Effect of postpartum pelvic floor muscle training on improving pelvic floor function

doi:10.3969/j.issn.1674-8115.2023.03.006

Abstract

Abstract:

Objective ·To evaluate the effect of pelvic floor muscle training (Kegel training) on the rehabilitation of pelvic floor function within 1 year after delivery. Methods ·From January to April 2020, primiparas with different degrees of urinary incontinence or pelvic organ prolapse were selected and divided into exercise group (147 cases) and control group (194 cases). The exercise group received Kegel training at 6 weeks of the postpartum period, while the control group received general postpartum health education only. At 6 weeks and 1 year after delivery, these postpartum women in the two groups were investigated with the general information questionnaire and International Consultation Incontinence Questionnaire-UI Short Form (ICIQ-SF). The pelvic floor muscle strength was measured (the pelvic floor muscle strength grade>Ⅲ indicates normal muscle strength). The pelvic organ prolapsed quantitation (POP-Q) score was assigned accordingly. The urinary incontinence score, pelvic floor muscle strength and pelvic floor organ prolapse were compared between the two groups, and the effect of pelvic floor muscle training was evaluated. Results ·In the exercise group, 20 postpartum women lost contact during follow up sections, and 28 women in the control group were unable to be contacted within 1 year. In the exercise group, the proportion of women with normal pelvic floor muscle strength at 1 year postpartum was significantly higher than that at 6 weeks postpartum (56.0% vs 34.7%, P=0.000), and the incidence of incontinence at 1 year postpartum was significantly lower than that at 6 weeks postpartum (25.2% vs 36.7%, P=0.040). In the control group, the proportion of women with normal pelvic floor muscle strength at 1 year postpartum was significantly higher than that at 6 weeks postpartum (43.4% vs 32.5%, P=0.033), and the incidence of incontinence at 1 year postpartum was significantly lower than that at 6 weeks postpartum (17.5% vs 28.9%, P=0.011). At 1 year postpartum, the proportion of women with normal pelvic floor muscle strength in the exercise group was higher than that in the control group (56.0% vs 43.4%, P=0.033). The improvement rate of muscle strength in the exercise group was higher than that in control group (50.4% vs 35.5%, P=0.011). There was no significant difference in the improvement rate of pelvic organ prolapse and frequency of urinary incontinence between the exercise group and the control group (P>0.05). Conclusion ·Postpartum pelvic floor muscle training can improve pelvic floor muscle strength, but has no significant effect on improving pelvic floor dysfunction in the current samples. The urinary incontinence condition and pelvic floor muscle strength of women improve 1 year after delivery, indicating that there is a mechanism for self recovery of pelvic floor muscle, but it may take a long time.

Key words: pelvic floor muscle training, postpartum, urinary incontinence, pelvic organ prolapse, pelvic floor muscle, natural childbirth

CLC Number:

R711.2

RAO Lin, ZHANG Linna, YUAN Jiaqi, LU Bangchun. Effect of postpartum pelvic floor muscle training on improving pelvic floor function[J]. Journal of Shanghai Jiao Tong University (Medical Science), 2023, 43(3): 308-313.

Figures/Tables 4

TrendMD

References 19

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Item	Exercise group (n=147)	Control group (n=194)	t/Z/χ² value	P value
Age/year	30.35±3.15	29.95±3.21	1.164	0.245
Gestational length/week	39.01±1.15	39.11±1.02	-0.847	0.398
Pre-gestational BMI/(kg·m^-2)	20.54±2.17	20.34±2.24	0.818	0.414
Weight gain/kg	15.69±4.39	15.50±4.36	0.408	0.684
Neonatal birth weight/g	3 366.84±330.85	3 329.15±393.47	0.937	0.349
Duration of the second stage/min	50.00 (31.00, 81.00)	55.00 (30.00, 83.25)	-0.245	0.807
Breast-feeding time/month	9.69±3.38	9.68±3.52	0.034	0.973
Education/n (%)			0.003	0.999
Secondary education	9 (6.1)	12 (6.2)
College or university	114 (77.6)	150 (77.3)
Graduate	24 (16.3)	32 (16.5)
Gravidity/n (%)			3.250	0.197
1	112 (76.2)	138 (71.1)
2	24 (16.3)	46 (23.7)
≥3	11 (7.5)	10 (5.2)
Episiotomy/n (%)			1.416	0.234
Yes	40 (27.2)	42 (21.6)
No	107 (72.8)	152 (78.4)
Perineal laceration/n (%)			1.479	0.477
0	41 (27.9)	43 (22.1)
Ⅰ	84 (57.1)	120 (61.9)
Ⅱ	22 (15.0)	31 (16.0)
Delivery mode/n (%)			0.514	0.473
Natural delivery	129 (87.8)	165 (85.1)
Forceps	18 (12.2)	29 (14.9)

Item	Exercise group (n=147)	Control group (n=194)	t/Z/χ² value	P value
Age/year	30.35±3.15	29.95±3.21	1.164	0.245
Gestational length/week	39.01±1.15	39.11±1.02	-0.847	0.398
Pre-gestational BMI/(kg·m^-2)	20.54±2.17	20.34±2.24	0.818	0.414
Weight gain/kg	15.69±4.39	15.50±4.36	0.408	0.684
Neonatal birth weight/g	3 366.84±330.85	3 329.15±393.47	0.937	0.349
Duration of the second stage/min	50.00 (31.00, 81.00)	55.00 (30.00, 83.25)	-0.245	0.807
Breast-feeding time/month	9.69±3.38	9.68±3.52	0.034	0.973
Education/n (%)			0.003	0.999
Secondary education	9 (6.1)	12 (6.2)
College or university	114 (77.6)	150 (77.3)
Graduate	24 (16.3)	32 (16.5)
Gravidity/n (%)			3.250	0.197
1	112 (76.2)	138 (71.1)
2	24 (16.3)	46 (23.7)
≥3	11 (7.5)	10 (5.2)
Episiotomy/n (%)			1.416	0.234
Yes	40 (27.2)	42 (21.6)
No	107 (72.8)	152 (78.4)
Perineal laceration/n (%)			1.479	0.477
0	41 (27.9)	43 (22.1)
Ⅰ	84 (57.1)	120 (61.9)
Ⅱ	22 (15.0)	31 (16.0)
Delivery mode/n (%)			0.514	0.473
Natural delivery	129 (87.8)	165 (85.1)
Forceps	18 (12.2)	29 (14.9)

Parameter	Exercise group (n=147)	Control group (n=194)	χ² /Z value	P value
POP stage/n (%)			5.414	0.067
Grade 0	23 (15.6)	36 (18.6)
Grade 1	68 (46.3)	107 (55.1)
Grade 2	56 (38.1)	51 (26.3)
Muscle strength/n (%)			0.185	0.728
>Ⅲ	51 (34.7)	63 (32.5)
≤Ⅲ	96 (65.3)	131 (67.5)
UI/n (%)			2.370	0.124
No	93 (63.3)	138 (71.1)
Yes	54 (36.7)	56 (28.9)
ICIQ-SF score	0 (0, 4.00)	0 (0, 3.35)	-1.493	0.136

Parameter	Exercise group (n=147)	Control group (n=194)	χ² /Z value	P value
POP stage/n (%)			5.414	0.067
Grade 0	23 (15.6)	36 (18.6)
Grade 1	68 (46.3)	107 (55.1)
Grade 2	56 (38.1)	51 (26.3)
Muscle strength/n (%)			0.185	0.728
>Ⅲ	51 (34.7)	63 (32.5)
≤Ⅲ	96 (65.3)	131 (67.5)
UI/n (%)			2.370	0.124
No	93 (63.3)	138 (71.1)
Yes	54 (36.7)	56 (28.9)
ICIQ-SF score	0 (0, 4.00)	0 (0, 3.35)	-1.493	0.136

Parameter	Exercise group (n=127)	Control group (n=166)	χ² /Z value	P value
POP stage change/n (%)			0.814	0.367
Better	30 (23.6)	32 (19.3)
No better	97 (76.4)	134 (80.7)
POP stage/n (%)			0.933	0.627
Grade 0	19 (15.0)	32 (19.3)
Grade 1	67 (52.8)	83 (50.0)
Grade 2	41 (32.2)	51 (30.7)
Muscle strength/n (%)			4.523	0.033
>Ⅲ	71 (56.0)	72 (43.4)
≤Ⅲ	56 (44.0)	94 (56.6)
Muscle strength change/n (%)			6.516	0.011
Better	64 (50.4)	59 (35.5)
No better	63 (49.6)	107 (64.5)
UI/n (%)			2.606	0.106
No	95 (74.8)	137 (82.5)
Yes	32 (25.2)	29 (17.5)
ICIQ-SF score	0 (0, 3.00)	0 (0, 2.00)	-1.730	0.084