Abstract
Introduction and hypothesis
All pregnant women should be given advice on the benefits of pelvic floor muscle exercises (PFMEs) in preventing urinary incontinence (UI) and know how to exercise correctly. This study explored women’s knowledge and practice of PFMEs, their sources of knowledge and prevalence of UI before and during pregnancy.
Methods
We conducted a cross-sectional study with 567 women, 239 primiparous and 328 multiparous, recruited from one maternity hospital in Ireland. Logistic regression was used to examine associations.
Results
Pre-pregnancy, 41% of women (n = 232) learnt to do PFMEs, 30% (n = 172) did exercises and 28% (n = 159) experienced UI. Women more likely to report UI were aged ≥ 35 years (p = 0.03), had a BMI ≥ 30 kg/m2 (p = 0.01) or did PFMEs but were unsure they were exercising correctly (p = 0.03). During pregnancy, 50% of women (n = 281) received PFME information during antenatal visits and 38.6% (n = 219) attended antenatal classes. Women less likely to do PFMEs daily or weekly had no formal educational qualification (p = 0.01), did not do PFMEs pre-pregnancy (p < 0.0001) or did not attend the physiotherapist-led PFME education session (p < 0.0001). In multivariable analysis, the two factors significantly associated with UI during pregnancy were being aged 30–34 years (p = 0.05) and reporting UI pre-pregnancy (p < 0.0001).
Conclusions
This benchmarking exercise revealed considerable gaps in the totality of PFME education and services offered in the site hospital. We recommend that others do likewise to enable learning from those who have addressed service deficits.
Similar content being viewed by others
References
Woodley SJ, Boyle R, Cody JD, Mørkved S, Hay-Smith EJC. Pelvic floor muscle training for prevention and treatment of urinary and faecal incontinence in antenatal and postnatal women. Cochrane Database Syst Rev. 2017;(12). doi:https://doi.org/10.1002/14651858.CD007471.pub3.
NICE. Antenatal care for uncomplicated pregnancies. Clinical guideline [CG 62] London, UK; 2017. Available at: https://www.nice.org.uk/guidance/cg62
Gerrard J, ten Hove R. RCM/CSP joint statement on pelvic floor muscle exercise. Improving health outcomes for women following pregnancy and birth. London: CSP, RCM; 2013. Available at: http://www.csp.org.uk/publications/improving-health-outcomes-women-following-pregnancy-birth
Mason L. Evidence-based midwifery in action. Guidelines on the teaching of pelvic floor exercises. Br J Midwifery. 2001;9(10):608–11. https://doi.org/10.12968/bjom.2001.9.10.12691.
Chiarelli P, Murphy B, Cockburn J. Women’s knowledge, practises, and intentions regarding correct pelvic floor exercises. Neurourol Urodyn. 2003;22(3):246–9. https://doi.org/10.1002/nau.10119.
Fine P, Burgio K, Borello-France D, Richter H, Whitehead W, Weber A, et al. Teaching and practice of pelvic floor muscle exercises in primiparous women during pregnancy and the postpartum period. Am J Obstet Gynecol. 2007;197(1):107–9. https://doi.org/10.1016/j.ajog.2007.02.052.
Brown SJ, Donath S, MacArthur C, McDonald EA, Krastev AH. Urinary incontinence in nulliparous women before and during pregnancy: prevalence, incidence, and associated risk factors. Int Urogynecol J. 2010;21(2):193–202. https://doi.org/10.1007/s00192-009-1011-x.
Daly D, Clarke M, Begley C. Urinary incontinence in nulliparous women before and during pregnancy: prevalence, incidence, type, and risk factors. Int Urogynecol J. 2018;29(3):353–62. https://doi.org/10.1007/s00192-018-3554-1.
Viktrup L, Lose G. Lower urinary tract symptoms 5 years after the first delivery. Int Urogynecol J Pelvic Floor Dysfunct. 2000;11(6):336–40. https://doi.org/10.1007/s001920070002.
Triviño-Juárez J-M, Romero-Ayuso D, Nieto-Pereda B, Forjaz M-J, Criado-Álvarez J-J, Arruti-Sevilla B, et al. Health related quality of life of women at the sixth week and sixth month postpartum by mode of birth. Women Birth. 2017;30(1):29–39. https://doi.org/10.1016/j.wombi.2016.06.005.
Coulter-Smith S. The Rotunda Hospital Dublin Clinical Report 2012. Rotunda Hospital, Dublin; 2013. Available at: https://rotunda.ie/rotunda-pdfs/Clinical%20Reports/Annual%20Clinical%20Report%202012.pdf
Marques A, Stothers L, Macnab A. The status of pelvic floor muscle training for women. Can Urolog Assoc J. 2010;4(6):419–24 Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2997838/pdf/cuaj-6-419.pdf.
World Medical Association. World medical association declaration of Helsinki: ethical principles for medical research involving human subjects. JAMA. 2013;310(20):2191–4. https://doi.org/10.1001/jama.2013.281053.
Haylen B, de Ridder D, Freeman R, Swift S, Berghmans B, Lee J, et al. An international urogynecological association (IUGA)/international continence society (ICS) joint report on the terminology for female pelvic floor dysfunction. Int Urogynecol J. 2010;21(1):5–26. https://doi.org/10.1007/s00192-009-0976-9.
Peat J, Barton B. Medical statistics a guide to data analysis and critical appraisal. Oxford: Blackwell Publishing Ltd.; 2005.
Bardino M, Di Martino M, Ricci E, Parazzini F. Frequency and determinants of urinary incontinence in adolescent and young nulliparous women. J Pediatr Adolesc Gynecol. 2015;28(6):462–70. https://doi.org/10.1016/j.jpag.2015.01.003.
Neels H, Wyndaele JJ, Tjalma WA, De Wachter S, Wyndaele M, Vermandel A. Knowledge of the pelvic floor in nulliparous women. J Phys Ther Sci. 2016;28(5):1524–33. https://doi.org/10.1589/jpts.28.1524.
Bump RC, Hurt WG, Fantl JA, Wyman JF. Assessment of Kegel pelvic muscle exercise performance after brief verbal instruction. Am J Obstset Gynecol. 1991;165(2):322–9.
Guerrero K, Owen L, Hirst G, Emery S. Antenatal pelvic floor exercises: a survey of both patients’ and health professionals’ beliefs and practice. J Obstet Gynaecol. 2007;27(7):684–7. https://doi.org/10.1080/01443610701612284.
Bø K, Haakstad LA, Voldner N. Do pregnant women exercise their pelvic floor muscles? Int Urogynecol J Pelvic Floor Dysfunct. 2007;18:733–6. https://doi.org/10.1007/s00192-006-0235-2.
O’Sullivan C, O’Connell R, Devane D. A descriptive survey of the educational preparation and practices of antenatal educators in Ireland. J Perinat Educ. 2014;23(1):33–40. https://doi.org/10.1891/1058-1243.23.1.33.
Fabian HM, Rådestad IM, Waldenström U. Characteristics of Swedish women who do not attend childbirth and parenthood education classes during pregnancy. Midwifery. 2004;20(3):226–35. https://doi.org/10.1016/j.midw.2004.01.003.
Stoll KH, Hall W. Childbirth education and obstetric interventions among low-risk Canadian women: is there a connection? J Perinat Educ. 2012;21(4):229–37. https://doi.org/10.1891/1058-1243.21.4.229.
Hines SH, Seng JS, Messer KL, Raghunathan TE, Diokno AC, Sampselle CM. Adherence to a behavioral program to prevent incontinence. West J Nurs Res. 2007;29(1):36–56. https://doi.org/10.1177/0193945906293793.
Messer KL, Hines SH, Raghunathan TE, Seng JS, Diokno AC, Sampselle CM. Self-efficacy as a predictor to PFMT adherence in a prevention of urinary incontinence clinical trial. Health Educ Behav. 2007;34(6):942–52. https://doi.org/10.1177/1090198106295399.
Hill AM, McPhail SM, Wilson JM, Berlach RG. Pregnant women’s awareness, knowledge and beliefs about pelvic floor muscles: a cross-sectional survey. Int Urogyn J. 2017;28(10):1557–65. https://doi.org/10.1007/s00192-017-3309-4.
Bø K, Owe KM, Nystad W. Which women do pelvic floor muscle exercises six months’ postpartum? Am J Obstet Gynecol. 2007;197(1):49–51. https://doi.org/10.1016/j.ajog.2007.02.014.
Frawley HC, McClurg D, Mahfooza A, Hay-Smith J, Dumoulin C. Health professionals’ and patients’ perspectives on pelvic floor muscle training adherence-2011 ICS state-of-the-science seminar research paper IV of IV. Neurourol Urodyn. 2015;34(7):632–9. https://doi.org/10.1002/nau.22774.
Dumoulin C, Hay-Smith J, Frawley H, McClurg D, Alewijnse D, Bø K, et al. 2014 consensus statement on improving pelvic floor muscle training adherence: international continence society 2011 state-of-the-science seminar. Neurourol Urodyn. 2015;34(7):600–5. https://doi.org/10.1002/nau.22796.
Department of Health. CREATING A BETTER FUTURE TOGETHER National Maternity Strategy 2016–2026. Department of Health, Dublin, Ireland; 2016. Available at: https://health.gov.ie/wp-content/uploads/2016/01/Final-version-27.01.16.pdf
Acknowledgements
Thanks to all midwives and physiotherapists who distributed the study information and collected the completed surveys. Sincere thanks to all the women who took part.
Funding
This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflicts of interest
None.
Additional information
Publisher’s note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Electronic supplementary material
ESM 1
(DOCX 14 kb)
Rights and permissions
About this article
Cite this article
Daly, D., Cusack, C. & Begley, C. Learning about pelvic floor muscle exercises before and during pregnancy: a cross-sectional study. Int Urogynecol J 30, 965–975 (2019). https://doi.org/10.1007/s00192-018-3848-3
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00192-018-3848-3