Elsevier

Obstetrics & Gynecology

Volume 101, Issue 2, February 2003, Pages 313-319
Obstetrics & Gynecology

Original research
Pelvic floor muscle training during pregnancy to prevent urinary incontinence: a single-blind randomized controlled trial

https://doi.org/10.1016/S0029-7844(02)02711-4Get rights and content

Abstract

Objective

Urinary incontinence is a chronic health complaint that severely reduces quality of life. Pregnancy and vaginal delivery are main risk factors in the development of urinary incontinence. The aim of this study was to assess whether intensive pelvic floor muscle training during pregnancy could prevent urinary incontinence.

Methods

We conducted a single-blind randomized controlled trial at Trondheim University Hospital and three outpatient physiotherapy clinics in a primary care setting. Three hundred one healthy nulliparous women were randomly allocated to a training (n = 148) or a control group (n = 153). The training group attended a 12-week intensive pelvic floor muscle training program during pregnancy, supervised by physiotherapists. The control group received the customary information. The primary outcome measure was self-reported symptoms of urinary incontinence. The secondary outcome measure was pelvic floor muscle strength.

Results

At follow-up, significantly fewer women in the training group reported urinary incontinence: 48 of 148 (32%) versus 74 of 153 (48%) at 36 weeks’ pregnancy (P = .007) and 29 of 148 (20%) versus 49 of 153 (32%) 3 months after delivery (P = .018). According to numbers needed to treat, intensive pelvic floor muscle training during pregnancy prevented urinary incontinence in about one in six women during pregnancy and one in eight women after delivery. Pelvic floor muscle strength was significantly higher in the training group at 36 weeks’ pregnancy (P = .008) and 3 months after delivery (P = .048).

Conclusion

Intensive pelvic floor muscle training during pregnancy prevents urinary incontinence during pregnancy and after delivery. Pelvic floor muscle strength improved significantly after intensive pelvic floor muscle training.

Section snippets

Materials and methods

Nulliparous women attending the routine ultrasound control at The National Center for Fetal Medicine, Trondheim University Hospital, at 18 weeks’ pregnancy were invited to participate in the study. They received a written invitation and information about the study as a supplement to the letter inviting them to the routine ultrasound control. The women were asked to return a signed consent form if they wanted to participate in the study. Women were eligible for the trial if they were nulliparous

Results

In all, 301 nulliparous women were randomized to a training group (n = 148) or a control group (n = 153) (Figure 1). The trial groups were comparable at baseline (Table 1). Seven women in the control group and five women in the training group withdrew after the first assessment. The reasons for withdrawal were diseases connected to pregnancy (n = 6) or personal (n = 6) (eg, changes in work situation, familiar causes, relocation).

In all, 120 (81%) of 148 women in the training group followed the

Discussion

We found that intensive pelvic floor muscle training during pregnancy prevents urinary incontinence during pregnancy and after childbirth. We also found higher pelvic floor muscle strength at 36 weeks’ pregnancy (immediately after the end of the supervised training period) and 3 months after delivery in the training group.

This was an RCT of nulliparous women, with blinding of the investigator, a low dropout rate, the use of a standardized training protocol following recommendations from

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    The authors thank the physiotherapists Hildegunn Børsting, Trude Hoff Leirvik, Bente Olsen, Monica U. Tøndel, and Bjørg Vada for their efforts in performing this study, by leading the training groups. Professor of Biostatistics Ingar Holme, Norwegian University of Sport and Physical Education, and Associate Professor Stian Lydersen, Norwegian University of Science and Technology, gave valuable advice on the statistical analysis. The English revision of the manuscript was done by Nancy Lea Eik-Nes.

    The work was funded by The Norwegian Fund for Postgraduate Training in Physiotherapy and the Norwegian Women’s Public Health Association.

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