Skip to main content


Log in

The Effects of home-based stabilization exercises focusing on the pelvic floor on postnatal stress urinary incontinence and low back pain: a randomized controlled trial

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

A Commentary to this article was published on 06 May 2020


Introduction and hypothesis

Stress urinary incontinence (SUI) and low back pain (LBP) are common postnatal problems. We aimed to compare the effects of stabilization exercises focusing on the pelvic floor on postnatal SUI and LBP.


This two-arm, single-blind, parallel, randomized controlled trial was done on 80 women (mean age: 30.5, range: 20–45 years), with postnatal SUI and LBP. They were randomized into two equal control and intervention groups. The control group received no treatment while the intervention group received home-based stabilization exercises focusing on pelvic floor muscles (PFM) 3 days a week for 12 weeks, three sets a day; each set included three different types of exercise each week. Outcome measures were UI severity, assessed by ICIQ-UI-SF, low back pain functional disability, assessed by the Oswestry Disability Index (ODI), LBP severity, assessed by visual analog scale (VAS), and PFM strength and endurance, assessed by vaginal examination. Transverse abdominis (TrA) muscle strength was assessed by manometric biofeedback. All outcomes were measured directly before and after treatment.


In the intervention group, PFM strength, TrA muscle strength, functional disability and pain severity were significantly improved (P < 0.05). Within-group results showed that all outcomes except pain severity (P = 0.06) had directly improved in the intervention group after treatment (P < 0.05), while in the control group only PFM strength and endurance and UI severity had improved (P < 0.05).


Home-based stabilization exercises focusing on the pelvic floor muscles could be effective for postnatal LBP and SUI.

Trial registration

Iranian Registry of Clinical Trials (Code: IRCT2017050618760N4).

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

Access this article

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

Instant access to the full article PDF.

Fig. 1
Fig. 2

Similar content being viewed by others



Stress urinary incontinence


Low back pain


Pelvic floor muscles


Pelvic floor disorders


Oswestry Disability Index


Visual analog scale


Transverse abdominis


  1. Katonis P, Kampouroglou A, Aggelopoulos A, Kakavelakis K, Lykoudis S, Makrigiannakis A, et al. Pregnancy-related low back pain. Hippokratia. 2011;15(3):205.

    CAS  PubMed Central  Google Scholar 

  2. Ghaderi F, Asghari Jafarabadi M, Mohseni Bandpei MA. Prevalence of musculoskeletal pain and associated factors with low back pain during pregnancy. The Iranian Journal of Obstetrics, Gynecology and Infertility. 2013;15(41):9–16.

    Google Scholar 

  3. Mantle J, Haslam J, Barton S, Polden M. Physiotherapy in obstetrics and gynaecology. London: Butterworth-Heinemann; 2004.

    Google Scholar 

  4. Barr K, Griggs M, Cadby T. Lumbar stabilization: a review of core concepts and current literature, part 2. Am J Phys Med Rehabil. 2007;86(1):72–80.

    Google Scholar 

  5. Bayramoglu M, Akman M, Kilinç S, Çetin N, Yavuz N, Özker R. Isokinetic measurement of trunk muscle strength in women with chronic low back pain. Am J Phys Med Rehabil. 2001;80(9):650–5.

    CAS  Google Scholar 

  6. Danneels L, Vanderstraeten G, Cambier D, Witvrouw E, Cuyper H. CT imaging of trunk muscles in chronic low back pain patients and healthy control subjects. Eur Spine J. 2000;9(4):266–72.

    CAS  PubMed Central  Google Scholar 

  7. Hodges P, Moseley G, Gabrielsson A, Gandevia S. Experimental muscle pain changes feed forward postural responses of the trunk muscles. Exp Brain Res. 2003;151(2):262–71.

    Google Scholar 

  8. Unsgaard-Tøndel M, Vasseljen O, Woodhouse A, Mørkved S. Exercises for women with persistent pelvic and low back pain after pregnancy. Global J Health Sci. 2016;8(9):107.

    Google Scholar 

  9. Bogaert J, Stack M, Partington S, Marceca J, Tremback-Ball A. The effects of stabilization exercise on low back pain and pelvic girdle pain in pregnant women. Ann Phys Rehabil Med. 2018;61:e157–8.

    Google Scholar 

  10. Hoyte L, Damaser M. Biomechanics of the female pelvic floor. 1st ed. United States: Academic; 2016.

    Google Scholar 

  11. Luo D, Chen L, Yu X, Ma L, Chen W, Zhou N, et al. Differences in urinary incontinence symptoms and pelvic floor structure changes during pregnancy between nulliparous and multiparous women. PeerJ. 2017;5:e3615.

    PubMed Central  Google Scholar 

  12. Noor R, Neelam H, Bashir MS. Mode of delivery and pelvic floor disorder. Rawal Medical Journal. 2017;42(4):503–6.

    Google Scholar 

  13. Blomquist JL, Muñoz A, Carroll M, Handa VL. Association of delivery mode with pelvic floor disorders after childbirth. Jama. 2018;320(23):2438–47.

    PubMed Central  Google Scholar 

  14. Memon HU, Handa VL. Vaginal childbirth and pelvic floor disorders. Women’s Health. 2013;9(3):265–77.

    CAS  Google Scholar 

  15. Thom DH, Rortveit G. Prevalence of postpartum urinary incontinence: a systematic review. Acta Obstet Gynecol Scand. 2010;89(12):1511–22.

    Google Scholar 

  16. Morkved S, Bo K. Effect of pelvic floor muscle training during pregnancy and after childbirth on prevention and treatment of urinary incontinence: a systematic review. Br J Sports Med. 2014;48(4):299–310.

    Google Scholar 

  17. Vermani E, Mittal R, Weeks A. Pelvic girdle pain and low back pain in pregnancy: a review. Pain Practice. 2010;10(1):60–71.

    Google Scholar 

  18. Ghaderi F, Oskouei AE. Physiotherapy for women with stress urinary incontinence: a review article. J Phys Ther Sci. 2014;26(9):1493–9.

    PubMed Central  Google Scholar 

  19. Kim E, Kim S, Oh D. Pelvic floor muscle exercises utilizing trunk stabilization for treating postpartum urinary incontinence: randomized controlled pilot trial of supervised versus unsupervised training. Clin Rehabil. 2012;26(2):132–41.

    Google Scholar 

  20. Sapsford R. Rehabilitation of pelvic floor muscles utilizing trunk stabilization. Man Ther. 2004;9(1):3–12.

    Google Scholar 

  21. Sapsford R, Hodges P, Richardson C, Cooper D, Markwell S, Jull G. Co-activation of the abdominal and pelvic floor muscles during voluntary exercises. Neurourol Urodyn. 2001;20(1):31–42.

    CAS  Google Scholar 

  22. Ghaderi F, Mohammadi K, Amir Sasan R, Niko Kheslat S, Oskouei AE. Effects of stabilization exercises focusing on pelvic floor muscles on low back pain and urinary incontinence in women. Urology. 2016;93:50–4.

    Google Scholar 

  23. Thüroff J, Abrams P, Andersson K, Artibani W, Chapple C, Drake M, et al. EAU guidelines on urinary incontinence. Actas Urológicas Españolas (English Edition). 2011;7(35):373–88.

    Google Scholar 

  24. Maher C, Underwood M, Buchbinder R. Non-specific low back pain. Lancet. 2017;10070(389):736–47.

    Google Scholar 

  25. Asghari-Jafarabadi M, Sadeghi-Bazargani H. Randomization: techniques and software-aided implementation in medical studies. J Clin Res Gov. 2015;4(2):1–6.

    Google Scholar 

  26. Faul F, Erdfelder E, Lang A, Buchner A. G power 3: a flexible statistical power analysis program for the social, behavioral, and biomedical sciences. Behav Res Methods. 2007;2(39):175–91.

    Google Scholar 

  27. Bijur PE, Silver W, Gallagher EJ. Reliability of the visual analog scale for measurement of acute pain. Acad Emerg Med. 2001;8(12):1153–7.

    CAS  Google Scholar 

  28. Mousavi SJ, Parnianpour M, Mehdian H, Montazeri A, Mobini B. The Oswestry disability index, the Roland-Morris disability questionnaire, and the Quebec back pain disability scale: translation and validation studies of the Iranian versions. Spine. 2006;31(14):E454–E9.

    Google Scholar 

  29. Hajebrahimi S, Nourizadeh D, Hamedani R, Pezeshki MZ. Validity and reliability of the international consultation on incontinence questionnaire-urinary incontinence short form and its correlation with urodynamic findings. Urol J. 2012;9(4):685–90.

    Google Scholar 

  30. Cynn H-S, Oh J-S, Kwon O-Y, Yi C-H. Effects of lumbar stabilization using a pressure biofeedback unit on muscle activity and lateral pelvic tilt during hip abduction in sidelying. Arch Phys Med Rehabil. 2006;87(11):1454–8.

    Google Scholar 

  31. Storheim K, Bø K, Pederstad O, Jahnsen R. Intra-tester reproducibility of pressure biofeedback in measurement of transversus abdominis function. Physiother Res Int. 2002;4(7):239–49.

    Google Scholar 

  32. Ferreira C, Barbosa P, de Oliveira SF, Antônio F, Franco M, Bø K. Inter-rater reliability study of the modified Oxford grading scale and the Peritron manometer. Physiotherapy. 2011;2(97):132–8.

    Google Scholar 

  33. Volløyhaug I, Mørkved S, Salvesen Ø, Salvesen KÅ. Assessment of pelvic floor muscle contraction with palpation, perineometry and transperineal ultrasound: a cross-sectional study. Ultrasound Obstet Gynecol. 2016;47(6):768–73.

    Google Scholar 

  34. Navarro Brazález B, Torres Lacomba M, de la Villa P, Sanchez Sanchez B, Prieto Gómez V, Asúnsolo del Barco Á, et al. The evaluation of pelvic floor muscle strength in women with pelvic floor dysfunction: a reliability and correlation study. Neurourol Urodyn. 2018;37(1):269–77.

    Google Scholar 

  35. Hayden J, Van Tulder M, Malmivaara A, Koes B. Meta-analysis: Exercice therapy for nonspecific low back pain. Ann Intern Med. 2005;142:765–75.

    Google Scholar 

  36. Liddle S, Baxter G, Gracey J. Exercice and chronic low back pain: what works? Pain. 2004;107:176–90.

    Google Scholar 

  37. França FR, Burke TN, Caffaro RR, Ramos LA, Marques AP. Effects of muscular stretching and segmental stabilization on functional disability and pain in patients with chronic low back pain: a randomized, controlled trial. J Manip Physiol Ther. 2012;35(4):279–85.

    Google Scholar 

  38. Kluge J, Hall D, Louw Q, Theron G, Grové D. Specific exercises to treat pregnancy-related low back pain in a south African population. Int J Gynecol Obstet. 2011;113(3):187–91.

    Google Scholar 

  39. Dougherty MC, Bishop KR, Abrams RM, Batich CD, Gimotty PA. The effect of exercise on the circumvaginal muscles in postpartum women. J Nurse Midwifery. 1989;34(1):8–14.

    CAS  Google Scholar 

Download references


The authors thank all of the participants, the Physiotherapy Department of Tabriz University of Medical Sciences and Al-Zahra Hospital.

Author information

Authors and Affiliations



F Ghaderi: Project development, Data Collection, Manuscript writing and editing

F Khorasani: Project development, Data collection

P Bastani: Data collection

P Sarbakhsh: Statistical Analysis

B Berghmans: Project Development, Manuscript writing and editing, English editing

Corresponding author

Correspondence to Fariba Ghaderi.

Ethics declarations

Conflicts of interest


Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Khorasani, F., Ghaderi, F., Bastani, P. et al. The Effects of home-based stabilization exercises focusing on the pelvic floor on postnatal stress urinary incontinence and low back pain: a randomized controlled trial. Int Urogynecol J 31, 2301–2307 (2020).

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: