How effective are pelvic floor muscle exercises undertaken during pregnancy or after birth for preventing or treating incontinence?
To assess whether doing pelvic floor muscle exercises (PFME) during pregnancy or after birth reduces incontinence. This is an update of a review published in 2012.
More than one-third of women experience unintentional (involuntary) loss of urine (urinary incontinence) in the second and third trimesters of pregnancy and about one-third leak urine in the first three months after giving birth. About one-quarter of women have some involuntary loss of flatus (wind) or faeces (anal incontinence) in late pregnancy and one fifth leak flatus or faeces one year after birth. PFME are commonly recommended by health professionals during pregnancy and after birth to prevent and treat incontinence. The muscles are strengthened and kept strong with regular PFME. Muscles are contracted several times in a row, more than once a day, several days a week and continued indefinitely.
How up-to-date is this review?
The evidence is current to 16 February 2017.
We included 38 trials (17 new to this update) involving 9892 women from 20 countries. The studies included pregnant women or women who had delivered their baby within the last three months. Women reported leakage of urine, faeces, both urine or faeces, or no leakage. They were allocated randomly to receive PFME (to try and prevent incontinence or as a treatment for incontinence) or not and the effects were compared.
Study funding sources
Nineteen studies were publicly funded. One received grants from public and private sources. Three studies received no funding and 15 did not declare funding sources.
Pregnant women without urine leakage who did PFME to prevent leakage: women may report less urine leakage in late pregnancy and three to six months after childbirth. There was not enough information to determine whether these effects continued beyond the first year after the baby’s birth.
Women with urine leakage, pregnant or after birth, who did PFME as a treatment: it was uncertain whether doing PFME during pregnancy reduced leakage in late pregnancy or in the year following childbirth. It was unclear if doing PFME helped women with leakage after giving birth.
Women with or without urine leakage (mixed group), pregnant or after birth, who did PFME to either prevent or treat leakage: women who began exercising during pregnancy were less likely to report leakage in late pregnancy and up to six months after birth, but it was uncertain if the effect lasted at one year following birth. For women who started PFME after delivery, the effect on leakage one year after birth was uncertain.
Leakage of faeces: few studies (only six) had evidence about leakage of faeces. One year after delivery, it was uncertain if PFME helped decrease leakage of faeces in women who started exercising following childbirth. It was also uncertain if women with or without leakage of faeces (mixed group) who started PFME while pregnant were less likely to leak faeces in late pregnancy or up to one year after birth.
There was little information about how PFME may affect leakage-related quality of life. There were two reports of pelvic floor pain but no other harmful effects of PFME were noted. It is unknown if PFMEs offer value for money because no study had a health economics analysis. It is unknown if PFME offer value for money as no health economics data were identified.
Quality of the evidence
Overall, studies were not large and most had design problems, including limited details on how women were randomly allocated into groups, and poor reporting of measurements. Some of the problems were expected because it was impossible to blind health professionals or women to whether they were exercising or not. The PFME differed considerably between studies and were often poorly described. Evidence quality was generally low to very low.