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Do pelvic floor muscle exercises reduce postpartum anal incontinence? A randomised controlled trial
Author(s) -
Johannessen HH,
Wibe A,
Stordahl A,
Sandvik L,
Mørkved S
Publication year - 2017
Publication title -
bjog: an international journal of obstetrics and gynaecology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.157
H-Index - 164
eISSN - 1471-0528
pISSN - 1470-0328
DOI - 10.1111/1471-0528.14145
Subject(s) - medicine , pelvic floor muscle , endoanal ultrasound , pelvic floor , physical therapy , anal sphincter , randomized controlled trial , external anal sphincter , fecal incontinence , anal canal , surgery , rectum
Objective To evaluate the effect of pelvic floor muscle exercises ( PFME ) for postpartum anal incontinence ( AI ). Design A parallel two‐armed randomised controlled trial stratified on obstetrical anal sphincter injury with primary sphincter repair and hospital affinity. Setting Ano‐rectal specialist out‐patient clinics at two hospitals in Norway. Population One hundred and nine postpartum women with AI at baseline. Methods The intervention group received 6 months of individual physiotherapy‐led PFME and the control group written information on PFME . Changes in St. Mark's scores and predictors of post‐intervention AI were assessed by independent samples t ‐tests and multiple linear regression analyses, respectively. The study was not blind. Main outcome measures The primary outcome measure was change in AI symptoms on the St. Mark's score from baseline to post‐intervention. Secondary outcome measures were manometry measures of anal sphincter length and strength, endoanal ultrasound ( EAUS ) defect score and voluntary pelvic floor muscle contraction. Results There was a significant difference in the reduction of St. Mark's scores from baseline to post‐intervention in favour of the PFME group (−2.1 versus −0.8 points, P = 0.040). No differences in secondary outcome measures were found between groups. Baseline St. Mark's, PFME group affinity and EAUS defect score predicted post‐intervention St. Mark's score in the imputed intention‐to‐treat analyses. The analysis on un‐imputed data showed that women performing weekly PFME improved their AI scores more than women in the control group did. Conclusions Our results indicate that individually adapted PFME reduces postpartum AI symptoms. Tweetable abstract Performing regular pelvic floor muscle exercises may be an effective treatment for postpartum anal incontinence.