Pelvic Exercises During Pregnancy Prevent Urinary Incontinence

Intensive pelvic floor muscle training during pregnancy prevents urinary incontinence during pregnancy and after delivery, according to a new study in Obstetrics and Gynecology (2003;101:313–9).

Urinary incontinence is defined as the involuntary leakage of urine. Those who suffer with this chronic condition report severely reduced quality of life in all areas. It affects women more often than men, and the elderly more than the young. The prevalence of urinary incontinence increases for women during pregnancy and after childbirth. Pregnancy and vaginal delivery stress and sometimes damage the muscles responsible for keeping the organs of the pelvis in place, known as the pelvic floor muscles. Ligaments, nerves and other tissues that help the bladder to function properly can also be compromised.

Surgery is the most effective curative treatment for urinary incontinence, but, due to its invasiveness and expense, other treatment options are usually tried first. These include absorbent pads worn externally, devices to close or block the urethral opening, and injections of substances that stiffen the tissues such as silicone or collagen. Exercises involving repetitive contractions of the pelvic floor muscles, sometimes called Kegel exercises, strengthen these muscles and have been shown to effectively prevent and treat urinary incontinence in many circumstances. While these exercises are frequently recommended, many women do not receive adequate instruction to perform them properly. Their effect on risk of urinary incontinence when practiced during pregnancy has not been well established.

Three hundred one healthy women in their first pregnancies participated in the current study. The women were randomly assigned to either a pelvic floor muscle-training group or a control group. All participants were given basic instructions for the performance of the exercises before the trial. Women in the training group received additional guidance in one-hour weekly sessions with a physiotherapist for 12 weeks during their pregnancies. Training involved repeating a series of pelvic floor muscle contractions, the first being a near maximal contraction sustained for six to eight seconds, followed by three to four fast contractions. In addition to weekly training sessions, the women in this group were encouraged to perform 12 equally intensive pelvic floor muscle contractions twice daily at home.

Evaluations were performed at 36 weeks of pregnancy and three months after delivery. The prevalence of urinary incontinence was significantly lower in the training group than in the control group at 36 weeks of pregnancy, (32% versus 48%) and at three months after delivery (20% versus 32%). The women receiving the pelvic floor muscle training were 33% less likely to report urinary incontinence at 36 weeks of pregnancy, and 39% less likely at three months postpartum, than women in the control group.

Several previous studies have demonstrated the benefit of pelvic floor muscle training after childbirth in prevention and treatment of urinary incontinence. This is the first trial examining the benefit of performing these exercises during pregnancy for healthy women. Given the prevalence of urinary incontinence and that this approach is inexpensive and without side effects, it would be reasonable for all pregnant women to receive training in the pelvic floor muscle strengthening exercises.

Maureen Williams, ND, received her bachelor’s degree from the University of Pennsylvania and her Doctorate of Naturopathic Medicine from Bastyr University in Seattle, WA. She has a private practice in Quechee, Vermont, and does extensive work with traditional herbal medicine in Guatemala and Honduras. Dr. Williams is a regular contributor to Healthnotes Newswire.

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