In this article, we will discuss incontinence in women and pelvic muscle training.
Women can experience incontinence and other problems during pregnancy and after childbirth.Experiencing incontinence is very undesirable, and pelvic floor muscle training is an intervention to reduce it.Although this method is recommended by professional organizations, here is a review of the effectiveness of these methods that have been tested.
The study
The review included 46 studies of 10,832 women from 21 countries.
These studies included women who were pregnant or had given birth within the past three months and reported urine leakage, feces, both urine or feces, or no leakage.
They were randomly assigned to receive pelvic floor muscle training (PFMT) to prevent or treat incontinence, and their effectiveness was compared.Pregnant women who underwent PMFT to prevent leakage.Women who received the intervention reported less leakage in late pregnancy and a slightly lower risk of leakage 3-6 months after delivery.There was not enough information to determine if this effect persisted beyond one year after delivery.Women with leakage during pregnancy or after delivery who had PFMT for therapeutic purposes
There are no reports of a decrease in leakage in late pregnancy or in the first year after delivery when PFMT is performed during pregnancy.Women who did PFMT to prevent or treat leakage during pregnancy or after delivery, regardless of whether they had leakage.Women who begin exercise during pregnancy may have slightly less leakage even in late pregnancy and no leakage until 6 months after birth.
Reports that have been followed up at one year postpartum do not provide evidence for continued effectiveness.For women who began exercising after delivery, the effect on leakage at one year postpartum was unknown.
Fecal leakage
Only eight studies reported on fecal leakage.One year after delivery, it was unclear whether PFMT would help reduce fecal leakage in women who started exercising after delivery.In the study that started PFMT during pregnancy, there was no evidence of a difference in fecal leakage between the different groups.
And for those who started PFMT after childbirth, there is no report of a decrease in leakage until one year after delivery.
There was little information on how PFMT affects leakage related quality of life.
There were two reports of pelvic floor pain as an effect of training, but no other adverse effects of PFMT were found.There was no evidence on whether PFMT is cost effective or not.
Reviewer's conclusions
This review provides evidence that early structured PFMT in early pregnancy in continent women may prevent the development of UI in late pregnancy and the postpartum period. The population approach (recruiting women before delivery regardless of incontinence status) may have a smaller impact on UI, but the reasons for this are unknown. A population-based approach to providing postnatal PFMT is unlikely to reduce UI. Uncertainty surrounds the effectiveness of PFMT as a treatment for UI in prenatal and postnatal women, which contrasts with its more established effectiveness in middle-aged women.
The effect of PFMT may be greater in certain groups of women with a targeted approach rather than a mixed approach of prevention and treatment. Hypothetically, for example, women with a high body mass index (BMI) are at risk for UI. Such uncertainties require further testing, as well as data on the duration of the effect. The physiological and behavioral aspects of the exercise program need to be described for both PFMT and control groups, and how well the PFMT women in both groups do, to improve our understanding of what works and for whom.
There is very little data on FI and it is important that this be included in future trials. It is essential that future trials use validated measures of incontinence-specific quality of life for both urinary and fecal incontinence. In addition to further clinical research, economic evaluations are needed to assess the cost-effectiveness of different management strategies for FI and UI.
Woodley SJ, Lawrenson P, Boyle R, Cody JD, Mørkved S, Kernohan A, Hay-Smith EJC. Pelvic floor muscle training for preventing and treating urinary and faecal incontinence in antenatal and postnatal women. Cochrane Database of Systematic Reviews 2020, Issue 5. Art. No.: CD007471. DOI: 10.1002/ DOI: 10.1002/ 14651858.CD007471.pub4.
Conclusion
It is unclear under what conditions pelvic floor muscle training can be effective.
Those who started the intervention in early pregnancy seemed to experience leakage less frequently from late pregnancy until about a year after delivery, but this is not conclusive evidence.There is a possibility that BMI and leakage are related, so there is no choice but to not do pelvic floor muscle training itself, but the question is cost effectiveness.
However, the problem is the cost effectiveness. Nowadays, training methods can be found for free on video streaming services, so you can do it for free by watching them.However, if you are worried about having an expert watch you, you will have to pay a certain amount of money.To be honest, the training itself is uncertain whether you need guidance from an expert or not, as long as you can do the movements properly, so you should start from the level you can do.
I don't think you need to spend a lot of money to train.
