Pelvic floor muscle function in pregnancy and after childbirth and the effect of postpartum pelvic floor muscle training on urinary incontinence in women with or without major defects of the levator ani muscle

Abstract

Background: Urinary incontinence (UI) is highly prevalent in the female population and strongly associated with pregnancy and childbirth. The pelvic floor muscles (PFM) play an important role in pelvic organ support and for staying continent. Vaginal delivery is considered the most established risk factor for weakening of the PFM. Women having their first child should be offered supervised PFM training (PFMT) during pregnancy, and PFMT is first-line treatment of UI (Grade A recommendations). However, in populations of postpartum women with and without UI (mixed population), the current evidence on efficacy of PFMT on UI prevalence is not clear. Further, the effect of PFMT in women with major levator ani (LA) muscle defects is unknown. Conclusions: Most nulliparous pregnant women knew about PFMT, but few performed PFMT. Pronounced reductions in vaginal resting pressure, PFM strength and endurance were found after vaginal delivery, whereas only vaginal resting pressure changed after caesarean section. Women with major LA muscle defects had weaker PFM than women without such defects, however most women were able to contract their PFM. The postpartum PFMT intervention did not decrease UI prevalence six months after delivery in primiparous women, and the stratified analysis on women with and without major LA muscle defects showed similar non-significant results.

Paper I: Hilde G, Staer-Jensen J, Ellström EM, Braekken IH, Bø K. Continence and pelvic floor status in nulliparous women at midterm pregnancy. Int Urogynecol J 2012; 23(9):1257-1263.

Paper II: Hilde G, Staer-Jensen J, Siafarikas F, Engh ME, Braekken IH, Bø K. 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.

Paper III: Hilde G, Staer-Jensen J, Siafarikas F, Gjestland K, Ellström EM, Bø K. How well can pelvic floor muscles with major defects contract? A cross-sectional comparative study 6 weeks after delivery using transperineal 3D/4D ultrasound and manometer. BJOG 2013; 120(11):1423- 1429.

Paper IV: Hilde G, Staer-Jensen J, Siafarikas F, Ellström EM, Bø K. Postpartum pelvic floor muscle training and urinary incontinence: a randomized controlled trial. Obstet Gynecol 2013; 122(6):1231-1238.