Physiotherapy according to the BeBo Concept as prophylaxis and treatment of urinary incontinence in women after natural childbirth

Aneta Śnieżek, Dorota Czechowska, Marta Curyło, Jacek Głodzik, Paweł Szymanowski, Anna Rojek, Anna Marchewka, Aneta Śnieżek, Dorota Czechowska, Marta Curyło, Jacek Głodzik, Paweł Szymanowski, Anna Rojek, Anna Marchewka

Abstract

Pelvic floor muscle dysfunctions can lead to urinary incontinence, a condition which often affects women both during pregnancy and after childbirth. As a result of this, certain exercises are recommended during and after pregnancy to prevent and treat this incontinence, and the BeBo Concept is one of these methods used to prevent pelvic floor muscle dysfunction. The aim of the present study was to evaluate the effects of a 6-week course of physical therapy according to the BeBo Concept on the improvement of perineal muscle strength and endurance as well as urinary continence in women after their first vaginal delivery. The study was conducted on a group of 56 women who were randomly assigned to the exercise (n = 30) or control (n = 26) group. The exercising group participated in a 6-week physical therapy program according to the BeBo Concept. Pelvic floor muscles were assessed using the perineometer and palpation Perfect Test. UDI6 and ICIQ-SF questionnaires were used to obtain information about the symptoms of urinary incontinence, evaluate the frequency, severity and impact of urine leakage on the quality of life. In all women after natural childbirth, regardless of treatment, it was observed that measured parameters improved, but the improvement was slightly more explicit in those who participated in the Bebo Concept exercise group (e.g. ICIQ-SF exercise group p = 0.001, control group p = 0.035). Due to its positive impact on the pelvic floor, this exercise program should be recommended to women after natural childbirth.

Conflict of interest statement

The authors declare no competing interests.

© 2021. The Author(s).

References

    1. Wiśniewska B, et al. Wysiłkowe nietrzymanie moczu—jedna z podstawowych chorób współczesnego społeczeństwa. Pol Merkuriusz Lek. 2015;38(223):51–54.
    1. Haylen BT, et al. An International Urogynecological Association (IUGA)/International Continence Society (ICS) joint report on the terminology for female pelvic floor dysfunction. Int. Urogynecol. J. 2010;21(1):5–26. doi: 10.1007/s00192-009-0976-9.
    1. Constantinou CE. Pelvic floor function in the female. Open J. Obstet. Gynecol. 2014;4:826–831. doi: 10.4236/ojog.2014.414115.
    1. Urbankova I, et al. The effect of the first vaginal birth on pelvic floor anatomy and dysfunction. Int. Urogynecol. J. 2019;30:1689–1696. doi: 10.1007/s00192-019-04044-2.
    1. Bortolini MA, Drutz HP, Lovatsis D, Alarab M. Vaginal delivery and pelvic floor dysfunction: Current evidence and implications for future research. Int. Urogynecol. J. 2010;21(8):1025–1030. doi: 10.1007/s00192-010-1146-9.
    1. Jundt K, et al. Incontinence, bladder neck mobility, and sphincter ruptures in primiparous women. Eur. J. Med. Res. 2010;15(6):246–252. doi: 10.1186/2047-783X-15-6-246.
    1. Sigurdardottir T, Steingrimsdottir T, Arnason A, Bø K. Pelvic floor muscle function before and after first childbirth. Int. Urogynecol. J. 2011;22(12):1497–1503. doi: 10.1007/s00192-011-1518-9.
    1. Bozkurt M, Yumru AE, Şahin L. Pelvic floor dysfunction, and effects of pregnancy and mode of delivery on pelvic floor. Taiwan J. Obstet. Gynecol. 2014;53:452–458. doi: 10.1016/j.tjog.2014.08.001.
    1. Soave I, et al. Pelvic floor muscle training for prevention and treatment of urinary incontinence during pregnancy and after childbirth and its effect on urinary system and supportive structures assessed by objective measurement techniques. Arch. Gynecol. Obstet. 2019;299(3):609–623. doi: 10.1007/s00404-018-5036-6.
    1. Wilson PD, Herbison RM, Herbison GP. Obstetric practice and the prevalence of urinary incontinence 3 months after delivery. BJOG. 1996;103(2):154–161. doi: 10.1111/j.1471-0528.1996.tb09668.x.
    1. Johannessen HH, et al. Prevalence and predictors of double incontinence 1 year after first delivery. Int. Urogynecol. J. 2018;29(10):1529–1535. doi: 10.1007/s00192-018-3577-7.
    1. Svare JA, Hansen BB, Lose G. Risk factors for urinary incontinence 1 year after the first vaginal delivery in a cohort of primiparous Danish women. Int. Urogynecol. J. 2014;25(1):47–51. doi: 10.1007/s00192-013-2233-5.
    1. Sangsawang B, Sangsawang N. Stress urinary incontinence in pregnant women: A review of prevalence, pathophysiology, and treatment. Int. Urogynecol. J. 2013;24(6):901–912. doi: 10.1007/s00192-013-2061-7.
    1. Arrue M, et al. Stress urinary incontinence 6 months after vaginal delivery. Eur. J. Obstet. Gynecol. Reprod. Biol. 2010;150(2):210–214. doi: 10.1016/j.ejogrb.2010.02.039.
    1. Leroy LS, Lúcio A, Lopes MH. Risk factors for postpartum urinary incontinence. Rev. Esc. Enferm. USP. 2016;50(2):200–207. doi: 10.1590/S0080-623420160000200004.
    1. Kucab-Klich K. Wykorzystanie koncepcji BeBo® trening dna miednicy w profilaktyce i terapii uroginekologicznej. Prakt Fizjoter Rehabil. 2015;59:18–22.
    1. Keller J, Krucker J, Seleger M. W drodze do istoty kobiecości. Trening dna miednicy. AEM; 2019. pp. 17–153.
    1. Elenskaia K, Thakar R, Sultan AH, Scheer I, Beggs A. The effect of pregnancy and childbirth on pelvic floor muscle function. Int. Urogynecol. J. 2011;22(11):1421–1427. doi: 10.1007/s00192-011-1501-5.
    1. Bø K, Finckenhagen HB. Vaginal palpation of pelvic floor muscle strength: Inter-test reproducibility and comparison between palpation and vaginal squeeze pressure. Acta Obstet. Gynecol. Scand. 2001;80(10):883–887.
    1. Laycock J, Jerwood D. Pelvic floor muscle assessment: The PERFECT scheme. Physiotherapy. 2001;87(12):631–642. doi: 10.1016/S0031-9406(05)61108-X.
    1. Thimpson JA, O’Sullovan PB, Briffa NK, Neumann P. Assessment of oluntary pelvic floor muscle contr action in continent and incontinent women using transperineal ultrasound manual muscle testing and vaginal squeeze pressure measurements. Int. Urogynecol. J. Pelvic Floor Dysfunct. 2006;17(6):524–630.
    1. Barbosa PB, et al. Comparison between measurements obtained with three different perineometers. Clinics. 2009;64(6):527–533. doi: 10.1590/S1807-59322009000600007.
    1. Ferreira CHJ, et al. Inter-rater reliability study of the modified Oxford Grading Scale and the Peritron manometr. Physiotherapy. 2011;97(2):132–138. doi: 10.1016/j.physio.2010.06.007.
    1. Caroci AS, Riesco MLG, Rocha BMC, Ventura LJ, Oliveira SG. Evaluation of perineal muscle strength in the first trimester of pregnancy. Rev. Lat. Am. Enfermagem. 2014;22(6):893–901. doi: 10.1590/0104-1169.3600.2492.
    1. Ribeiro JS, et al. Inter-rater reliability study of the Peritron TM perineometer in pregnant women. Physiother Theory Pract. 2016;32(3):209–217. doi: 10.3109/09593985.2015.1129654.
    1. Cygańska AK, Sobieska D, Truszczyńska-Baszak A, Tomaszewski P, Krzysztoszek K. Świadomość kobiet dotycząca metod fizjoterapeutycznych w leczeniu nietrzymania moczu. Postępy Rehabil. 2018;4:21–27.
    1. Wlaźlak E, Surkont G, Stetkiewicz T, Suzin J. Wpływ wybranych metod nieoperacyjnego leczenia nietrzymania moczu (WNM) na jakość życia pacjentek. Prz Menopauz. 2005;2:53–60.
    1. Skorupska KA, Miotla P, Kubik-Komar A, Skorupski P, Rechberger T. Development and validation of the Polish version of the Urogenital Distress Inventory short form and the Incontinence Impact Questionnaire short form. Eur. J. Obstetr. Gynecol. Reprod. Biol. 2017;215:171–174. doi: 10.1016/j.ejogrb.2017.06.024.
    1. Özdemır ÖÇ, Bakar Y, Özengın N, Duran B. The effect of parity on pelvic floor muscle strength and quality of life in women with urinary incontinence: A cross sectional study. J. Phys. Ther. Sci. 2015;27(7):2133–2137. doi: 10.1589/jpts.27.2133.
    1. Hilde G, et al. Impact of childbirth and mode of delivery on vaginal resting pressure and on pelvic floor muscle strength and endurance. Am. J. Obstet. Gynecol. 2013;208(1):50.e1–7. doi: 10.1016/j.ajog.2012.10.878.
    1. Sobhgol SS, Priddis H, Smith CA, Dahlen HG. Evaluation of the effect of an antenatal pelvic floor muscle exercise programme on female sexual function during pregnancy and the first 3 months following birth: Study protocol for a pragmatic randomised controlled trial. Trials. 2019;20:144. doi: 10.1186/s13063-019-3226-6.
    1. Hall B, Woodward S. Pelvic floor muscle training for urinary incontinence postpartum. Br. J. Nurs. 2015;24(11):576–579. doi: 10.12968/bjon.2015.24.11.576.
    1. Sapsford R. The pelvic floor. A clinical model for function and rehabilitation. Physiotherapy. 2001;87(12):620–630. doi: 10.1016/S0031-9406(05)61107-8.
    1. Colla C, et al. Pelvic floor dysfunction in the immediate puerperium, and 1 and 3 months after vaginal or cesarean delivery. Int. J. Gynaecol. Obstet. 2018;143(1):94–100. doi: 10.1002/ijgo.12561.
    1. Zarawski M, et al. The impact of pelvic floor exercises on the quality of life of women with urinary incontinence—Analysis of pregnancy and the postpartum period. J. Nov. Physiother. Phys. Rehabil. 2017;4(2):035–041.
    1. El Nahas EM, Mohamed MA, Kamal HM. Postnatal rehabilitation of pelvic floor muscles using aerobic and Kegel exercises. Bull. Fac. Phys. Ther. 2017;22:67–73.
    1. Ahlund S, Nordgren B, Wilander EL, Wiklund I, Fridén C. Is home-based pelvic floor muscle training effective in treatment of urinary incontinence after birth in primiparous women? A randomized controlled trial. Acta Obstet. Gynecol. Scand. 2013;92(8):909–915. doi: 10.1111/aogs.12173.
    1. Kahyaoglu Sut H, Balkanli Kaplan P. Effect of pelvic floor muscle exercise on pelvic floor muscle activity and voiding functions during pregnancy and the postpartum period. Neurourol. Urodyn. 2016;35:417–422. doi: 10.1002/nau.22728.
    1. Price N, Dawood R, Jackson SR. Pelvic floor exercise for urinary incontinence: A systematic literature review. Maturitas. 2010;67(4):309–315. doi: 10.1016/j.maturitas.2010.08.004.
    1. Junginger B, Vollhaber H, Baessler K. Submaximal pelvic floor muscle contractions: Similar bladder-neck elevation, longer duration, less intra-abdominal pressure. Int. Urogynecol. J. 2018;29(11):1681–1687. doi: 10.1007/s00192-018-3725-0.
    1. Oliveira M, Ferreira M, Azevedo MJ, Firmino-Machado J, Santos PC. Pelvic floor muscle training protocol for stress urinary incontinence in women: A systematic review. Rev. Assoc. Med. Bras. (1992) 2017;63(7):642–650. doi: 10.1590/1806-9282.63.07.642.
    1. Gagnon LH, Boucher J, Robert M. Impact of pelvic floor muscle training in the postpartum period. Int. Urogynecol. J. 2016;27(2):255–260. doi: 10.1007/s00192-015-2822-6.

Source: PubMed

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