International Urogynecology Journal

, Volume 8, Issue 4, pp 217–222 | Cite as

The effect of postpartum pelvic floor muscle exercise in the prevention and treatment of urinary incontinence

  • S. Mørkved
  • K. Bø
Original Article


The aim of this study was to evaluate the effect of postpartum pelvic floor muscle exercise in the prevention and treatment of urinary incontinence. A prospective comparison design of 99 matched pairs (n=198) of mothers, a training group and a control group, was used. Eight weeks postpartum the training group attended an 8-week intensive pelvic floor muscle exercise course, training in groups led by a physical therapist for 45 minutes once a week. In addition they were asked to exercise at home at least three times per week. The control group followed the ordinary written postpartum instructions from the hospital. Pelvic floor muscle strength was measured pretreatment at the eighth, and post-treatment at the 16th week after delivery, using a vaginal balloon catheter connected to a pressure transducer. Vaginal palpation and observation of inward movement of the balloon catheter during contraction were used to test the ability to perform correct the pelvic floor muscle contraction. Urinary leakage was registered by interview, specially designed instruments to measure how women perceive SUI, and a standardized pad test. At baseline (8 weeks postpartum) there was no significant difference in the number of women with urinary incontinence in the training group compared to the control group. At 16 weeks postpartum, after the 8-week treatment period, there was a significant (P<0.01) difference in favor of the training group. In addition, a significantly greater improvement in pelvic floor muscle strength between test 1 and test 2 was found in the training group compared to the control group. The results show that a specially designed postpartum pelvic floor muscle exercise course is effective in increasing pelvic floor muscle strength and reducing urinary incontinence in the immediate postpartum period.


Pelvic floor muscles Physical therapy Postpartum exercise Prevention Strength training Urinary incontinence 


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  1. 1.
    Allen RE, Hosker GL, Smith ARB, Warell DW. Pelvic floor damage and childbirth: a neurophysiological study.Br J Obstet Gynaecol 1990;97:770–779PubMedGoogle Scholar
  2. 2.
    Snooks SJ, Setchell M, Swash M, Henry MM. Injury to innervation of pelvic floor sphincter musculature in childbirth.Lancet 1984;8:546–550CrossRefGoogle Scholar
  3. 3.
    Snooks SJ, Swash M, Mathers SE, Henry MM. Effect of vaginal delivery on the pelvic floor: a five year follow-up.Br J Surg 1990;77:1358–13560PubMedCrossRefGoogle Scholar
  4. 4.
    Bø K, Mæhlum S, Oseid S, Larsen S. Prevalence of stress urinary incontinence among physically active and sedentary female students.Scand J Sports Sci 1989;11:113–116Google Scholar
  5. 5.
    Nygaard I, DeLancey JOL, Arnsdorf L, Murphy E. Exercise and incontinence.Obstet Gynecol 1990;75:848–851PubMedGoogle Scholar
  6. 6.
    Sommer P, Bauer T, Nielsen KK et al. Voiding patterns and prevalence in women.Br J Urol 1990;66:12–15PubMedGoogle Scholar
  7. 7.
    Thomas TM, Plymat KT, Blannin J, Meade TW. Prevalence of urinary incontinence.Br Med J 1980;281:1243–1245PubMedCrossRefGoogle Scholar
  8. 8.
    Kegel AH. Progressive resistance exercise in the functional restoration of the perineal muscles.Am J Obstet Gynecol 1948;56:238–249PubMedGoogle Scholar
  9. 9.
    Polden M, Mantle J. Physiotherapy in obstetrics and gynaecology. Oxford: Butterworth Heinemann, 1992Google Scholar
  10. 10.
    Sleep J, Grant A. Pelvic floor exercises in postnatal care.Midwifery 1987;3:158–164PubMedCrossRefGoogle Scholar
  11. 11.
    Dumolin C, Seaborne DE, Quirion-DeGiradi C, Sullivan SJ. Pelvic floor rehabilitation. Pt. 2.Phys Ther 1995;75:1075–1081Google Scholar
  12. 12.
    Bø K, Hagen RH, Kvarstein B, Larsen S. Pelvic floor muscle exercise for the treatment of female stress urinary incontinence. II. Validity of vaginal pressure measurements of pelvic floor muscle strength. The necessity of supplementary methods for control of correct contraction.Neurourol Urodyn 1990;9:479–487CrossRefGoogle Scholar
  13. 13.
    Bø K. Pelvic floor muscle exercise for the treatment of stress urinary incontinence: an exercise physiology perspective.Int Urogynecol J 1995;6:282–291CrossRefGoogle Scholar
  14. 14.
    DiNubile NA. Strength training.Clin Sports Med 1991;10:33–62PubMedGoogle Scholar
  15. 15.
    Bø K, Hagen RH, Kvarstein B, Jørgensen J, Larsen S. Pelvic floor muscle exercise for the treatment of female stress urinary incontinence. III. Effects of two different degrees of pelvic floor muscle exercises.Neurourol Urodyn 1990;9:489–502CrossRefGoogle Scholar
  16. 16.
    Hanzal E, Berger E, Koelbl H. Levator ani muscle morphology and recurrent genuine stress incontinence.Obstet Gynecol 1993;81:426–429PubMedGoogle Scholar
  17. 17.
    Koelbl H, Bernascheck G, Wolf G. A comparative study of perineal ultrasound scanning and urethrocystography in patients with genuine stress incontinence.Arch Gynecol Obstet 1988;244:39–45CrossRefGoogle Scholar
  18. 18.
    Constantinou CE, Govan DE. Contribution and timing of transmitted and generated pressure components in the female urethra. In: Female Incontinence. New York: Allan R. Liss, 1981:113–120Google Scholar
  19. 19.
    DeLancey JOL. Anatomy and mechanics of structures around the vesical neck: how vesical neck position might affect its closure.Neurourol Urodyn 1988;7:161–162CrossRefGoogle Scholar
  20. 20.
    Bø K. Reproducibility of instruments designed to measure objective evaluation of female stress urinary incontinence.Scand J Urol Nephrol 1994;28:27–100CrossRefGoogle Scholar
  21. 21.
    Sayer TR, Dixon JS, Hosker GL, Warell DW. A study of periurethral connective tissue in women with stress incontinence of urine.Neurourol Urodyn 1990;9:319–320CrossRefGoogle Scholar
  22. 22.
    Landon CR, Crofts CE, Smith ARB, Trowbridge EA. Mechanical properties of facia during pregnancy: a possible factor in the development of stress incontinence of urine.Contempt Rev Obstet Gynaecol 1990;2:40–46Google Scholar
  23. 23.
    Ulmsten U, Ekman G, Giertz G, Malmstrøm A. Different biochemical composition of connective tissue in continent and stress incontinent women.Acta Obstet Gynecol Scand 1987;66:455–457PubMedCrossRefGoogle Scholar
  24. 24.
    Wilson PD, Sammarai TAL, Deakin M, Kolbe E, Brown ADG. An objective assessment of physiotherapy for female genuine stress incontinence.Br J Obstet Gynaecol 1987;94:575–582PubMedGoogle Scholar
  25. 25.
    Krajl B. Comparative study of pad tests — reliability and repetiveness.Neurourol Urodyn 1989;8:305–306Google Scholar
  26. 26.
    Lose G, Rosenkilde P, Gammelgaard J, Schroeder T. Pad weighing test performed with standardized bladder volume.Urology 1988;32:78–80PubMedCrossRefGoogle Scholar
  27. 27.
    Blavias JG, Rodney AA, Appell RA, et al. Standards of efficacy for evaluation of treatment outcomes in urinary incontinence: recommendations of the Urodynamic Society.Neurourol Urodyn 1997;16:145–147CrossRefGoogle Scholar

Copyright information

© Springer-Verlag London Ltd 1997

Authors and Affiliations

  • S. Mørkved
    • 1
  • K. Bø
    • 2
  1. 1.School of Health Education, Nursing and Social WorkSør-Trøndelag CollegeTrondheim
  2. 2.Norwegian Center for Physical Therapy ResearchOsloNorway

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