Postpartum Pelvic Floor Muscle Training in Women With and Without Injured Pelvic Floor Muscles (PP-PFMT)

Although pregnancy and childbirth are associated with happiness and a positive life change for most women, it can also be considered as risk periods for injuries to the pelvic floor and development of pelvic floor dysfunction. This may leed to devastating loss of function and quality of life (DeLancey & Ashton-Miller 2007).

The aim of this study is to evaluate the effect of postpartum pelvic floor muscle training for primiparous women with and without pelvic floor muscle injury.

Injuries to the pelvic floor muscles (PFM) and fascias may lead to urinary incontinence (UI), fecal incontinence, pelvic organ prolapse (POP), sensory and emptying abnormalities of the lower urinary tract, defecatory dysfunction, sexual dysfunction and chronic pain syndromes (Bump & Norton 1998). Prevalens rates of the most common pelvic floor disorders are generally high in the fertile female population

To date many randomized controlled trials (RCT) have demonstrated significant effect of pelvic floor muscle training (PFMT) in treatment of stress and mixed urinary incontinence, and it is recommended as first line treatment for stress and mixed UI in women (Level A) (Hay Smith & Dumoulin 2006, Wilson et al 2005, Welsh 2006). The effect of postpartum PFMT in prevention and treatment of urinary incontinence investigated in only four RCTs (Sleep & Grant 1987, Meyer et al 2001, Chiarelli & Cockburn 2001, Ewings et al 2005) and one matched controlled trial (Mørkved & Bø 1997, Mørkved & Bø 2000), shows conflicting results. In the Norwegian matched controlled trial, Mørkved and Bø (1997) showed the far most effective intervention so far with 50% less prevalence of UI in the training group with the same long term effect (Mørkved & Bø 2000). The high effect size may be explained by the close follow-up and relative high training dosage. However, as this was not a RCT, the effect may be overestimated and the trial is often not included in systematic reviews (Hay-Smith et al 2008).

Only few research groups have measured PFM function and strength, and there are no studies evaluating possible effects of PFMT on PFM injuries and morphology following pregnancy and childbirth. DeLancey (1996) have suggested that the effect of PFMT would be much higher if we knew the causes of incontinence and were able to include only those with intact pelvic floor muscles. This may be true, but the statement also reflects a belief that muscle injury of the PFM cannot be treated with exercise. However, this is in contrast to common practice in treatment of other skeletal muscles e.g after sport injuries, where all injuries are treated and it is believed that early mobilization and training is important in speeding up tissue healing (Jarvinen et al 2005). Hence, there is a need to conduct a RCT with high methodological and interventional quality (Herbert and Bø 2005) to investigate the effect of PFMT postpartum.

• Pelvic Floor
• Pelvic Floor Dysfunction
• Pelvic Floor Muscle Injury

• Experimental: Post partum pelvic floor muscle training
  The participants are given supervised pelvic floor muscle group training led by physiotherapists once a week. In addition, the participants train every day at home, with at least 3 sets of 8-12 contractions. Adherence is reported in a training diary. Training period is 4 months.
  Intervention: Other: Post partum pelvic floor muscle training
• No Intervention: Usual care
  The control group receive usual care
  Intervention: Other: Post partum pelvic floor muscle training

Inclusion Criteria:

• Primipara women giving birth at Akershus University Hospital, Norway
• Women giving birth to a healthy singleton baby at term
• Women who speak/ understand Scandinavian language

Exclusion Criteria:

• Multiparity
• C-section
• Premature birth (< week 32)
• Women who do not speak/ understand Scandinavian language
• Illnesses that may interfere with the ability to follow-up

• University Hospital, Akershus
• The Research Council of Norway