Antenatal pelvic floor muscle training and urinary incontinence: a randomized controlled 7-year follow-up study

Introduction and hypothesis Urinary incontinence is common postpartum. Our aims were to assess whether antenatal exercise including pelvic floor muscle training (PFMT) has long-term effects on urinary incontinence (UI) and to explore factors associated with UI 7 years postpartum. Methods A follow-up of a two-centre randomized controlled trial performed at St. Olavs Hospital and Stavanger University Hospital, Norway. In the original trial women were randomized to a 12-week structured exercise protocol including PFMT or standard antenatal care during pregnancy. Link to an electronic questionnaire was sent by postal mail 7 years postpartum. Prevalence of UI was assessed with Sandvik severity index and compared between groups. Factors associated with UI were studied using multivariable logistic regression analysis. Results The response rate was 35% (298/855). UI was reported by 78 (51%) in the intervention group and 63 (57%) in the control group (p = 0.539). In the multivariable logistic regression analyses, women with UI at inclusion had a five-fold increase in odds of UI at 7 years (OR 5.4, 95% CI 2.6, 11.5). Engaging in regular exercise was not significantly associated with UI at 7 years; however, UI was associated with lower exercise intensity (OR 2.4, 95% CI 1.2, 4.6). Conclusions We found no group differences of antenatal exercise including PFMT on UI after 7 years among the responders. UI in pregnancy increased the risk of long-term UI. Regular exercise was not associated with UI at 7 years; however, women with UI were more than twice as likely to exercise at lower intensity than continent women.

The Effect of Pelvic Floor Muscle Training on Pelvic Floor Function and Sexuality Postpartum. A Randomized Study Including 300 Primiparous

PurposeAlthough pregnancy and childbirth are physiological processes, they may be associated with pelvic floor disorders. The aim of this study was to evaluate the influence of pelvic floor muscle training on postpartum pelvic floor and sexual function of primiparous. MethodsThis is a randomized, prospective study including 300 primiparous women. Inclusion criteria were the delivery of the first, mature baby, the ability to speak, understand German. The participants were evaluated by clinical examinations and questionnaires after 6, 12 months postpartum. After 6 months the women were randomized in two groups. Compared to the control group the intervention groups participated in pelvic floor muscle training once a week over 6 weeks. ResultsThe results of the questionnaires showed no significant differences between the groups after 12 months. A significant stronger pelvic floor muscle strength was found for the intervention group after 12 months. The improvement of the pelvic floor and sexual function over the time showed a significant improvement in both groupsConclusionSupervised pelvic floor muscle training did not improve both the pelvic floor and the female sexual function in comparison to the control group. After 12 months the pelvic floor and sexual function improved significant in all women.Trial registration numberGerman Clinical Trials Register (DRKS00024725), retrospectively registrated

Augmented Core Breathing Pelvic Floor Muscle Training for Patients with Genitourinary Syndrome in Different Phases of Menopause

Pelvic floor muscle has a role in core breathing for twenty-four hours and offers an influence to modulate the lumbar spine and pelvic floor. Several studies reported on pelvic floor muscle strength. Women with genitourinary syndrome do not seek care for their condition and are dismayed to speak with the health care provider about the condition. In the present work, we evaluated the efficiency of augmented core breathing in the genitourinary syndrome of menopause for pelvic floor muscle strength. We tested the role of augmented core breathing efficacy using pelvic floor muscle training in patients with the genitourinary syndrome. Our data revealed significant beneficial effects of core breathing with pelvic floor muscle training and Kegel’s exercise in patients with genitourinary syndrome in different phase of menopause. KEY WORDS: genitourinary syndrome; menopause; pelvic exerciser; pelvic floor muscle training; Utian quality of life scale.

Effect of the App-Based Video Guidance on Prenatal Pelvic Floor Muscle Training Combined with Global Postural Re-education for Stress Urinary Incontinence Prevention: A Protocol for a Multicenter, Randomized Controlled Trial

Background: As the effectiveness on stress urinary incontinence (SUI) prevention of pelvic floor muscle training (PFMT) for pregnant women has been inconclusive, we are planning to conduct a trial to evaluate a video program designed for prevention of SUI developed through combining PFMT with global postural reeducation (GPR). Methods: As a randomized controlled trial, eligible participants will be randomized (1:1) into an exercise group and a control group to perform PFMT regularly following video guidance or with no intervention, respectively. The experimental stage will be from the 16th gestation week (GW) to the 12th month postpartum, with eight appointments at the 16th, 28th, 37th GW, delivery, the 6th week and the 3rd, 6th, and 12th month postpartum. Data will be collected regarding urinary leakage symptoms, the stress test, the modified Oxford Scale, pelvic floor ultrasound, perineal laceration classification at delivery, neonatal Apgar score, and questionnaires (PISQ-12, ICIQ-UI SF, I-QOL, OABSS). The primary outcome is the occurrence of the symptomatic SUI and positive stress test at the 6th week postpartum. Discussion: This protocol is anticipated to evaluate the efficacy of the intervention via video app for the design of a future randomized control trial (RCT). Trial registration: The trial has been registered at Chinese Clinical Trial Registry (registration number: ChiCTR2000029618).

Designing a Personalised Mobile Application to Improve Engagement With PFMT Therapy Amongst Women From Pregnancy To One Year After Delivery

<p>Women who are pregnant, or have given birth are at high risk of developing Pelvic Floor Disorder (PFD) due to the physical stress placed on the pelvic muscles during this time. When left untreated, PFD can cause symptoms such as incontinence, organ prolapse and pelvic pain in sufferers. Pelvic Floor Muscle Training (PFMT) is a highly effective means of treating and preventing symptoms of PFD. However, adherence rates to PFMT remain low. Amongst the biggest barriers to adherence are incorrect technique, lack of knowledge, memory, time, low motivation and stigma. As with the physical symptoms of PFD, these barriers impact sufferers in ways unique to each individual. Findings from the existing literature suggest that personalising the intervention to accommodate these varying factors may improve adherence. This study focuses on the development of a personalised mobile application to improve engagement with PFMT amongst women from pregnancy, up to one year after delivery. The goal of the application is to improve engagement with PFMT through addressing key barriers to adherence, and guiding correct performance of PFMT. An initial design criteria and five user personas were developed. The criteria and personas were used to develop prototypes, which were then user tested. The designs were then refined based on user feedback. Designs were also informed by feedback from interviews with clinicians and women. The results of this study indicate that a mobile application is an ineffective means of guiding PFMT technique. However the application proved effective in addressing the barrier of memory through the use of context based triggers. The integration of the Hooked model in the application design had a low to moderate effect on improving engagement with PFMT. Opportunities for a personalised design approach in the areas of instruction, facilitation of exercises and preferences for application features were identified.</p>

Designing a Personalised Mobile Application to Improve Engagement With PFMT Therapy Amongst Women From Pregnancy To One Year After Delivery

<p>Women who are pregnant, or have given birth are at high risk of developing Pelvic Floor Disorder (PFD) due to the physical stress placed on the pelvic muscles during this time. When left untreated, PFD can cause symptoms such as incontinence, organ prolapse and pelvic pain in sufferers. Pelvic Floor Muscle Training (PFMT) is a highly effective means of treating and preventing symptoms of PFD. However, adherence rates to PFMT remain low. Amongst the biggest barriers to adherence are incorrect technique, lack of knowledge, memory, time, low motivation and stigma. As with the physical symptoms of PFD, these barriers impact sufferers in ways unique to each individual. Findings from the existing literature suggest that personalising the intervention to accommodate these varying factors may improve adherence. This study focuses on the development of a personalised mobile application to improve engagement with PFMT amongst women from pregnancy, up to one year after delivery. The goal of the application is to improve engagement with PFMT through addressing key barriers to adherence, and guiding correct performance of PFMT. An initial design criteria and five user personas were developed. The criteria and personas were used to develop prototypes, which were then user tested. The designs were then refined based on user feedback. Designs were also informed by feedback from interviews with clinicians and women. The results of this study indicate that a mobile application is an ineffective means of guiding PFMT technique. However the application proved effective in addressing the barrier of memory through the use of context based triggers. The integration of the Hooked model in the application design had a low to moderate effect on improving engagement with PFMT. Opportunities for a personalised design approach in the areas of instruction, facilitation of exercises and preferences for application features were identified.</p>

Pelvic floor rehabilitation in the treatment of mixed urinary incontinence among women

Background Mixed urinary incontinence (MUI) is a common underreported problem among females; it has a major effect on patients’ quality of life. Treatment may be difficult since a single modality cannot be enough to alleviate both the urge and the stress symptoms. Biofeedback-assisted pelvic floor muscle training (PFMT) has a great role in strengthening the pelvic floor muscles especially when accompanied by electrical stimulation. Neuromodulation is another safe well-tolerated method that may improve symptoms of female voiding dysfunction. There are no previous studies that assessed the efficacy of biofeedback-assisted pelvic floor muscle training versus two different types of peripheral neuromodulation which are transcutaneous posterior tibial nerve stimulation (TPTNS) and anogenital neuromodulation in the treatment of mixed urinary incontinence among women. The aim of this work is to study the effectiveness of biofeedback-assisted pelvic floor muscle training with electrostimulation versus two different methods of peripheral neuromodulation techniques in the treatment of women with MUI. Patients were subjected to history taking, assessment questionnaires (Questionnaire for female Urinary Incontinence Diagnosis (QUID), Australian Pelvic Floor Questionnaire (PFQ), and International Consultation on Incontinence Questionnaire-Urinary Incontinence-Short Form (ICIQ-UI-SF)), clinical examination, and manometric pressure assessment. The patients were allocated randomly into three groups. Group I received biofeedback-assisted pelvic floor muscle training and faradic electrical stimulation, group II received posterior tibial neuromodulation, and group III received anogenital neuromodulation. Results The present study included 68 non-virgin female patients with mixed urinary incontinence. Significant improvement was noticed in the three studied groups on the subjective and objective levels. No statistically significant difference was reported between the studied groups following the different types of intervention. Conclusions Biofeedback-assisted pelvic floor muscle training with electrostimulation is as effective as anogenital neuromodulation and posterior tibial neuromodulation in the treatment of mixed urinary incontinence among females. Trial registration PACTR, PACTR202107816829078. Registered 29 July 2021 - Retrospectively registered.

Intravaginal electrical stimulation associated with pelvic floor muscle training for women with stress urinary incontinence: study protocol for a randomized controlled trial with economic evaluation

Introduction Pelvic floor muscle training (PFMT) exercises and neuromuscular electrical stimulation (NMES) are described as conservative interventions to prevent or treat female stress urinary incontinence (SUI). However, it has not been described yet the effect of PFMT associated to intravaginal NMES which evaluated the cost-effectiveness and cost-utility of treating. Aims To evaluate the effects of intravaginal NMES associated with the PFMT protocol on urinary loss and quality of life in women with SUI and to evaluate the cost-effectiveness and cost-utility and pelvic floor muscle in women with SUI. Methods Randomized controlled trial study with economic evaluation. Inclusion criteria are woman (biological), aged ≥ 18 years old and with a report of SUI ≥ once/week. Exclusion criteria are presence of vaginal or urinary infection, virginity, being in the gestational or puerperium period, or neurological disease. Participants will undergo physical therapy assessment and intervention: anamnesis, pelvic floor muscle assessment by vaginal palpation and manometry (PeritronTM), questionnaires (Short-Form 6 Dimensions—Brazil (SF-6D), King's Health Questionnaire (KHQ) and King´s Health Questionnaire for Scoring Algorithm), health costs, and voiding diary. Participants will be randomly allocated into 3 groups: CG (control group), IG 1 (intervention group 1, PFMT), and IG2 (intervention group 2, PFMT + NMES). The statistical analysis will be performed by intention to treat, and multivariate analysis of mixed effects will be used to compare outcomes. Effect size measurements will be calculated and will be provided by Cohen’s d test. A significance level of 5% will be adopted. Additionally, the incremental cost-effectiveness and incremental cost-utility ratios will be used. Discussion This protocol can corroborate with the literature in order to identify the effect of techniques, based on the possibility of confirming the hypothesis that the NMES associated with PFMT performed concurrently will be the best treatment option; considering the effectiveness, cost-effectiveness, and cost-utility analysis, it will be used as an option for optimization of the treatment of SUI. Trial registration Brazilian Registry of Clinical Trials (ReBEC) ID: RBR-6gtzg4. Registered on September 3, 2019.