Cochrane for Clinicians

Putting Evidence into Practice

Pelvic Floor Muscle Training to Prevent and Treat Urinary and Fecal Incontinence in Antenatal and Postnatal Patients

 

Am Fam Physician. 2021 Sep ;104(2):234-235.

Author disclosure: No relevant financial affiliations.

Clinical Question

Does pelvic floor muscle training (PFMT) help prevent or treat urinary or fecal incontinence during pregnancy or after delivery?

Evidence-Based Answer

Structured PFMT beginning early in pregnancy prevents the onset of urge incontinence later in pregnancy and in the postpartum period compared with no intervention (number needed to treat = 4; 95% CI, 3 to 9). (Strength of Recommendation [SOR]: B, based on inconsistent or limited-quality patient-oriented evidence.) There is no evidence that PFMT improves urinary incontinence later in pregnancy or in the postpartum period in pregnant patients who already have urinary incontinence. (SOR: B, based on inconsistent or limited-quality patient-oriented evidence.) There is no clear evidence that PFMT effectively prevents or treats fecal incontinence later in pregnancy or after delivery.1 (SOR: B, based on inconsistent or limited-quality patient-oriented evidence.)

Practice Pointers

More than one-third of pregnant patients experience urinary incontinence at some point in their second and third trimesters. Approximately one-fourth of pregnant patients experience fecal incontinence—the involuntary loss of flatus or feces—late in pregnancy, and about one-fifth of patients leak flatus or feces one year after delivery.1 Other factors that may increase incontinence include elevated prepregnancy body mass index, method of delivery (vaginal vs. cesarean), forceps- or vacuum-assisted delivery, multiple gestations, or history of multiple pregnancies. PFMT is the repeated voluntary contraction of the pelvic floor muscles (also known as Kegel exercises), and health care professionals commonly advise pregnant patients to do PFMT one or more times per day for at least eight weeks during and after pregnancy to prevent and treat urinary incontinence.

This Cochrane review included 46 trials involving 10,832 patients from 21 countries.1 Overall, the studies were small, and the PFMT programs varied in training methods as well as

Author disclosure: No relevant financial affiliations.

References

1. Woodley SJ, Lawrenson P, Boyle R, et al. Pelvic floor muscle training for preventing and treating urinary and faecal incontinence in antenatal and postnatal women. Cochrane Database Syst Rev. 2020;(5):CD007471.

2. ACOG practice bulletin no. 155: urinary incontinence in women. Obstet Gynecol. 2015;126(5):e66–e81.

These are summaries of reviews from the Cochrane Library.

This series is coordinated by Corey D. Fogleman, MD, assistant medical editor.

A collection of Cochrane for Clinicians published in AFP is available at https://www.aafp.org/afp/cochrane.

 

 

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