Pelvic exercises treat persistent incontinence

Physical therapy aimed at strengthening the pelvic floor muscles may help many women who suffer lingering incontinence months after giving birth, a study suggests.

Many women have urinary incontinence for a time after pregnancy, and pelvic floor exercises after childbirth have been shown to prevent or alleviate the problem. Less is known about how effective the exercises are for women whose incontinence lasts more than three months after delivery, the new study's lead author told AMN Health.

The study, said Dr. Chantale Dumoulin of the University of Montreal, is the first to assess supervised pelvic floor conditioning for persistent post-pregnancy incontinence. She and her colleagues report the findings in the journal Obstetrics & Gynecology.

The study involved 64 women with stress urinary incontinence, in which urine leaks during a physical stress like heavy lifting. All of the women were still suffering symptoms at least weekly, three months or more after giving birth.

Dumoulin and her colleagues randomly assigned the women to one of three groups: one that received eight sessions of pelvic floor conditioning with a physical therapist; one that received the same treatment plus deep abdominal exercises; and a "control" group that received eight massage sessions.

For women in the exercise groups, each weekly session also involved therapy that electrically stimulated the pelvic floor muscles, and both groups performed exercises at home.

After eight weeks, more than 70 percent of the women in the exercise groups - 31 of 43 - were no longer incontinent, while no one in the control group was cured, according to the researchers. Most of the other exercisers had at least a substantial improvement in their urine leakage.

The addition of deep abdominal exercises did not appear to augment the effects of pelvic floor conditioning. This is important, Dumoulin said, because one of the "new theories" in physical therapy is that such abdominal training improves the outcome of pelvic floor training, and some believe that pelvic conditioning should be done "indirectly" via the deep abdominal muscles.

"The results of this study indicate that the addition of abdominal training does not further improve urinary incontinence," she said.

Yet exactly why the pelvic floor exercises helped these women is unclear. The researchers found that pelvic floor strength did not improve in either exercise group. They speculate that factors other than muscle strength, such as improved perception of pelvic floor contraction, may deserve the credit.

SOURCE: Obstetrics & Gynecology, September 2004.