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Am J Obstet Gynecol. 2019 Sep 14. pii: S0002-9378(19)31116-0. doi: 10.1016/j.ajog.2019.09.011. [Epub ahead of print]

Can postpartum pelvic floor muscle training reduce urinary and anal incontinence? An assessor-blinded randomized controlled trial.

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Faculty of Medicine, School of Health Sciences, University of Iceland, Reykjavik; Department of Obstetrics and Gynecology, Landspitali University Hospital, Reykjavik. Electronic address:
Faculty of Medicine, School of Health Sciences, University of Iceland, Reykjavik; Department of Obstetrics and Gynecology, Landspitali University Hospital, Reykjavik.
Faculty of Food Sciences and Nutrition, School of Health Sciences, University of Iceland, Reykjavik, Iceland.
Faculty of Medicine, School of Health Sciences, University of Iceland, Reykjavik.
Department of Sports Medicine, Norwegian School of Sports Sciences, Oslo; Department of Obstetrics and Gynecology, Akershus University Hospital, Lørenskog, Norway.



Pelvic floor dysfunction, including urinary and anal incontinence, is a common postpartum complaint and likely to reduce quality of life.


To study the effects of individualized physical therapist-guided pelvic floor muscle training in the early postpartum period on urinary and anal incontinence and related bother, as well as pelvic floor muscle strength and endurance.


Assessor-blinded parallel randomized controlled trial evaluating effects of pelvic floor muscle training by a physical therapist on the rate of urinary and/or anal leakage (primary outcomes), while related bother and muscle strength and endurance in the pelvic floor were secondary outcomes. Between 2016-2017 primiparous women giving birth at Landspitali University Hospital in Reykjavik, Iceland were screened for eligibilty 6-10 weeks after childbirth. Of those identified as urinary incontinent 95 were invited to participate of whom 84 agreed. The intervention, starting at ∼9 weeks postpartum consisted of 12 weekly sessions with a physical therapist after which the main outcomes were assessed (endpoint, ∼6 months postpartum). Additional follow-up was conducted at ∼12 months postpartum. The control group received no instructions after the initial assessment. Fisher´s exact test was used to test differences in the proportion of women with urinary and anal incontinence between intervention and control groups, while independent sample t-tests were used for mean differences in muscle strength and endurance. Significance levels were set as α=0.05.


Forty-one and 43 women were randomized to the intervention and control groups, respectively. Three and one participants withdrew from these respective groups. Measurement variables and main delivery outcomes were not different at recruitment. At the endpoint, urinary incontinence was less frequent in the intervention group with 21 (57%) still symptomatic compared to 31 (82%) of the controls (P=0.03), as was bladder-related bother with 10 (27%) in the intervention vs. 23 (60%) in the control group, P=0.005. Anal incontinence was not influenced by pelvic floor muscle training (P=0.33), nor was bowel-related bother (P=0.82). The mean differences between groups in measured pelvic floor muscle strength changes at endpoint was 5 hPa (95%CI 2-8; P=0.003), and for pelvic floor muscle endurance changes, 50 hPa/sec (95%CI 23-77; P=0.001), both in favor of the intervention group. The mean between-group differences for anal sphincter strength changes was 10 hPa (95%CI 2-18; P=0.01), and for anal sphincter endurance changes 95 hPa/sec (95%CI 16-173; P=0.02), both in favor of the intervention. At the follow-up visit, 12 months postpartum, no differences were observed between the groups regarding rates of urinary and anal incontinence, nor related bother. Pelvic floor- and anal muscle strength and endurance favoring the intervention group were maintained.


Postpartum pelvic floor mucle training decreased the rate of urinary incontinence and related bother 6 months postpartum and increased muscle strength and endurance.


Quality of life; anal incontinence; anal sphincter muscles; pelvic floor muscle training; pelvic floor muscles; postpartum; primiparity; short-term; urinary incontinence


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