Title:The Pelvic Floor During Pregnancy and after Childbirth, and the Effect of Pelvic Floor Muscle Training on Urinary Incontinence - A Literature Review
VOLUME: 11 ISSUE: 1
Author(s):Gunvor Hilde and Kari Bo
Affiliation:Akershus University Hospital, Department of Obstetrics and Gynecology, Sykehusveien 25, 1478 Lørenskog, Norway.
Keywords:Childbirth, pelvic floor, pelvic floor muscle training, pregnancy, postpartum, urinary incontinence.
Abstract:Pregnancy and especially vaginal childbirth are risk factors for pelvic floor dysfunctions
such as urinary incontinence (UI). The aim of this literature review was to give an overview of how
the pelvic floor may be affected by pregnancy and childbirth, and further state the current evidence
on pelvic floor muscle training (PFMT) on UI. Connective tissue, peripheral nerves and muscular
structures are already during pregnancy subjected to hormonal, anatomical and morphological changes.
During vaginal delivery, the above mentioned structures are forcibly stretched and compressed. This
may initiate changed tissue properties, which may contribute to altered pelvic floor function and
increased risk of UI. Trained pelvic floor muscles (PFM) may counteract the hormonally mediated increased laxity of the
pelvic floor and the increased intra-abdominal pressure during pregnancy. Further, a trained PFM may encompass a
greater functional reserve so that childbirth does not cause the sufficient loss of muscle function to develop urinary leakage.
Additionally, a trained PFM may recover better after childbirth as the appropriate neuromuscular motor patterns have
already been learned. Evidence based guidelines recommend that pregnant women having their first child should be offered
supervised PFMT, and likewise for women with persistent UI symptoms after delivery (Grade A recommendations).
Conclusion: Several observational studies have demonstrated significantly higher PFM strength in continent women than
in women having UI, and further that vaginal delivery weakens the PFM. Current evidence based guidelines state that
PFMT can prevent and treat UI, and recommend strength training of the PFM during pregnancy and postpartum.
