Effect of postpartum pelvic floor muscle training on improving pelvic floor function
RAO Lin,, ZHANG Linna, YUAN Jiaqi, LU Bangchun,
Department of Obstetrics and Gynecology, The International Peace Maternity & Child Health Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200030, China
目的·评价产后1年内盆底肌训练（Kegel训练）对产妇盆底功能康复的作用。方法·选取2020年1—4月在上海交通大学医学院附属国际和平妇幼保健院产后6周检查有不同程度尿失禁和/或盆腔器官脱垂的阴道分娩初产妇，分为锻炼组（147例）和对照组（194例）。锻炼组于产后6周开始进行Kegel训练，对照组进行一般的产后健康教育。在产后6周及产后1年，对2组产妇进行一般情况问卷及国际尿失禁咨询委员会尿失禁问卷表简表（International Consultation Incontinence Questionnaire-UI Short Form，ICIQ-SF）调查，并进行盆底肌力测定和分级（盆底肌力分级>Ⅲ级表明肌力正常）；根据盆腔器官脱垂分度法（pelvic organ prolapsed quantitation，POP-Q）定量评估脱垂程度。比较2组产妇的盆底肌力分级、尿失禁评分以及盆底器官脱垂情况，评价盆底肌训练的效果。结果·随访至产后1年，锻炼组和对照组失访数分别为20例和28例。锻炼组产后1年盆底肌力正常的比例显著高于产后6周（56.0% vs 34.7%，P=0.000），尿失禁发生率显著低于产后6周（25.2% vs 36.7%，P=0.040）。对照组产后1年盆底肌力正常的比例显著高于产后6周（43.4% vs 32.5%，P=0.033），尿失禁发生率显著低于产后6周（17.5% vs 28.9%，P=0.011）。产后1年，锻炼组盆底肌力正常的比例高于对照组（56.0% vs 43.4%，P=0.033），盆底肌力好转率高于对照组（50.4% vs 35.5%，P=0.011）。盆腔器官脱垂程度改善率和尿失禁好转率在锻炼组和对照组之间分别比较，差异均无统计学意义（P>0.05）。结论·产后进行盆底肌训练可提高盆底肌力，但对改善产妇盆底功能障碍的效果并不明显；产后1年产妇尿失禁和盆底肌力均有改善，表明盆底肌有自行恢复的机制，但可能需要较长的时间。
关键词：盆底肌训练
;
产后
;
尿失禁
;
盆腔器官脱垂
;
盆底肌
;
自然分娩
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.
Keywords：pelvic floor muscle training
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postpartum
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urinary incontinence
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pelvic organ prolapse
;
pelvic floor muscle
;
natural childbirth
RAO Lin, ZHANG Linna, YUAN Jiaqi, LU Bangchun. Effect of postpartum pelvic floor muscle training on improving pelvic floor function. Journal of Shanghai Jiao Tong University (Medical Science)[J], 2023, 43(3): 308-313 doi:10.3969/j.issn.1674-8115.2023.03.006
盆底功能障碍性疾病（pelvic floor dysfunction，PFD）主要包括盆腔器官脱垂（pelvic organ prolapse，POP）和尿失禁（urinary incontinence，UI），是影响女性生活质量的常见病。妊娠和分娩是导致PFD的常见病因。有文献报道，产后UI发病率可高达30%［1］，一半以上的产妇存在不同程度的POP［2-3］。妊娠分娩导致盆底肌功能受损可能是UI和POP发生的原因［4］。产后盆底肌训练（Kegel训练）被认为是产后PFD的一线治疗方法［5］，但其对PFD是否具有改善作用目前仍不确定。国外已经开展了一些随机对照研究，但结果不一致，存在一定争议［1，6-8］。WOODLEY等［1］认为，Kegel训练对产后UI的治疗效果存在不确定性；SIGURDARDOTTIR等［8］的研究表明Kegel训练至产后6个月可显著改善产妇的UI情况，但至产后1年效果不明显。在国内，产后康复训练的研究多集中在电刺激生物反馈治疗方面，但该疗法需要特殊设备，且要求产妇反复前往医院治疗，给哺乳期产妇带来不便；此外，该疗法还具有阴道炎或阴道出血等禁忌证。单纯Kegel训练具有便捷、经济、随时可进行的优势。本研究旨在探讨产后1年内行Kegel训练对产妇盆底功能康复的作用，以期为PFD产妇的康复训练提供依据。
共纳入341例产妇，其中锻炼组147例，对照组194例。产后1年，锻炼组共有20例退出研究，包括14例未达到锻炼标准，4例因在外地中途退出，1例再次妊娠，1例采用物理治疗；对照组共有28例退出研究，包括21例中途退出（9例无法联系，12例拒绝复诊），2例再次妊娠，3例采用物理治疗，2例资料不全。锻炼组和对照组的失访率分别为13.6%和14.4%。2组产妇的年龄、分娩孕周、孕前体质量指数（body mass index，BMI）、孕期增加体质量、新生儿出生体质量、第二产程时长、哺乳时间、文化程度、孕次、会阴侧切率、产钳助产率等指标比较，差异均无统计学意义。结果见表1。
Tab 1
表1
表12组产妇的一般情况比较
Tab 1 Comparison of baseline data between the two groups of postpartum women
RAO Lin and LU Bangchun participated in the design of the study, writing and revision of the manuscript. ZHANG Linna, YUAN Jiaqi and LU Bangchun participated in maternal follow-up, data collection and statistics. All the authors have read the last version of paper and consented for submission.
利益冲突声明
所有作者声明不存在利益冲突。
All authors disclose no relevant conflict of interests.
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