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.