Main findings
POP symptoms were overall reduced considerably in this group of
first-time mothers during the postpartum year, and the feelings of
bother were in general mild and not common. This is in line with the
results from a cohort study by Reimers et al (2016) which showed good
recovery of POP symptoms in primiparous women during the first year
postpartum.22
Limited data from RCTs are available regarding the treatment effects of
PFMT for POP symptoms in the postpartum period despite the wide practice
of advising and providing such treatment. Bø et al (2015) did not find
improvements for POP symptoms when assessing the effect of a 4-month
group-lead PFMT at 6 months postpartum. However, that study included
women with diagnosed major levator ani tears which might have reduced
the odds for improvement.23 Yang et al (2013) found
significant differences in postpartum POP stages in favour of the two
training groups when measured at three months postpartum, where one
group included PFMT and the other involved PFMT combined with vaginal
electrical stimulation. The combination treatment was superior to PFMT
alone when compared to a control group.24 Both studies
had larger sample sizes than our study. A Chinese RCT with only the
abstract available in English disclosed positive results regarding
postpartum POP symptoms after PFMT with biofeedback combined with
electrical stimulation when measured 12 weeks
postpartum.25
It is, however, difficult to evaluate the information given with regard
to how the treatment was conducted. Pelvic floor electrical stimulation
can provoke the muscles to contract as well as produce responses from
the central nervous system, i.e. increase the awareness of the muscle
contractions which could be important for women with a weak
PFM.26–28 However, use of electrical stimulation can
be questioned in the early postpartum period and when women are
breast-feeding. Low levels of estrogen and thinning of the vaginal
mucosa may make electrical stimulation painful. To date, the evidence
indicates that in the general female population electrical stimulation
of the pelvic floor muscles is better than no treatment, but the low
quality of published studies on the matter prevents conclusions when
comparing PFMT and electrical stimulation in treatment of
UI.27
In our study, symptoms were in general benign and women may well have
had difficulties in distinguishing between never or occasionally (less
than once a week). Women in the TG might also have been more aware of
their symptoms during the intervention period as a result of the weekly
contacts with a women´s health physiotherapist. Conversely, with no
contact to treatment providers, women in the CG could have considered
themselves as less symptomatic.
The steady decrease in the number of women with symptoms in the TG from
recruitment to one year after childbirth did, however, follow a measured
increase in PFM strength during the study period. As previously
reported, this improvement was significantly better in the
TG.13 The low number of symptomatic women at 6 months
postpartum in the CG seems to be an incongruity when looking at the
development of symptoms.
Adherence to PFM exercises at home which was encouraged by the
physiotherapists for the participants in the TG during the study period
has been published in an article reporting the effect of PFMT on
postpartum UI and AI.13 Adherence was in general poor,
especially during the latter half of the year which may have influenced
the results.