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Cited by 347Pelvic floor disorders treatmentsUrinary Bladder and Prostate ResearchPregnancy-related medical research

Pelvic floor muscle training for preventing and treating urinary and faecal incontinence in antenatal and postnatal women

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Woodley, Stephanie J, Lawrenson, Peter, Boyle, Rhianon, Cody, June D, Mørkved, Siv, Kernohan, Ashleigh, Hay-Smith, E Jean C·2020·Cochrane Database of Systematic Reviews
DOI 10.1002/14651858.cd007471.pub4PMC PMC7203602
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Abstract

BACKGROUND: About one-third of women have urinary incontinence (UI) and up to one-tenth have faecal incontinence (FI) after childbirth. Pelvic floor muscle training (PFMT) is commonly recommended during pregnancy and after birth for both preventing and treating incontinence. This is an update of a Cochrane Review previously published in 2017. OBJECTIVES: To assess the effects of PFMT for preventing or treating urinary and faecal incontinence in pregnant or postnatal women, and summarise the principal findings of relevant economic evaluations. SEARCH METHODS: We searched the Cochrane Incontinence Specialised Register, which contains trials identified from the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, MEDLINE In-Process, MEDLINE Epub Ahead of Print, CINAHL, ClinicalTrials.gov, WHO ICTRP, and handsearched journals and conference proceedings (searched 7 August 2019), and the reference lists of retrieved studies. SELECTION CRITERIA: We included randomised or quasi-randomised trials in which one arm included PFMT. Another arm was no PFMT, usual antenatal or postnatal care, another control condition, or an alternative PFMT intervention. Populations included women who, at randomisation, were continent (PFMT for prevention) or incontinent (PFMT for treatment), and a mixed population of women who were one or the other (PFMT for prevention or treatment). DATA COLLECTION AND ANALYSIS: We independently assessed trials for inclusion and risk of bias. We extracted data and assessed the quality of evidence using GRADE. MAIN RESULTS: We included 46 trials involving 10,832 women from 21 countries. Overall, trials were small to moderately-sized. The PFMT programmes and control conditions varied considerably and were often poorly described. Many trials were at moderate to high risk of bias. Two participants in a study of 43 pregnant women performing PFMT for prevention of incontinence withdrew due to pelvic floor pain. No other trials reported any adverse effects of PFMT. Prevention of UI: compared with usual care, continent pregnant women performing antenatal PFMT probably have a lower risk of reporting UI in late pregnancy (62% less; risk ratio (RR) 0.38, 95% confidence interval (CI) 0.20 to 0.72; 6 trials, 624 women; moderate-quality evidence). Antenatal PFMT slightly decreased the risk of UI in the mid-postnatal period (more than three to six months' postpartum) (29% less; RR 0.71, 95% CI 0.54 to 0.95; 5 trials, 673 women; high-quality evidence). There was insufficient information available for the late postnatal period (more than six to 12 months) to determine effects at this time point (RR 1.20, 95% CI 0.65 to 2.21; 1 trial, 44 women; low-quality evidence). Treatment of UI: compared with usual care, there is no evidence that antenatal PFMT in incontinent women decreases incontinence in late pregnancy (very low-quality evidence), or in the mid-(RR 0.94, 95% CI 0.70 to 1.24; 1 trial, 187 women; low-quality evidence), or late postnatal periods (very low-quality evidence). Similarly, in postnatal women with persistent UI, there is no evidence that PFMT results in a difference in UI at more than six to 12 months postpartum (RR 0.55, 95% CI 0.29 to 1.07; 3 trials; 696 women; low-quality evidence). Mixed prevention and treatment approach to UI: antenatal PFMT in women with or without UI probably decreases UI risk in late pregnancy (22% less; RR 0.78, 95% CI 0.64 to 0.94; 11 trials, 3307 women; moderate-quality evidence), and may reduce the risk slightly in the mid-postnatal period (RR 0.73, 95% CI 0.55 to 0.97; 5 trials, 1921 women; low-quality evidence). There was no evidence that antenatal PFMT reduces the risk of UI at late postpartum (RR 0.85, 95% CI 0.63 to 1.14; 2 trials, 244 women; moderate-quality evidence). For PFMT started after delivery, there was uncertainty about the effect on UI risk in the late postnatal period (RR 0.88, 95% CI 0.71 to 1.09; 3 trials, 826 women; moderate-quality evidence). Faecal incontinence: eight trials reported FI outcomes. In postnatal women with persistent FI, it was uncertain whether PFMT reduced incontinence in the late postnatal period compared to usual care (very low-quality evidence). In women with or without FI, there was no evidence that antenatal PFMT led to a difference in the prevalence of FI in late pregnancy (RR 0.64, 95% CI 0.36 to 1.14; 3 trials, 910 women; moderate-quality evidence). Similarly, for postnatal PFMT in a mixed population, there was no evidence that PFMT reduces the risk of FI in the late postnatal period (RR 0.73, 95% CI 0.13 to 4.21; 1 trial, 107 women, low-quality evidence). There was little evidence about effects on UI or FI beyond 12 months' postpartum. There were few incontinence-specific quality of life data and little consensus on how to measure it. AUTHORS' CONCLUSIONS: This review provides evidence that early, structured PFMT in early pregnancy for continent women may prevent the onset of UI in late pregnancy and postpartum. Pop

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Authors
Woodley, S. J., Lawrenson, P., Boyle, R., Cody, J. D., Mørkved, S., Kernohan, A., & Hay-Smith, E. J. C.
Affiliations
  • University of Otago (NZ)
  • University of Aberdeen (GB)
  • Newcastle University (GB)
  • St Olav's University Hospital (NO)
  • Rehabilitation Teaching and Research Unit, Department of Medicine; University of Otago; Wellington New Zealand
ORCID
Venue
Cochrane Database of Systematic Reviews
Publisher
Wiley
Published
2020-05-07
Volume
2021
Issue
3
Pages
CD007471-CD007471
ISSN
  • 1361-6137 (ISSN-L)
  • 1465-1858
DOI
10.1002/14651858.cd007471.pub4
PMC
PMC7203602
OpenAlex
W3200838742
Cited by
347
References
204
Citations by year
2026: 41 · 2025: 52 · 2024: 69 · 2023: 80 · 2022: 58 · 2021: 36 · 2020: 8 · 2019: 1 · 2016: 1
FWCI
7.08
Type
journal article
Language
en
Open access
Locations
  • Cochrane Database of Systematic Reviews (publishedVersion)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
  • Newcastle University ePrints (Newcastle Univesity)
Topics
  • Health Sciences › Medicine › Rheumatology › Pelvic floor disorders treatments
  • Health Sciences › Medicine › Urology › Urinary Bladder and Prostate Research
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Pregnancy-related medical research
Keywords
pelvic floor muscle training, urinary incontinence, fecal incontinence, pregnancy, childbirth, pelvic floor pain, economic evaluation, cost-effectiveness, cost-benefit analysis, cost-utility analysis, cost minimization, quality of life, risk of bias, adverse effects, women's health services, health care utilization
MeSH terms
Exercise Therapy, Fecal Incontinence, Female, Humans, Postnatal Care, Pregnancy, Pregnancy Complications, Prenatal Care, Puerperal Disorders, Urinary Incontinence, Randomized Controlled Trials as Topic, Pelvic Floor

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