Participants and randomization
Through 2016 and 2017, primiparous women with one live newborn were approached before discharge from the maternity ward of the Landspitali University Hospital in Reykjavik. Women who approved were sent an electronic questionnaire through e-mail about their experiences of pelvic floor dysfunction (PFD) 6-10 weeks postpartum.6Of all the women who answered the questionnaire, 95 were invited to participate in an RCT.13 Eligibility criteria were established for that study, i.e. the presence of self-reported postpartum symptoms of UI. The women had to be generally healthy, aged ≥18 years, able to understand Icelandic and to attend the treatment sessions. Women with a multiple birth, a gestaional length of <32 weeks, a stillbirth or an unwell newborn or those who otherwise had conditions that could interfere with their ability to participate were excluded (inability to contract their pelvic floor muscles (PFM), neurological conditions, previous urogynecological and/or bowel surgery or cognitive disorders). The main outcome assessor (T.S.) evaluated participants initially and before randomization at an outpatient physiotherapy clinic.
At baseline, all the women received instructions about how to correctly contract their PFM, which was confirmed with an observation and vaginal palpation of PFM contractions defined as an inward movement of the perineum and a squeeze around the pelvic openings.14–16 Subsequently, measurements of PFM variables were done with a vaginal manometer, the Myomed 932 (Enraf Nonius, Netherlands). The results have been reported elsewhere.13 Following this clinical assessment, the clinics´ secretary allocated participants to either a training group (TG) or a control group (CG) using conceiled random sequence numbers from an on-line generator (https://stattrek.com/statistics/random-number-generator.aspx). The Microsoft Excel document containing the randomization code was locked with a password and only accessible to the secretary. She was responsible for booking participants for the short-term and long-term appointments.