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Pelvic Floor Education After Vaginal Delivery

MEYER, S. MD; HOHLFELD, P. MD; ACHTARI, C. MD; DE GRANDI, P. MD

Original Research

Objective To assess the effect of pelvic floor education after vaginal delivery 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, clinical examination, perineosonography, urethral pressure profiles, and intravaginal and intra-anal pressure recordings during pelvic floor contraction. After the second examination, the women were assigned in alternating manner to either 12 sessions of pelvic floor exercises with biofeedback and electrostimulation (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 subjects compared with 19% of women who underwent pelvic floor education (P = .002), whereas the incidence of fecal incontinence (5% versus 4%, P = 1) and the percentage of women who recovered predelivery pelvic floor contraction strength (33% versus 41%, P = .4) were no different. We observed no significant differences in bladder neck position and mobility, urethral functional length, maximal urethral closure pressure, pressure transmission ratio, residual area of continence at stress standing, or intravaginal or intra-anal pressures during pelvic floor contraction between groups at the third examination.

Conclusion Pelvic floor education, begun 2 months postpartum, significantly reduced the incidence of stress urinary incontinence, but not fecal incontinence or weak pelvic floor. Similarly, bladder neck behavior, urodynamic characteristics, intravaginal or intra-anal pressures during pelvic floor squeezing also were not modified.

Pelvic floor education postpartum lowers the frequency of stress incontinence without modifying bladder neck behavior, urodynamic indices, or intravaginal and intra-anal pressures.

Urogynecology Unit, Department of Obstetrics and Gynecology, CHUV, Lausanne, Switzerland.

Address reprint requests to: Sylvain Meyer, MD, Urogynecology Unit, Department of Obstetrics and Gynecology, CHUV, 1011 Lausanne, Switzerland. E-mail: sylvain.meyer@chuv.hospvd.ch

Supported financially by the Swiss National Fund for Scientific Research.

Received March 3, 2000. Received in revised form September 8, 2000. Accepted September 28, 2000.

© 2001 The American College of Obstetricians and Gynecologists