Can postpartum pelvic floor muscle training reduce urinary and anal incontinence? An assessor-blinded randomized controlled trial

Key points

1. 01Assessor-blinded randomized controlled trial in first-time mothers after vaginal delivery, comparing supervised pelvic floor muscle training plus daily home exercise against no further intervention.
2. 02Urinary incontinence rates after the program were 34.5% in the training group and 38.6% in the control group, a difference that was not statistically significant.
3. 03The relative risk of incontinence was 0.89, with a confidence interval crossing 1, meaning no proven benefit from training.
4. 04Splitting women by whether they had a major levator ani muscle defect made no difference, with both subgroups showing similar nonsignificant results.
5. 05The senior author is a leading expert in pelvic floor training, and the disappointing result actually contradicts that group's earlier work.

How it was conducted

Design

Two-armed, assessor-blinded randomized controlled trial

Participants

Primiparous (first-time) women, several weeks after vaginal delivery

Stratification

By major levator ani muscle defect, verified with transperineal ultrasonography

Groups

Training (weekly supervised pelvic floor muscle class plus daily home exercise) versus control (no further intervention); both taught to contract the pelvic floor

Primary outcome

Self-reported any urinary incontinence, analyzed by relative risk

What they found

• Baseline urinary incontinence prevalence was 39.1% in the training group (n = 87) and 50% in the control group (n = 88).
• Fifteen women (8.6%) were lost to follow-up.
• After the intervention, 34.5% of the training group versus 38.6% of the control group reported urinary incontinence.
• The relative risk of urinary incontinence was 0.89 (nonsignificant, with the confidence interval crossing 1; upper bound 1.32).
• In the stratum with major levator ani muscle defects the relative risk was 0.89 (95% CI 0.51 to 1.56), and without defects it was 0.90 (95% CI 0.53 to 1.52).

Limitations

• Outcome was self-reported urinary incontinence rather than an objective measure such as a pad test.
• About 9% of participants were lost to follow-up, which can affect the results.
• The trial enrolled only first-time mothers after vaginal delivery, so findings may not apply to other groups.
• Follow-up was relatively short, leaving open whether longer or more sustained training would eventually help.

Why it matters

For patients

If you are a new mother hoping pelvic floor exercises will fix leakage after birth, this trial suggests a structured program may not lower your chance of incontinence, so discuss expectations and other options with your clinician.

For clinicians

A well-designed trial found no significant reduction in postpartum urinary incontinence from supervised pelvic floor muscle training, including in women with major levator defects, which should temper firm promises of benefit.

For readers

Even an exercise program delivered by leading experts failed to reduce postpartum urinary incontinence in this trial, a reminder that earlier positive findings do not always replicate.