue during later stages of life. Being highly recommended for UI management, pelvic floor muscle training (PFMT) application should be aimed toward an efficient return to urinary continence postpartum. Noticing the lack of evidence towards PFMT done both during pregnancy and postpartum, the purpose of this PICO study is to provide an understanding of the effectiveness and significance of this approach for a fast and efficient return to urinary continence level postpartum, when compared to doing postpartum PFMT only. The research question: Does pelvic floor training commencing prepartum, and continuing postpartum, have an effect on the return to urinary continence postpartum when compared to postpartum training only? The research question was formulated using the PICO format. PICO Elements: Population: Pregnant women and postpartum women; Intervention: PFMT done prepartum and postpartum; Comparison: PFMT done only postpartum; Outcome: Return to urinary continence level postpartum. Method: The search engines Hydi, Google Scholar, PubMed and CINAHL were utilised to conduct two main searches i.e. Antenatal PFMT and Postpartum PFMT. Studies were included if a PFMT programme was done by the exercise group with more monitored PFMT than the control group either prepartum or postpartum only or commencing prepartum and continuing postpartum. The outcomes considered were UI symptoms and UI-specific quality of life (QOL). Meta-analyses, systematic reviews and RCTs were included. Articles that incorporated therapeutic modalities or other exercises and failed to conduct a follow-up postpartum were excluded. Studies that had a high initial cohort but a high dropout were eliminated. The CASP tools, the RoB 2.0 tool and the MINORS were used to appraise the literature. Results: Results show significance of commencing PFMT during pregnancy and continued in the postpartum, as well as additional benefits with regards UI symptoms, PFM strength and UI-related QoL. Conclusions and recommendations: Whilst performing pre- and postpartum PFMT can potentially provide a better outcome of a fast return to continence level postpartum compared to performing postpartum PFMT only, studies that compare these 2 interventions should be conducted. Nonetheless, in order to maintain results, PFMT must be adhered to in the long term and this has been shown to be an issue. Hence, advanced approaches must be implemented to improve adherence.