Skip to main content

Advertisement

SpringerLink
Log in

Continence and pelvic floor status in nulliparous women at midterm pregnancy

  • Original Article
  • Published:
International Urogynecology Journal Aims and scope Submit manuscript

Abstract

Introduction and hypothesis

A Cochrane review recommends antenatal pelvic floor muscle training (PFMT) in urinary incontinence (UI) prevention. The aim of the study was to investigate nulliparous pregnant women’s knowledge about and practising of PFMT, their pelvic floor muscle (PFM) function, and ability to contract correctly. It was hypothesized that continent women had higher PFM strength and endurance than women with UI.

Methods

Three hundred nulliparous women at gestational week 18–22 were included in a cross-sectional study. Vaginal resting pressure, maximum voluntary contraction, and PFM endurance were measured by manometer. UI was assessed by International Consultation on Incontinence Questionnaire Urinary Incontinence Short Form (ICIQ-UI-SF). Comparisons of PFM function in continent women and women with UI were analyzed using independent-samples t test. Mean differences with 95 % confidence interval (CI) are presented.

Results

Of 300 women, 89 % had heard of PFMT at mid pregnancy, and 35 % performed PFMT once or more a week. After thorough instruction 4 % were unable to contract correctly. Thirty-five percent reported UI, of whom 48 % performed PFMT once or more a week. Continent women had significantly higher PFM strength and endurance when compared with women having UI, with mean differences of 6.6 cmH2O (CI 2.3–10.8, p = 0.003), and 41.5 cmH2Osec (CI 9.8–73.1, p = 0.010), respectively. No difference was found for vaginal resting pressure (p = 0.054).

Conclusions

Most nulliparous pregnant women knew about PFMT. Thirty-five percent performed PFMT once or more a week. Incontinent nulliparous pregnant women had weaker PFM than their continent counterparts. More emphasis on information regarding PFM function and PFMT is warranted during pregnancy.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Hay-Smith J, Mørkved S, Fairbrother KA, Herbison GP (2008) Pelvic floor muscle training for prevention and treatment of urinary and faecal incontinence in antenatal and postnatal women. Cochrane Database Syst RevCD007471

  2. Chiarelli P, Murphy B, Cockburn J (2003) Women's knowledge, practises, and intentions regarding correct pelvic floor exercises. Neurourol Urodyn 22:246–249

    Article  PubMed  Google Scholar 

  3. Whitford HM, Alder B, Jones M (2007) A cross-sectional study of knowledge and practice of pelvic floor exercises during pregnancy and associated symptoms of stress urinary incontinence in North-East Scotland. Midwifery 23:204–217

    Article  PubMed  Google Scholar 

  4. Bø K, Haakstad AH, Voldner N (2007) Do pregnant women exercise their pelvic floor muscles? Int Urogynecol J Pelvic Floor Dysfunct 18:733–736

    Article  PubMed  Google Scholar 

  5. Bø K, Fleten C, Nystad W (2009) Effect of antenatal pelvic floor muscle training on labor and birth. Obstet Gynecol 113:1279–1284

    PubMed  Google Scholar 

  6. Mason L, Glenn S, Walton I (1999) The prevalence of stress incontinence during pregnancy and following delivery. Midwifery 15:120–128

    Article  PubMed  CAS  Google Scholar 

  7. Kegel AH (1952) Stress incontinence and genital relaxation; a nonsurgical method of increasing the tone of sphincters and their supporting structures. Ciba Clin Symp 4:35–51

    PubMed  CAS  Google Scholar 

  8. Benvenuti F, Caputo GM, Bandinelli S, Mayer F, Biagini C, Sommavilla A (1987) Reeducative treatment of female genuine stress incontinence. Am J Phys Med 66:155–168

    PubMed  CAS  Google Scholar 

  9. Bump RC, Hurt WG, Fantl JA, Wyman JF (1991) Assessment of Kegel pelvic muscle exercise performance after brief verbal instruction. Am J Obstet Gynecol 165:322–327

    PubMed  CAS  Google Scholar 

  10. Mørkved S, Salvesen KA, Bø K, Eik-Nes S (2004) Pelvic floor muscle strength and thickness in continent and incontinent nulliparous pregnant women. Int Urogynecol J Pelvic Floor Dysfunct 15:384–389

    Article  PubMed  Google Scholar 

  11. Sampselle CM (1990) Changes in pelvic muscle strength and stress urinary incontinence associated with childbirth. J Obstet Gynecol Neonatal Nurs 19:371–377

    Article  PubMed  CAS  Google Scholar 

  12. Samuelsson E, Victor A, Svardsudd K (2000) Determinants of urinary incontinence in a population of young and middle-aged women. Acta Obstet Gynecol Scand 79:208–215

    Article  PubMed  CAS  Google Scholar 

  13. Morin M, Bourbonnais D, Gravel D, Dumoulin C, Lemieux MC (2004) Pelvic floor muscle function in continent and stress urinary incontinent women using dynamometric measurements. Neurourol Urodyn 23:668–674

    Article  PubMed  Google Scholar 

  14. Thompson JA, O'Sullivan PB, Briffa NK, Neumann P (2006) Assessment of voluntary pelvic floor muscle contraction in continent and incontinent women using transperineal ultrasound, manual muscle testing and vaginal squeeze pressure measurements. Int Urogynecol J Pelvic Floor Dysfunct 17:624–630

    Article  PubMed  Google Scholar 

  15. Shishido K, Peng Q, Jones R, Omata S, Constantinou CE (2008) Influence of pelvic floor muscle contraction on the profile of vaginal closure pressure in continent and stress urinary incontinent women. J Urol 179:1917–1922

    Article  PubMed  Google Scholar 

  16. Hahn I, Milsom I, Ohlsson BL, Ekelund P, Uhlemann C, Fall M (1996) Comparative assessment of pelvic floor function using vaginal cones, vaginal digital palpation and vaginal pressure measurements. Gynecol Obstet Invest 41:269–274

    Article  PubMed  CAS  Google Scholar 

  17. Bø K, Stien R, Kulseng-Hanssen S, Kristofferson M (1994) Clinical and urodynamic assessment of nulliparous young women with and without stress incontinence symptoms: a case-control study. Obstet Gynecol 84:1028–1032

    PubMed  Google Scholar 

  18. Sartore A, Pregazzi R, Bortoli P, Grimaldi E, Ricci G, Guaschino S (2003) Assessment of pelvic floor muscle function after vaginal delivery. Clinical value of different tests J Reprod Med 48:171–174

    Google Scholar 

  19. Avery K, Donovan J, Peters TJ, Shaw C, Gotoh M, Abrams P (2004) ICIQ: a brief and robust measure for evaluating the symptoms and impact of urinary incontinence. Neurourol Urodyn 23:322–330

    Article  PubMed  Google Scholar 

  20. Bø K, Hagen RH, Kvarstein B, Larsen S (1990) Pelvic floor muscle exercise for the treatment of of female stress urinary incontinence. I. Reliability of vaginal pressure measurements of pelvic muscle strength. Neurourol Urodyn 9:471–477

    Article  Google Scholar 

  21. Bø K, Hagen RH, Kvarstein B, Larsen S (1990) Pelvic floor muscle exercise for the treatment of of female stress urinary incontinence. II. Validity of vaginal pressure measurements of pelvic muscle strength- The necessity of supplementary methods for control of correct contraction. Neurourol Urodyn 9:479–487

    Article  Google Scholar 

  22. Braekken IH, Majida M, Ellstrom EM, Holme IM, Bø K (2009) Pelvic floor function is independently associated with pelvic organ prolapse. BJOG 116:1706–1714

    Article  PubMed  CAS  Google Scholar 

  23. Mason L, Glenn S, Walton I, Hughes C (2001) The instruction in pelvic floor exercises provided to women during pregnancy or following delivery. Midwifery 17:55–64

    Article  PubMed  CAS  Google Scholar 

  24. McLennan MT, Melick CF, Alten B, Young J, Hoehn MR (2006) Patients' knowledge of potential pelvic floor changes associated with pregnancy and delivery. Int Urogynecol J Pelvic Floor Dysfunct 17:22–26

    Article  PubMed  Google Scholar 

  25. Horsley K (2011) Fitness in the child-bearing years. In: Sapsford R, Bullock-Saxton J, Markwell S (eds) Women's health. A textbook for physiotherapists. Thieme, New York, pp 168–191

    Google Scholar 

  26. Salvesen KA, Mørkved S (2004) Randomised controlled trial of pelvic floor muscle training during pregnancy. BMJ 329:378–380

    Article  PubMed  Google Scholar 

  27. Agur W, Steggles P, Waterfield M, Freeman R (2008) Does antenatal pelvic floor muscle training affect the outcome of labour? a randomised controlled trial. Int Urogynecol J Pelvic Floor Dysfunct 19:85–88

    PubMed  Google Scholar 

  28. Dietz HP (2006) Pelvic floor trauma following vaginal delivery. Curr Opin Obstet Gynecol 18:528–537

    Article  PubMed  Google Scholar 

  29. Bø K, Sherburn M (2005) Evaluation of female pelvic-floor muscle function and strength. Phys Ther 85:269–282

    PubMed  Google Scholar 

  30. Bø K, Finckenhagen HB (2001) Vaginal palpation of pelvic floor muscle strength: inter-test reproducibility and comparison between palpation and vaginal squeeze pressure. Acta Obstet Gynecol Scand 80:883–887

    PubMed  Google Scholar 

Download references

Acknowledgements

We gratefully acknowledge the South-Eastern Norway Regional Health Authority and the Norwegian Research Council for funding this research.

Conflicts of interest

None.

Author information

Authors and Affiliations

  1. Department of Sports Medicine, Norwegian School of Sport Sciences, PO Box 4014, Ullevål stadion, 0806, Oslo, Norway

    Gunvor Hilde & Kari Bø

  2. Department of Obstetrics and Gynaecology, Akershus University Hospital, Lørenskog, Norway

    Gunvor Hilde, Jette Stær-Jensen, Marie Ellström Engh, Ingeborg Hoff Brækken & Kari Bø

  3. Faculty Division Akershus University Hospital, University of Oslo, Oslo, Norway

    Marie Ellström Engh

Authors
  1. Gunvor Hilde
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Jette Stær-Jensen
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Marie Ellström Engh
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Ingeborg Hoff Brækken
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Kari Bø
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Gunvor Hilde.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Hilde, G., Stær-Jensen, J., Ellström Engh, M. et al. Continence and pelvic floor status in nulliparous women at midterm pregnancy. Int Urogynecol J 23, 1257–1263 (2012). https://doi.org/10.1007/s00192-012-1716-0

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00192-012-1716-0

Keywords

Search

Navigation