Regular antenatal exercise including pelvic floor muscle training reduces urinary incontinence 3 months postpartum-Follow up of a randomized controlled trial

Hege H Johannessen, Betina E Frøshaug, Pernille J G Lysåker, Kjell Å Salvesen, Mirjam Lukasse, Siv Mørkved, Signe N Stafne, Hege H Johannessen, Betina E Frøshaug, Pernille J G Lysåker, Kjell Å Salvesen, Mirjam Lukasse, Siv Mørkved, Signe N Stafne

Abstract

Introduction: Urinary incontinence is a frequently reported condition among women with pregnancy and delivery as established risk factors. The aims of this study were to evaluate the effect of an antenatal exercise program including pelvic floor muscle training on postpartum urinary incontinence, and to explore factors associated with urinary incontinence three months postpartum.

Material and methods: This is a short-term follow-up and secondary analysis of a randomized controlled trial conducted at two Norwegian University Hospitals including healthy, pregnant women aged >18 years with a singleton live fetus. Women in the exercise group received a 12-week standardized exercise program including pelvic floor muscle training, with once weekly group exercise classes led by a physiotherapist and twice weekly home exercise sessions. The controls received standard antenatal care. Data were obtained from questionnaires answered in pregnancy weeks 18-22, and three months postpartum. Urinary incontinence prevalence in the exercise and control groups was compared, and multivariable logistic regression analyses were applied. Urinary incontinence prevalence three months postpartum was assessed by the Sandvik severity index.

Results: Among the 722 (84%) women who responded three months postpartum, significantly fewer women in the exercise group (29%) reported urinary incontinence compared with the standard antenatal care group (38%, P = .01). Among women who were incontinent at baseline, 44% and 59% (P = .014) were incontinent at three months postpartum in the exercise and control groups, respectively. Urinary incontinence three months postpartum was associated with age (OR 1.1, 95% CI 1.0-1.1), experiencing urinary incontinence in late pregnancy (OR 3.6, 95% CI 2.3-5.9), birthweight ≥4000 g (OR 1.8, 95% CI 1.2-2.8), and obstetric anal sphincter injuries (OR 2.6, 95% CI 1.1-6.1). Cesarean section significantly reduced the risk of urinary incontinence three months postpartum compared with spontaneous vaginal delivery (OR 0.2, 95% CI 0.1-0.5).

Conclusions: A moderate-intensity exercise program including pelvic floor muscle training reduced prevalence of urinary incontinence 3 months postpartum in women who were incontinent at baseline.

Trial registration: ClinicalTrials.gov NCT00476567.

Keywords: antenatal exercise; pelvic floor muscle training; postpartum; risk factors; urinary incontinence.

© 2020 Nordic Federation of Societies of Obstetrics and Gynecology (NFOG). Published by John Wiley & Sons Ltd.

References

REFERENCES

    1. Haylen BT, de Ridder D, Freeman RM, et al. An International Urogynecological Association (IUGA)/International Continence Society (ICS) joint report on the terminology for female pelvic floor dysfunction. Neurourol Urodyn. 2010;29:4-20.
    1. Thom DH, Rørtveit G. Prevalence of postpartum urinary incontinence: a systematic review. Acta Obstet Gynecol Scand. 2010;89:1511-1522.
    1. Hägglund D, Walker-Engström ML, Larsson G, Leppert J. Quality of life and seeking help in women with urinary incontinence. Acta Obstet Gynecol Scand. 2001;80:1051-1055.
    1. Rørtveit G, Daltveit AK, Hannestad YS, Hunskaar S. Urinary incontinence after vaginal delivery or cesarean section. N Engl J Med. 2003;348:900-907.
    1. Wesnes SL, Hunskaar S, Bø K, Rørtveit G. The effect of urinary incontinence status during pregnancy and delivery mode on incontinence postpartum. A cohort study. BJOG. 2009;116:700-707.
    1. Wesnes SL, Lose G. Preventing urinary incontinence during pregnancy and postpartum: a review. Int Urogynecol J. 2013;24:889-899.
    1. Wesnes SL, Hannestad Y, Rørtveit G. Delivery parameters, neonatal parameters and incidence of urinary incontinence six months postpartum: a cohort study. Acta Obstet Gynecol Scand. 2017;96:1214-1222.
    1. Dumoulin C, Cacciari LP, Hay-Smith EJC. Pelvic floor muscle training versus no treatment, or inactive control treatments, for urinary incontinence in women. Cochrane Database Syst Rev. 2018;10:CD005654.
    1. Woodley SJ, Lawrenson P, Boyle R, et al. Pelvic floor muscle training for preventing and treating urinary and faecal incontinence in antenatal and postnatal women. Cochrane Database Syst Rev. 2020;5:CD007471.
    1. Stafne SN, Salvesen KÅ, Romundstad PR, Torjusen IH, Mørkved S. Does regular exercise including pelvic floor muscle training prevent urinary and anal incontinence during pregnancy? A randomised controlled trial. BJOG. 2012;119:1270-1280.
    1. Hvidman L, Foldspang A, Mommsen S, Nielsen JB. Postpartum urinary incontinence. Acta Obstet Gynecol Scand. 2003;82:556-563.
    1. Chang SR, Chen KH, Lin HH, Lin MI, Chang TC, Lin WA. Association of mode of delivery with urinary incontinence and changes in urinary incontinence over the first year postpartum. Obstet Gynecol. 2014;123:568-577.
    1. Rørtveit G, Daltveit AK, Hannestad YS, Hunskaar S. Vaginal delivery parameters and urinary incontinence: the Norwegian EPINCONT study. Am J Obstet Gynecol. 2003;189:1268-1274.
    1. Gartland D, Donath S, MacArthur C, Brown SJ. The onset, recurrence and associated obstetric risk factors for urinary incontinence in the first 18 months after a first birth: an Australian nulliparous cohort study. BJOG. 2012;119:1361-1369.
    1. Stafne SN, Salvesen KÅ, Romundstad PR, Eggebø TM, Carlsen SM, Mørkved S. Regular exercise during pregnancy to prevent gestational diabetes: a randomized controlled trial. Obstet Gynecol. 2012;119:29-36.
    1. Bø K, Talseth T, Holme I. Single blind, randomised controlled trial of pelvic floor exercises, electrical stimulation, vaginal cones, and no treatment in management of genuine stress incontinence in women. BMJ. 1999;318:487-493.
    1. Miller JM, Perucchini D, Carchidi LT, DeLancey JO, Ashton-Miller J. Pelvic floor muscle contraction during a cough and decreased vesical neck mobility. Obstet Gynecol. 2001;97:255-260.
    1. Sandvik H, Hunskaar S, Vanvik A, Bratt H, Seim A, Hermstad R. Diagnostic classification of female urinary incontinence: an epidemiological survey corrected for validity. J Clin Epidemiol. 1995;48:339-343.
    1. Sandvik H, Seim A, Vanvik A, Hunskaar S. A severity index for epidemiological surveys of female urinary incontinence: comparison with 48-hour pad-weighing tests. Neurourol Urodyn. 2000;19:137-145.
    1. Bø K, Nygaard IE. Is physical activity good or bad for the female pelvic floor? A Narrative Review. Sports Med. 2020;50:471-484.
    1. Nygaard IE, Shaw JM. Physical activity and the pelvic floor. Am J Obstet Gynecol. 2016;214:164-171.
    1. Zhu L, Li L, Lang JH, Xu T. Prevalence and risk factors for peri- and postpartum urinary incontinence in primiparous women in China: a prospective longitudinal study. Int Urogynecol J. 2012;23:563-572.
    1. Boyles SH, Li H, Mori T, Osterweil P, Guise JM. Effect of mode of delivery on the incidence of urinary incontinence in primiparous women. Obstet Gynecol. 2009;113:134-141.
    1. Eliasson K, Nordlander I, Larson B, Hammarström M, Mattsson E. Influence of physical activity on urinary leakage in primiparous women. Scand J Med Sci Sports. 2005;15:87-94.
    1. Bø K, Aschehoug A. Strength training. In: Bø K, Berghmans B, Mørkved S, Van Kampen M, eds. Evidence-Based Physical Therapy for the Pelvic Floor Bridging Science and Clinical Practice. 2nd ed. Elsevier; 2015:117-130.
    1. Schytt E, Lindmark G, Waldenstrom U. Symptoms of stress incontinence 1 year after childbirth: prevalence and predictors in a national Swedish sample. Acta Obstet Gynecol Scand. 2004;83:928-936.
    1. Burgio KL, Zyczynski H, Locher JL, Richter HE, Redden DT, Wright KC. Urinary incontinence in the 12-month postpartum period. Obstet Gynecol. 2003;102:1291-1298.
    1. Wesnes SL, Seim E. Birthweight and urinary incontinence after childbirth: a systematic review and meta-analysis. Eur J Obstet Gynecol Reprod Biol X. 2020;8:100115.
    1. Dudding TC, Vaizey CJ, Kamm MA. Obstetric anal sphincter injury: incidence, risk factors, and management. Ann Surg. 2008;247:224-237.
    1. Volløyhaug I, Mørkved S, Salvesen Ø, Salvesen K. Pelvic organ prolapse and incontinence 15-23 years after first delivery: a cross-sectional study. BJOG. 2015;122:964-971.
    1. Wesnes SL, Hunskaar S, Bø K, Rørtveit G. Urinary incontinence and weight change during pregnancy and postpartum: a cohort study. Am J Epidemiol. 2010;172:1034-1044.

Source: PubMed

赞助者和合作者

医疗条件

药物干预

3
订阅