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Effectiveness of physiotherapy for lower urinary tract symptoms in postpartum women: systematic review and meta-analysis

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Abstract

Introduction and hypothesis

The efficacy of physiotherapy for postpartum lower urinary tract symptoms (LUTS) has attracted considerable research interest. In the current study we evaluated the efficacy and safety of pelvic floor muscle training (PFMT) combined with biofeedback (BF), electrical stimulation (ES) therapy, or both for postpartum LUTS.

Methods

PUBMED, EMBASE, Web of Science, Cochrane Library, Chinese Biomedical Literature Database, China National Knowledge Infrastructure, Chinese Science and Technique Journals Database, and Wanfang databases were searched from inception to December 2020. Eligible randomized controlled trials on postpartum LUTS comparing PFMT plus BF, ES, or both with PFMT alone were included. The Cochrane handbook was used to evaluate the quality of the studies.

Results

Seventeen studies were included. The results of the meta-analysis showed that PFMT plus ES with or without BF was more effective than PFMT alone. Patients receiving PFMT plus ES and BF achieved greater improvement than controls receiving PFMT alone in incontinence quality of life scores (mean difference: 15.33, 95% confidence interval [CI]: 11.70–18.97, P < 0.00001), pelvic floor muscle strength (risk ratio: 2.29, 95% CI: 1.53–3.43, P < 0.0001), and urodynamic parameters (maximum urethral closure pressure, abdominal leak point pressure, and maximum urinary flow rate), and 1-h urine leakage (standardized mean difference: −0.70, 95% CI: −1.23 to −0.17, P = 0.010) also decreased.

Conclusions

PFMT plus ES with or without BF exhibited better efficacy and safety for early postpartum LUTS than PFMT alone.

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Abbreviations

LUTS:

Lower urinary tract symptoms

SUI:

Stress urinary incontinence

PUI:

Postpartum urinary incontinence

PFMT:

Pelvic floor muscle training

BF:

Biofeedback

ES:

Electrical stimulation

RCT:

Randomized controlled trail

I-QoL:

Incontinence quality of life scores

ALPP:

Abdominal leak point pressure

MUCP:

Maximum urethral closure pressure

CI:

Confidence interval

RR:

Risk ratio

MD:

Mean difference

SMD:

Standardized mean difference

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Acknowledgments

We thank all the authors who responded to us and those who provided their study data.

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Authors and Affiliations

  1. Department of Obstetrics and Gynecology, Pelvic Floor Disease Diagnosis and Treatment Center, Shengjing Hospital of China Medical University, Shenyang City, 110004, Liaoning Province, China

    Dai Zhu, Zhijun Xia & Zhiqi Yang

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  1. Dai Zhu
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Correspondence to Zhijun Xia.

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Zhu, D., Xia, Z. & Yang, Z. Effectiveness of physiotherapy for lower urinary tract symptoms in postpartum women: systematic review and meta-analysis. Int Urogynecol J 33, 507–521 (2022). https://doi.org/10.1007/s00192-021-04939-z

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