EFFECT OF PELVIC MUSCLE EXERCISE ON TRANSIENT INCONTINENCE DURING PREGNANCY AND AFTER BIRTH

Objective: To test the effect of pelvic muscle exercise on postpartum symptoms of stress urinary incontinence and pelvic muscle strength in primigravidas during pregnancy and postpartum Methods: A prospective t rial randomized women into treatment (standardized instruction in pelv ic muscle exercise) or control (routine care with no systematic pelvic muscle exercise instruction). Urinary incontinence symptoms were meas ured by questionnaire. Pelvic muscle strength was quantified by an ins trumented gynecologic speculum. Time points were 20 and 35 weeks gesta tion and 6 weeks, 6 months, and 12 months postpartum. Results: Outcome s are reported for 46 women with vaginal or cesarean birth and for a s ubsample of 37 women with vaginal birth. Longitudinal analyses are rep orted for cases with complete data across time points. Diminished urin ary incontinence symptoms were seen in the treatment group, with signi ficant treatment effects demonstrated at 35 weeks' gestation (F [1,43] = 4.36, P =.043), 6 weeks postpartum (F [1,43] = 4.94, P =.032), and 6 months postpartum (F [1,43] = 4.29, P =.044). A repeated measures an alysis of variance showed a significant interaction between time and t reatment for urinary incontinence (F [4, 41] = 2.83, P =.037). A signi ficant effect of initial pelvic muscle strength was demonstrated; ie, pelvic muscle strength at 20 weeks' gestation predicted significantly 12-months postpartum strength (F [1, 13] = 8.12, P =.014). Group diffe rences in pelvic muscle strength were observed (the treatment group ha d greater strength at 6 weeks and at 6 months postpartum than did cont rols), but these differences were not statistically significant. Concl usion: Practice of pelvic muscle exercise by primiparas results in few er urinary incontinence symptoms during late pregnancy and postpartum. (C) 1998 by The American College of Obstetricians and Gynecologists.