Pelvic floor education after vaginal delivery

Objective: To assess the effect of pelvic floor education after vaginal del ivery on pelvic floor characteristics in nulliparous women. Methods: We examined 107 nulliparas during pregnancy and at 9 weeks and 10 months after vaginal delivery. Methods used included a questionnaire, clini cal examination, perineosonography, urethral pressure profiles, and intrava ginal and intra-anal pressure recordings during pelvic floor contraction. A fter the second examination, the women were assigned in alternating manner to either 12 sessions of pelvic floor exercises with biofeedback and electr ostimulation (n = 51) or no training (n = 56). The two groups were compared at the third examination. Results: Stress urinary incontinence incidence decreased in 2% of control s ubjects compared with 19% of women who underwent pelvic floor education (P =.002), whereas the incidence of fecal incontinence (5% versus 4%, P = 1) a nd the percentage of women who recovered predelivery pelvic floor contracti on strength (33% versus 41%, P =.4) were no different. We observed no signi ficant differences in bladder neck position and mobility, urethral function al length, maximal urethral closure pressure, pressure transmission ratio, residual area of continence at stress standing, or intravaginal or intra-an al pressures during pelvic floor contraction between groups at the third ex amination. Conclusion: Pelvic floor education, begun 2 months postpartum, significantl y reduced the incidence of stress urinary incontinence, but not fecal incon tinence or weak pelvic floor. Similarly, bladder neck behavior, urodynamic characteristics, intravaginal or intra-anal pressures during pelvic floor s queezing also were not modified. (Obstet Gynecol 2001;97: 673-7. (C) 2001 b y The American College of Obstetricians and Gynecologists.).