Restricted accessResearch articleFirst published online 2012-2
Pelvic floor muscle exercises utilizing trunk stabilization for treating postpartum urinary incontinence: randomized controlled pilot trial of supervised versus unsupervised training
Objective: To investigate the effect of supervised and unsupervised pelvic floor muscle exercises utilizing trunk stabilization for treating postpartum urinary incontinence and to compare the outcomes.
Subjects: Eighteen subjects with postpartum urinary incontinence.
Interventions: Subjects were randomized to either a supervised training group with verbal instruction from a physiotherapist, or an unsupervised training group after undergoing a supervised demonstration session.
Main measures: Bristol Female Lower Urinary Tract Symptom questionnaire (urinary symptoms and quality of life) and vaginal function test (maximal vaginal squeeze pressure and holding time) using a perineometer.
Results: The change values for urinary symptoms (−27.22 ± 6.20 versus −18.22 ± 5.49), quality of life (−5.33 ± 2.96 versus −1.78 ± 3.93), total score (−32.56 ± 8.17 versus −20.00 ± 6.67), maximal vaginal squeeze pressure (18.96 ± 9.08 versus 2.67 ± 3.64 mmHg), and holding time (11.32 ± 3.17 versus 5.72 ± 2.29 seconds) were more improved in the supervised group than in the unsupervised group (P < 0.05). In the supervised group, significant differences were found for all variables between pre- and post-test values (P < 0.01), whereas the unsupervised group showed significant differences for urinary symptom score, total score and holding time between the pre- and post-test results (P < 0.05).
Conclusions: These findings suggest that exercising the pelvic floor muscles by utilizing trunk stabilization under physiotherapist supervision may be beneficial for the management of postpartum urinary incontinence.
Get full access to this article
View all access options for this article.
References
1.
AltmanDEkstromAForsgrenCNordenstamJZetterstromJ. Symptoms of anal and urinary incontinence following cesarean section or spontaneous vaginal delivery. Am J Obstet Gynecol2007; 197: 512e1–7.
2.
ViktrupL. The risk of the urinary tract symptoms five years after the first delivery. Neurourol Urodyn2002; 21: 2–9.
3.
ParenteMPLNatal-JorgeRMMascarenhasTFernandesAAMartinsJAC. Deformation of the pelvic floor muscles during a vaginal delivery. Int Urogynecol J2008; 19: 65–71.
4.
SapsfordR. Rehabilitation of pelvic floor muscles utilizing trunk stabilization. Man Ther2004; 9: 3–12.
5.
ArabAMBehbahaniRBLorestaniLAzariA. Correlation of digital palpation and transabdomonal ultrasound for assessment of pelvic floor muscle contraction. J Man Manip Ther2009; 17: 75–79.
6.
GirãoMJBC. Incontinência urinária de esforço: Fisiopatologia. In: GirãoMJBCBaracatCERodrigues de LimaG (eds). Uroginecologia. São Paulo: Artes Médicas, 1997.
7.
BøK. Pelvic floor muscle training is effective in treatment of female stress urinary incontinence, but how does it work?Int Urogynecol J Pelvic Floor Dysfunct2004; 15: 76–84.
8.
Ashton-MillerJHowardDDeLanceyJO. The functional anatomy of the female pelvic floor and stress incontinence control system. Scand J Urol Nephrol Suppl2001; 207: 1–7.
9.
BøKMorkvedSFrawleyHSherbumM. Evidence for benefit of transversus abdominis training alone or in combination with pelvic floor muscle training to treat female urinary incontinence: A systematic review. Neurourol Ulrodyn2010; 28: 368–373.
10.
HodgesPWErikssonAEMShirleyDGandeviaSC. Intra-abdominal pressure increases stiffness of the lumbar spine. J Biomech2005; 38: 1873–1880.
11.
CodyJDRichardsonKMoehrerBHextallAGlazenerCMA. Oestrogen therapy for urinary incontinence in post-menopausal women. Cochrane Database Syst Rev2009; (4): CD001405.
12.
HodgesPWRichardsonCA. Inefficient muscular stabilization of the lumbar spine associated with low back pain. Spine1996; 21: 2640–2650.
13.
ZanettiMRCastroRARottaALSantosPDSartoriMGiraoMJ. Impact of supervised physiotherapeutic pelvic floor exercises for treating female stress urinary incontinence. Sao Paulo Med J2007; 125: 265–269.
14.
GibbsCFJohnsonTMOuslanderJG. Office Management of Geriatric Urinary Incontinence. Am J Med2007; 120: 211–220.
15.
KonstantinidouEApostolidisAKondelidisNTsimtsiouZHatzichristouDLoannidesE. Short-term efficacy of group pelvic floor training under intensive supervision versus unsupervised home training for female urinary stress incontinence: A randomized pilot study. Neurourol Urodyn2007; 26: 486–491.
16.
PriceNDawoodRJacksonSR. Pelvic floor exercise for urinary incontinence: A systematic literature review. Maturitas2010; 67: 309–315.
17.
FelicíssimoMFCarneiroMMSalemeCSPintoRZdaFonsecaAMda Silva-FilhoAL. Intensive supervised versus unsupervised pelvic floor muscle training forthe treatment of stress urinary incontinence: A randomized comparative trial. Int Urogynecol J Pelvic Floor Dysfunct2010; 21: 835–840.
18.
Hay-SmithEJDumoulinC. Pelvic floor muscle training versus no treatment or inactive control treatments, for urinary incontinence in women. Cochrane Database Syst Rev2006; (1): CD005654.
19.
JacksonSDonovanJBrookesS. The Bristol female lower urinary tract symptoms questionnaire: Development and psychometric testing. Br J Urol1996; 77: 805–812.
20.
AbramsPKlevmarkB. Frequency volume charts: An indispensable part of lower urinary tract assessment. Scand J Urol Nephrol1996; 179: 47–53.
21.
DurantLECareyMP. Self-administered questionnaires versus face-to-face interviews in assessing sexual behaviour in young women. Arch Sexual Behaviour2000; 29: 309–322.
22.
BoyingtonARDoughertyMC. Pelvic muscle exercise effects on pelvic muscle performance in women. Int J Urol2000; 11: 212–218.
23.
KoumantakisGAWatsonPJOldhamJA. Trunk muscle stabilization training plus general exercise versus general exercise only: Randomized controlled trial of patients with recurrent low back pain. Phys Ther2005; 85: 209–225.
24.
ArtalRTooleMO. Guidelines of the American College of Obstericians and Gyneologists for exercise during pregnancy and postpartum period. Br J Sports Med2003; 37: 6–12.
25.
AlewijnseDMestersIMetsemakersJAdriaansJvan den BorneB. Predictors of intention to adhere to physiotherapy among women with urinary incontinence. Health Educ Res2001; 16: 173–186.
26.
ThompsonJAO’SullivanPB. Levator plate movement during voluntary pelvic floor muscle contraction in subjects with incontinence and prolapse: A cross-sectional study and review. Int Urogynecol J Pelvic Floor Dysfunct2003; 14: 84–88.
27.
BaesslerKMiskaKDrathsRSchuesslerB. Effects of voluntary pelvic floor contraction and relaxation on the urethral closure pressure. Int Urogynecol J Pelvic Floor Dysfunct2005; 16: 187–190.
28.
DumoulinCBourbonnaisDLemieuxMC. Development of a dynamometer for measuring the isometric force of the pelvic floor musculature. Neurourol Urodyn2003; 22: 648–653.
29.
DevreeseAStaesFde WeerdtW. Clinical evaluation of pelvic floor muscle function in continent andincontinent women. Neurourol Urodyn2004; 23: 190–197.
30.
Hay-SmithEJCBøKBerghmansLC. Pelvic floor muscle training for urinary incontinence in women. Cochrane Database Syst Rev2001; 1CD001407.
31.
WilsonPDBøKHay-SmithEJNygaardIStaskinDWymanJ. Conservative management in women. In: AbramsPCardozoLKhourySWeinA (eds). Incontinence, second edition. Plymouth: Health Publications, 2002.
32.
MorkvedSBøKScheiBSalvesenKA. Pelvic floor muscle training during pregnancy to prevent urinary incontinence: A single-blind randomized controlled trial. Obstet Gynecol2003; 101: 313–319.
33.
RettMTSimoesJAHerrmannVPintoCLBMarquesAAMoraisSS. Management of stress urinary incontinence with surface electromyography-assisted biofeedback in women of reproductive age. Physio Ther2007; 87: 136–142.
34.
HungHCHsiaoSMChihSYLinHHTsauoJY. An alternative intervention for urinary incontinence: Retraining diaphragmatic, deep abdominal and pelvic floor muscle coordinated function. Manu Ther2010; 15: 273–279.
