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Pelvic floor muscle training for prevention and treatment of urinary incontinence during pregnancy and after childbirth and its effect on urinary system and supportive structures assessed by objective measurement techniques

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Abstract

Purpose

During the second and the third trimesters of pregnancy and in the first 3 months following childbirth, about one-third of women experience urinary incontinence (UI). During pregnancy and after delivery, the strength of the pelvic floor muscles may decrease following hormonal and anatomical changes, facilitating musculoskeletal alterations that could lead to UI. Pelvic floor muscle training (PFMT) consists in the repetition of one or more sets of voluntary contractions of the pelvic muscles. By building muscles volume, PFMT elevates the pelvic floor and the pelvic organs, closes the levator hiatus, reduces pubovisceral length and elevates the resting position of the bladder. Objective of this review is to evaluate the efficacy of PFMT for prevention and treatment of UI during pregnancy and after childbirth and its effect on urinary system and supportive structures assessed by objective measurement techniques.

Methods

The largest medical information databases (Medline–Pubmed, EMBASE, Lilacs, Cochrane Library and Physiotherapy Evidence Database) were searched using the medical subject heading terms “pelvic floor muscle training”, “prevention”, “urinary incontinence”, “urinary stress incontinence”, “objective measurement techniques”, “pregnancy, “exercise”, “postpartum” and “childbirth” in different combinations.

Results and conclusions

Overall, the quality of the studies was low. At the present time, there is insufficient evidence to state that PFMT is effective in preventing and treating UI during pregnancy and in the postpartum. However, based on the evidence provided by studies with large sample size, well-defined training protocols, high adherence rates and close follow-up, a PFMT program following general strength-training principles can be recommended both during pregnancy and in the postnatal period.

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Authors and Affiliations

  1. Department of Surgical and Medical Sciences and Translational Medicine, Sapienza University of Rome, S. Andrea Hospital, via di Grottarossa, 1035, Rome, Italy

    Ilaria Soave, Simona Scarani, Maddalena Mallozzi, Flavia Nobili & Donatella Caserta

  2. Department of Morphology, Surgery and Experimental Medicine, University of Ferrara, Ferrara, Italy

    Roberto Marci

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  1. Ilaria Soave
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  2. Simona Scarani
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  3. Maddalena Mallozzi
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  4. Flavia Nobili
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IS: Protocol/project development, Data analysis, Manuscript writing/editing. SS: Data collection or management, Data analysis. MM: Data collection or management. FN: Data collection or management. RM: Protocol/project development. DC: Protocol/project development.

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Correspondence to Donatella Caserta.

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Soave, I., Scarani, S., Mallozzi, M. et al. Pelvic floor muscle training for prevention and treatment of urinary incontinence during pregnancy and after childbirth and its effect on urinary system and supportive structures assessed by objective measurement techniques. Arch Gynecol Obstet 299, 609–623 (2019). https://doi.org/10.1007/s00404-018-5036-6

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