Pelvic floor exercises during and after pregnancy: a systematic review of their role in preventing pelvic floor dysfunction.

OBJECTIVE: To review the literature on the origin, anatomical rationale, techniques, and evidence-based effectiveness of peripartum pelvic floor exercises (PFEs) in the prevention of pelvic floor problems including urinary and anal incontinence, and prolapse. DATA SOURCES: Literature was reviewed for background information. MEDLINE, EMBASE, CINAHL, and proceedings of scientific meetings were searched for evidence-based data. A comprehensive literature search was performed to find all studies that involved the use of antepartum and/or postpartum PFEs. For the MEDLINE (1966 to 2002) and CINAHL (1980 to 2002) searches, the following key words were used: urinary incontinence (prevention and control, rehabilitation, therapy), fecal incontinence, exercise or exercise therapy, Kegel, muscle contraction, muscle tonus, muscle development, pelvic floor, pregnancy, puerperium, puerperal disorders. For the EMBASE (1980 to 2002) search, the following key words were used: micturition disorder (prevention, rehab, disease management, therapy), fecal incontinence, labour complication, pregnancy disorder, puerperal disorder, antepartum care, pregnancy, kinesiotherapy, exercise, pelvic floor, bladder. A manual search was performed of available abstracts presented at the annual scientific meetings of the International Continence Society (1997, 1999 to 2002), American Urogynecologic Association (1997 to 1998, 2000 to 2002), and International Urogynecological Association (1997, 1999 to 2002). Twelve studies evaluating the role of antepartum PFE were found, of which 3 randomized controlled trials (RCTs) comparing PFEs for the prevention of urinary incontinence to controls were included. Twelve studies evaluating postpartum PFEs for prevention of urinary incontinence were reviewed, of which 4 RCTs were included. Five studies evaluating postpartum PFEs for the prevention of anal incontinence were reviewed, of which 4 RCTs were included. Participants in the studies were primiparous women. DATA TABULATION AND INTEGRATION: Data were extracted using a standardized collection form. Quality of the data was evaluated using the Jadad scale. Where possible, a meta-analysis was conducted using a random effect model. Heterogeneity between trials was assessed and sensitivity analyses were performed.
RESULTS: Antepartum PFEs, when used with biofeedback and taught by trained health care personnel, using a conservative model, does not result in significant short-term (3 months) decrease in postpartum urinary incontinence, or pelvic floor strength. Postpartum PFEs, when performed with a vaginal device providing resistance or feedback, appear to decrease postpartum urinary incontinence and to increase strength. Reminder and motivational systems to perform "Kegel" exercises are ineffective in preventing postpartum urinary incontinence. Postpartum PFEs do not consistently reduce the incidence of anal incontinence.
CONCLUSION: Postpartum PFEs appear to be effective in decreasing postpartum urinary incontinence. Data regarding the effect of PFEs on prevention of anal incontinence are lacking, and also on its prevention of prolapse.