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Intervention Review

Pelvic floor muscle training for prevention and treatment of urinary and faecal incontinence in antenatal and postnatal women

  1. Jean Hay-Smith1,*,
  2. Siv Mørkved2,
  3. Kate A Fairbrother3,
  4. G Peter Herbison4

Editorial Group: Cochrane Incontinence Group

Published Online: 8 OCT 2008

Assessed as up-to-date: 22 APR 2008

DOI: 10.1002/14651858.CD007471


How to Cite

Hay-Smith J, Mørkved S, Fairbrother KA, Herbison GP. Pelvic floor muscle training for prevention and treatment of urinary and faecal incontinence in antenatal and postnatal women. Cochrane Database of Systematic Reviews 2008, Issue 4. Art. No.: CD007471. DOI: 10.1002/14651858.CD007471.

Author Information

  1. 1

    Department of Medicine, Rehabilitation Teaching and Research Unit, Wellington South, Wellington, New Zealand

  2. 2

    Norwegian University of Science and Technology, Department of Community Medicine and General Practice, Faculty of Medicine, Trondheim, Norway

  3. 3

    Lakes District Health Board, Rotorua, New Zealand

  4. 4

    Dunedin School of Medicine, University of Otago, Department of Preventive & Social Medicine, Dunedin, New Zealand

*Jean Hay-Smith, Rehabilitation Teaching and Research Unit, Department of Medicine, Wellington School of Medicine and Health Sciences, University of Otago, PO Box 7343, Wellington South, Wellington, New Zealand. jean.hay-smith@otago.ac.nz.

Publication History

  1. Publication Status: Edited (no change to conclusions)
  2. Published Online: 8 OCT 2008

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Abstract

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Background

About a third of women have urinary incontinence and up to a tenth have faecal incontinence after childbirth. Pelvic floor muscle training is commonly recommended during pregnancy and after birth both for prevention and treatment of incontinence.

Objectives

To determine the effect of pelvic floor muscle training compared to usual antenatal and postnatal care on incontinence.

Search methods

We searched the Cochrane Incontinence Group Specialised Register (searched 24 April 2008) and the references of relevant articles.

Selection criteria

Randomised or quasi-randomised trials in pregnant or postnatal women. One arm of the trials needed to include pelvic floor muscle training (PFMT). Another arm was either no pelvic floor muscle training or usual antenatal or postnatal care. The pelvic floor muscle training programmes were divided into either: intensive; or unspecified if training elements were lacking or information was not provided. Reasons for classifying as intensive included one to one instruction, checking for correct contraction, continued supervision of training, or choice of an exercise programme with sufficient exercise dose to strengthen muscle.

Data collection and analysis

Trials were independently assessed for eligibility and methodological quality. Data were extracted then cross checked. Disagreements were resolved by discussion. Data were processed as described in the Cochrane Handbook. Three different populations of women were considered separately: women dry at randomisation (prevention); women wet at randomisation (treatment); and a population-based approach in women who might be one or the other (prevention or treatment). Trials were further divided into: those which started during pregnancy (antenatal); and after delivery (postnatal).

Main results

Sixteen trials met the inclusion criteria. Fifteen studies involving 6181 women (3040 PFMT, 3141 controls) contributed to the analysis. Based on the trial reports, four trials appeared to be at low risk of bias, two at low to moderate risk, and the remainder at moderate risk of bias.

Pregnant women without prior urinary incontinence who were randomised to intensive antenatal PFMT were less likely than women randomised to no PFMT or usual antenatal care to report urinary incontinence in late pregnancy (about 56% less; RR 0.44, 95% CI 0.30 to 0.65) and up to six months postpartum (about 30% less; RR 0.71, 95% CI 0.52 to 0.97).

Postnatal women with persistent urinary incontinence three months after delivery and who received PFMT were less likely than women who did not receive treatment or received usual postnatal care (about 20% less; RR 0.79, 95% CI 0.70 to 0.90) to report urinary incontinence 12 months after delivery. It seemed that the more intensive the programme the greater the treatment effect. Faecal incontinence was also reduced at 12 months after delivery: women receiving PFMT were about half as likely to report faecal incontinence (RR 0.52, 95% CI 0.31 to 0.87).

Based on the trial data to date, the extent to which population-based approaches to PFMT are effective is less clear (that is, offering advice on PFMT to all pregnant or postpartum women whether they have incontinence symptoms or not). It is possible that population-based approaches might be effective when the intervention is intensive enough.

There was not enough evidence about long-term effects for either urinary or faecal incontinence.

Authors' conclusions

There is some evidence that PFMT in women having their first baby can prevent urinary incontinence in late pregnancy and postpartum. In common with older women with stress incontinence, there is support for the widespread recommendation that PFMT is an appropriate treatment for women with persistent postpartum urinary incontinence. It is possible that the effects of PFMT might be greater with targeted rather than population-based approaches and in certain groups of women (for example primiparous women; women who had bladder neck hypermobility in early pregnancy, a large baby, or a forceps delivery). These and other uncertainties, particularly long-term effectiveness, require further testing.

 

Plain language summary

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Pelvic floor muscle training for prevention and treatment of urinary and faecal incontinence in pregnant women and women who have recently given birth

About a third of women have urine leakage, and up to a tenth of women leak stool (faeces), after childbirth. Pelvic floor muscle training is commonly recommended during pregnancy and after birth for prevention and treatment of incontinence. This is a programme of exercises that women can do several times a day to strengthen their pelvic floor muscles. They are usually taught by a health professional such as a physiotherapist. The review of trials showed that women who do not leak urine while pregnant can reduce urine leakage for the first six months after childbirth by doing the exercises during and after pregnancy. Exercises can also help women who do leak urine after the birth and they may help them leak less stool. They may be helpful for women who are at higher risk of urine leakage, such as after having a large baby or a forceps delivery. However, there was not enough evidence to say if these effects last after the first year.

 

摘要

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

背景

骨盆底肌收縮訓練對於預防和治療產前和產後婦女之尿/大便失禁

大約有三分之一的婦女有尿失禁問題,約十分之一有產後大便失禁。通常在懷孕期間和分娩後會建議進行骨盆底肌收縮訓練通,藉以預防和治療失禁。

目標

藉著比較一般產前及產後預防失禁之護理來確立骨盆底肌收縮訓練的效果。

搜尋策略

我們檢索了考科藍實證醫學資料庫之尿失禁組專科試驗(搜查日期2008年4月24日)和參考相關的文獻。

選擇標準

隨機或半隨機試驗,關於懷孕或產後婦女。一種試驗需要包括骨盆底肌收縮訓練(PFMT)。另一種為無骨盆底肌收縮訓練或一般的產前和產後護理。骨盆底肌收縮訓練方案分為:密集或不明 (如果訓練內容缺乏或沒有提供資料)。被列為密集訓練的條件包括:一對一指示、檢視正確的肌肉收縮、持續不斷的監督,或是選擇具有足夠的運動量以加強肌力的單一訓練計畫。

資料收集與分析

試驗的合格與否和方法學優劣被獨立的評估。提取數據之後,然後交互核對。分歧的意見將由討論解決。數據的處理皆根據Cochrane的手冊闡述。三群不同婦女被分開考慮:隨機分派無失禁婦女(預防)隨機分派失禁婦女(治療)和根據族群為基礎的方法,女性可選擇任何一方(預防或治療)。試驗進一步分為:懷孕期間開始(產前)和分娩之後(產後)。

主要結論

16個試驗符合納入標準。15個研究涉及6181名婦女(PFMT:3040人,控制組:3141人)進入分析。根據試驗報告,四個試驗似乎具有低風險的誤差,兩個低到中度風險的誤差,其餘為中度風險誤差。隨機分派到產前密集PFMT組且之前無尿失禁的懷孕婦女在妊娠晚期(降低了56%相對危險性:0.44,95%CI為 0.30~0.65)及產後6個月(降低30%,相對危險性:0.71,95%CI為0.52到0.97)有較低的比例發生尿失禁,相較於被分派到無PFMT或接受一般產前護理的婦女。產後婦女於生產後 3個月有持續的尿失禁,然而接受PFMT訓練的婦女比接受一般護理的婦女,在生產後12個月內有較低的比例發生尿失禁(降低 20%相對危險性:0.79,95%CI為 0.70至0.90)。似乎月密集的訓練有更良好的治療效果。產後12個月內的大便失禁情形也降低了:婦女接受PFMT僅有一半發生大便失禁(相對危險性0.52,95%CI為 0.31至0.87)。根據試驗數據,到目前為止,進行大規模PFMT訓練是否有效仍舊不清楚(即,提供PFMT訓練給所有孕婦或產後婦女,不論他們是否有小便失禁的症狀)。若訓練是密集的,這種大規模的作法可能是有效的。目前沒有足夠的證據顯示對於或尿或大便失禁的長期效果。

作者結論

有一些證據顯示,PFMT訓練可讓婦女在懷第一個孩子時,在妊娠晚期和產後防止尿失禁。相似於年長婦女的應力性尿失禁,有支持建議使用PFMT訓練來治療持續性的婦女產後尿失禁是一個合適的作法。PFMT的效果對於特定標的族群可能優於大規模的群體和某些婦女群體(例如初產婦女,懷孕初期膀胱頸過動症婦女,巨大胎兒,產箝分娩) 。這些不確定因素,特別是長期效益,需要進一步的研究。

翻譯人

本摘要由中國醫藥大學附設醫院陳祖裕翻譯。

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。

總結

約三分之一的產後婦女有尿液滲漏問題,以及十分之一有糞便滲漏的問題。懷孕期間和產後的通常會建議利用骨盆底肌收縮訓練來預防和治療尿失禁。這是一系列的運動,婦女可以在一天中多次練習,以加強其骨盆底肌肉。它們通常由健康專業人員教導,如物理治療師。臨床試驗顯示,產前沒有尿失禁的婦女,在懷孕期間練習PFMT,可以降低產後6個月尿失禁的發生機會。PFMT還可以幫助婦女產後尿失禁,甚至減少糞便失禁。對於高尿失禁風險的女性,如巨大胎兒或產鉗分娩,PFMT也是有幫助的。然而,沒有足夠的證據顯示這些效果在一年之後仍舊持續