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Pelvic Floor Muscle Training Versus Watchful Waiting and Pelvic Floor Disorders in Postpartum Women: A Systematic Review and Meta-analysis

Wu, You, (Maria), MD*†; McInnes, Natalia, MD, MSc†‡; Leong, Yvonne, MD*

Female Pelvic Medicine & Reconstructive Surgery: March/April 2018 - Volume 24 - Issue 2 - p 142–149
doi: 10.1097/SPV.0000000000000513
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Objectives Pelvic floor muscle training (PFMT) is often recommended to treat postpartum urinary incontinence (UI). However, the role of postpartum PFMT in pelvic organ prolapse (POP), sexual function, and anal incontinence (AI) remains unclear. We therefore aim to assess the efficacy of postpartum PFMT on these pelvic floor disorders.

Methods This study is a meta-analysis consisting of randomized controlled trials (RCTs). We searched databases including CENTRAL, MEDLINE, EMBASE, CINAHL, and PEDro. We also sought after grey literature including conference proceedings. We included RCTs comparing PFMT versus watchful waiting in women with stage II or less POP within 1 year postpartum. Two authors independently performed study screening, risk of bias assessments, and data extraction.

Results Fifteen RCTs (3845 patients) were included. Women undergoing PFMT less likely report bothersome POP symptoms (risk ratio [RR], 0.48 [0.30–0.76]; very low-quality evidence). There is no significant difference in the number of women with stage II or greater POP (RR, 0.74 [0.45–1.24]; moderate-quality evidence). Fewer women receiving PFMT report the presence of sexual dysfunction (RR, 0.48 [0.30–0.77]; low-quality evidence). There is no significant difference in AI symptoms (RR, 1.11 [0.82–1.51]), but PFMT may be more beneficial for women with anal sphincter injuries (standardized mean differencein AI scores, −0.57 [−1.12 to −0.02]; low-quality evidence). Women receiving PFMT less likely report UI (RR, 0.44 [0.25–0.75]; moderate-quality evidence) with a more pronounced effect on stress UI (SUI).

Conclusions At present, it remains uncertain whether postpartum PFMT improves POP symptoms because of very low-quality evidence, and more high-quality RCTs are needed in this area. The POP staging will likely not change with postpartum PFMT. The PFMT may result in improved postpartum sexual function compared to watchful waiting, and may provide benefit for AI in women with anal sphincter injuries. Postpartum PFMT likely reduces the risk of UI, particularly stress urinary incontinence symptoms. There is currently little evidence about postpartum PFMT and long-term pelvic floor function.

It remains uncertain whether pelvic floor muscle training (PFMT) improves prolapse symptoms in postpartum women; PFMT may not alter prolapse staging but may improve urinary incontinence. Further high-quality randomized controlled trials are needed to study PFMT and postpartum pelvic floor disorders.

From the *Department of Obstetrics and Gynecology, Western University, London; †Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario; and ‡Population Health Research Institute, Hamilton, Ontario, Canada.

Correspondence: You (Maria) Wu, MD, Department of Obstetrics and Gynecology, Western University, Room B4-401, 800 Commissioners Road East, London, Ontario N6H 5W9, Canada. E-mail: ymariawu@gmail.com.

Natalia McInnes has received grant support from Astra Zeneca, Merck, and Sanofi outside of the submitted work. All the other authors have declared they have no conflicts of interest.

Natalia McInnes and Yvonne Leong provided equal senior author contributions for this work.

AUGS 2017 Oral Presentation number 2745739.

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