International Urogynecology Journal

, Volume 27, Issue 2, pp 255–260 | Cite as

Impact of pelvic floor muscle training in the postpartum period

  • Louise-Helene GagnonEmail author
  • Jodi Boucher
  • Magali Robert
Original Article


Introduction and hypothesis

Our study piloted a novel, two-tiered approach to delivering pelvic floor muscle training (PFMT) to postpartum women involving a standardized group workshop followed by the opportunity to self-select for individual PFMT sessions. The aim of the study was to evaluate the outcomes in women who self-selected for individual PFMT using validated quality of life (QoL) questionnaires, the Pelvic Floor Distress Inventory-20 (PFDI-20), the Pelvic Floor Impact Questionnaire-7 (PFIQ-7), the Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire-12 (PISQ-12), as well as the Modified Oxford Scale (MOS) for strength. Women’s satisfaction with the program was also assessed.


This was a single-center prospective cohort study conducted between December 2013 and September 2014. Changes from baseline to postintervention QoL and MOS scores were tested using the Wilcoxon signed-rank test.


Two hundred and eighteen women attended the workshop, 54 enrolled in PFMT sessions, and 50 completed follow-up. Significant improvements were seen in the PFDI-20 (mean change −41.8, p < 0.001) and PFIQ-7 (mean change −23.0, p < 0.001) questionnaires. Results for the PISQ-12 could not be tabulated, as there were too many missing responses. The MOS score was significantly improved from baseline (4; range {0–5} compared with 3; range {0–4}; p < 0.001). Forty-nine of 50 women’s expectations for the program were met [9 of 10; standard deviation (SD) 1.4].


Results suggest that a two-tiered, self-selection approach to administering PFMT in the postpartum period contributes to significant improvements in pelvic floor function, QoL, MOS strength, and to high satisfaction rates.


Pelvic floor muscle training Quality of life Postpartum 



The following people contributed to data collection and analysis: Kirk Stephenson and Selphee Tang. The authors are grateful for support from the Canadian Foundation for Women’s Health and the Canadian Continence Foundation supported by Watson Pharma Company.

Conflicts of interest


Supplementary material

192_2015_2822_MOESM1_ESM.docx (672 kb)
ESM 1 (DOCX 671 kb)


  1. 1.
    Foldspang A, Mommsen S, Djurhuus JC (1999) Prevalent urinary incontinence as a correlate of pregnancy, vaginal childbirth, and obstetric techniques. Am J Public Health 89:209–212PubMedCentralCrossRefPubMedGoogle Scholar
  2. 2.
    Rortveit G, Daltveit AK, Hannestad YS, Hunskaar S, Norwegian EPINCONT study (2003) Urinary incontinence after vaginal delivery or caesarean section. N Engl J Med 348:900–907CrossRefPubMedGoogle Scholar
  3. 3.
    Rortveit G, Daltveit AK, Hannestad YS, Hunskaar S (2003) Vaginal delivery parameters and urinary incontinence: the Norwegian EPINCONT study. Am J Obstet Gynecol 189(5):1268–1274CrossRefPubMedGoogle Scholar
  4. 4.
    Viktrup L, Rortveit B, Lose G (2006) Risk of stress urinary incontinence twelve years after the first pregnancy and delivery. Obstet Gynecol 108:248–254CrossRefPubMedGoogle Scholar
  5. 5.
    Eason E, Labrecque M, Marcous S, Mondor M (2002) Anal incontinence after childbirth. CMAJ 166:326–330PubMedCentralPubMedGoogle Scholar
  6. 6.
    MacArthur C, Glazener CM, Wilson PD, Herbison GP, Gee H, Lang GD, Lancashire R (2001) Obstetric practice and faecal incontinence three months after delivery. Br J Obstet Gynaecol 108:678–683Google Scholar
  7. 7.
    Pollack J, Nordenstam J, Brismar S, Lopez A, Altman D, Zetterstrom J (2004) Anal incontinence after vaginal delivery: a five-year prospective cohort study. Obstet Gynecol 104:1397–1402CrossRefPubMedGoogle Scholar
  8. 8.
    Sultan AH, Monga AK, Kumar D, Stanton SL (1999) Primary repair of obstetric anal sphincter rupture using the overlap technique. Br J Obstet Gynaecol 106:318–323CrossRefPubMedGoogle Scholar
  9. 9.
    Abdool Z, Thakar R, Sultan AH (2009) Postpartum female sexual function. Eur J Obstet Gynecol Reprod Biol 145(2):133–137CrossRefPubMedGoogle Scholar
  10. 10.
    Luthander C, Emilsson T, Ljunggren G, Hammarström M (2011) A questionnaire on pelvic floor dysfunction postpartum. Int Urogynecol J 22:105–113PubMedCentralCrossRefPubMedGoogle Scholar
  11. 11.
    MacArthur C, Lewis M, Knox EG (1991) Health after childbirth. Br J Obstet Gynaecol 98:1193–1195CrossRefPubMedGoogle Scholar
  12. 12.
    Wilson PD, Herbison RM, Herbison GP (1996) Obstetric Practice and the prevalence of urinary incontinence three months after delivery. Br J Obstet Gynaecol 103:154–161CrossRefPubMedGoogle Scholar
  13. 13.
    MacArthur C, Bick DE, Keighley MRB (1997) Faecal incontinence after childbirth. Br J Obstet Gynaecol 104:46–50CrossRefPubMedGoogle Scholar
  14. 14.
    Sultan AH, Kamm MA, Hudson CN, Thomas JM, Bartram CI (1993) Anal-sphincter disruption during vaginal delivery. N Engl J Med 329:1905–1911CrossRefPubMedGoogle Scholar
  15. 15.
    Boyle R, Hay-Smith EJC, Cody JD, Mørkved S (2014) Pelvic floor muscle training for prevention and treatment of urinary and faecal incontinence in antenatal and postnatal women: A Short Version Cochrane Review. Neurol Urodyn 3:269–276CrossRefGoogle Scholar
  16. 16.
    Meyer S, Hohlfeld P, Achtari C et al (2001) Pelvic floor education after vaginal delivery. Obstet Gynecol 97:673–677CrossRefPubMedGoogle Scholar
  17. 17.
    Chiarelli P, Cockburn J (2002) Promoting urinary continence in women after delivery: Randomised controlled trial. BMJ 324:1–6CrossRefGoogle Scholar
  18. 18.
    Ewings P, Spencer S, Marsh H, O’Sullivan M (2005) Obstetric risk factors for urinary incontinence and preventative pelvic floor exercises: Cohort study and nested randomized controlled trial. J Obstet Gynaecol 25:558–564CrossRefPubMedGoogle Scholar
  19. 19.
    Sleep J, Grant A (1987) Pelvic floor exercises in postnatal care. Midwifery 3:158–164CrossRefPubMedGoogle Scholar
  20. 20.
    Elder JP, Ayala GX, Harris S (1999) Theories and intervention approaches to health-behavior change in primary care. Am J Prev Med 17(4):275–284CrossRefPubMedGoogle Scholar
  21. 21.
    Anderson JG, Bartkus DE (1973) Choice of medical care: a behavioral model of health and illness behavior. J Health Soc Behav 14(4):348–362CrossRefPubMedGoogle Scholar
  22. 22.
    University of South Florida, College of Public Health (2013). Health, Behavior and Society: Theories and Concepts in Public Health. Available at: Accessed 22 Feb 2014
  23. 23.
    Barber MD, Walters MD, Bump RC (2005) Short forms of two condition-specific quality-of-life questionnaires for women with pelvic floor disorders (PFDI-20 and PFIQ-7). Am J Obstet Gynecol 93(1):103–113CrossRefGoogle Scholar
  24. 24.
    Rogers RG, Coates KW, Kammerer-Doak D, Khalsa S, Qualls C (2003) A short form of the Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire (PISQ-12). Int Urogynecol J Pelvic Floor Dysfunct 14(3):164–168CrossRefPubMedGoogle Scholar
  25. 25.
    Isherwood PJ, Rane A (2000) Comparative assessment of pelvic floor strength using a perineometer and digital examination. Br J Obstet Gynaecol 107:1007–1011CrossRefGoogle Scholar
  26. 26.
    Gafni-Kane A, Goldberg RP, Sand PK, Botros SM (2012) Enhanced interpretability of the PFDI-20 with establishment of reference scores among women in the general population. Neurourol Urodyn 31(8):1252–1257CrossRefPubMedGoogle Scholar
  27. 27.
    Haylen BT, de Ridder D, Freeman RM et al (2010) An International Urogynecological Association (IUGA)/International Continence Society (ICS) joint report on the terminology for female pelvic floor dysfunction. Int Urogynecol J 21:5–26CrossRefPubMedGoogle Scholar
  28. 28.
    Public Health Agency of Canada (2008) Canadian Perinatal Health Report, Health Canada. Available at: Accessed 16 Oct 2014

Copyright information

© The International Urogynecological Association 2015

Authors and Affiliations

  • Louise-Helene Gagnon
    • 1
    Email author
  • Jodi Boucher
    • 2
  • Magali Robert
    • 3
  1. 1.Division of Urogynecology, Department of Obstetrics and GynecologyUniversity of CalgaryCalgaryCanada
  2. 2.Division of UrogynecologyUniversity of CalgaryCalgaryCanada
  3. 3.Division of Urogynecology, Department of Obstetrics and GynecologyUniversity of CalgaryCalgaryCanada

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