Patients’ knowledge of potential pelvic floor changes associated with pregnancy and delivery

Investigation of the quality and health literacy demand of online information on pelvic floor exercises to reduce stress urinary incontinence

BACKGROUND

Many women are embarrassed to discuss pelvic floor exercises with health professionals during pregnancy; instead they search the internet for information on pelvic floor exercises.

AIMS

This project investigated the quality and health literacy demand in terms of readability, understandability and actionability of information available on the internet relating to pelvic floor exercises.

MATERIALS AND METHODS

An analysis was conducted on 150 websites and 43 videos obtained from three consecutive Google searches relating to pelvic floor exercises. Websites were assessed for Health on the Net certification. Readability was assessed using a readability calculator, and understandability/actionability of website and video information was assessed using the Patient Education Materials Assessment Tool (PEMAT) for Print or Audiovisual Materials.

RESULTS

Less than one-third (24%) of the websites were certified for quality. The median readability score for the websites was grade 9 and the websites and videos both rated highly for understandability and actionability. The median understandability score for the website information was 87%, and the median actionability score was 71%. The median understandability score of the video information was 95.5% and the median actionability score was 100%. The understandability and actionability of video information was also significantly greater than that for website information (P < 0.01).

CONCLUSION

Clinicians could consider directing patients to video-based resources when advising online pelvic floor exercise resources for women during pregnancy, especially those with lower health literacy.

Educating Women About Pelvic Floor Disorders During Pregnancy From the First to the "Fourth Trimester": A Randomized Clinical Trial

IMPORTANCE

Pregnancy and childbirth are risk factors for developing pelvic floor disorders (PFDs), and this continues postpartum ("fourth trimester"). Knowledge of PFDs among women of childbearing age is lacking and presents an opportunity for education.

OBJECTIVES

The aim of this study was to compare the increase in knowledge of PFDs in patients who received written handouts versus interactive workshops as measured by the Prolapse and Incontinence Knowledge Questionnaire (PIKQ).

STUDY DESIGN

This was a randomized clinical trial of pregnant patients 18 years or older. Patients either received written handouts only or received handouts and attended an interactive workshop. Handouts were created in collaboration with communication specialists focusing on risk factors and prevention strategies. The primary outcome was the change in PIKQ score. Secondary outcomes were Pelvic Floor Distress Inventory score and postpartum phone interviews of workshop group participants. Questionnaires were assessed at recruitment and 6 weeks postpartum. The nonparametric Wilcoxon test compared continuous variables, and the Fisher exact test compared categorical variables.

RESULTS

One hundred twenty patients were randomized. Demographics were similar between groups. Median PIKQ score change showed no difference between groups (P = 0.37). Pelvic Floor Distress Inventory-20 scores were similar between groups at baseline (P = 0.78) and postpartum (P = 0.82). Quantile regression showed posteducation PIKQ scores were significantly higher in the workshop (21.00 vs 17.00; P = 0.011) and written (21.00 vs 17.00; P < 0.001) groups. Phone interviews showed consistent themes: (1) greater awareness of PFDs, (2) more likely to discuss PFDs, and (3) relief that PFDs are treatable. Fifty-nine percent of patients preferred learning through workshops compared with the handouts.

CONCLUSIONS

Both groups showed improvement in knowledge of PFDs. Well-written, illustrated handouts were effective in increasing patient knowledge of PFDs.

Pelvic floor dysfunction in rural postpartum mothers in the United States: prevalence, severity, and psychosocial correlates

Pelvic floor dysfunction (PFD) is a common gynecological problem; however, women residing in rural communities may refrain from seeking treatment for PFD. The purpose of this study was to characterize severity of PFD among postpartum women residing in rural communities (<50,000 residents) in the United States and explore the demographic and psychosocial correlates of PFD.

METHODS

A survey packet comprised of the Pelvic Floor Disability Index (PFDI-20) and Prolapse and Incontinence Knowledge Questionnaire (PIKQ) as well as the Edinburgh Perinatal Depression Screening (EPDS), items from the Canadian Sexual Health Indicator (CSHI) survey, and demographic questions were distributed via electronic link following recruitment using social media. Descriptive statistics were calculated, and multivariate logistic regression was used to assess the factors associated with PFDI-20 score.

RESULTS

Participants (n = 383) have limited pelvic health knowledge (PIKQ) despite self-reporting moderate symptoms of dysfunction (PFDI-20). Over half of women scored ≥14 on the EPDS, indicating probable depression. Women with high scores on the EPDS had greater odds of reporting moderate/severe PFD. Women that identified as Black and/or having a college degree were more likely to report moderate/severe PFD.

CONCLUSION

Rural women require further support to improve their physical and psychological health in the postpartum period.

Scale of pregnant women's assessment of knowledge, attitude and practice related to urinary incontinence

INTRODUCTION AND HYPOTHESIS

Urinary incontinence (UI) is prevalent during pregnancy and negatively affects quality of life. Despite this, few women seek professional assistance during prenatal care. Assessing the knowledge, attitude and practice (KAP) of pregnant women related to UI can contribute to the development and improvement of the quality of interventions performed during this period. For this, it is essential to apply targeted and valid instruments for this population. Thus, the present study aimed to construct and validate the content of a scale to evaluate the KAP of pregnant women related to UI.

METHODS

Extensive literature review guided the operationalization of the instrument's initial items. Ten experts were selected for the theoretical analysis of the items, which was carried out using the Delphi technique, and the analysis of semantic adequacy proceeded from the application of the scale to 30 pregnant women. The data were analyzed using the content validity coefficient and kappa coefficient.

RESULTS

The proposed Scale of Pregnant Women's Assessment of Knowledge, Attitude and Practice related to UI was approved by consensus by the experts, with a mean Cohen's kappa of 0.84 (p < 0.01), comprising 23 items.

CONCLUSIONS

The results of the study confirm that the presented scale can be used as a valid tool to assess the KAP of pregnant women related to UI.

[Knowledge of pelvic floor disorders in peripartum women: A systematic review]

BACKGROUND

Pregnancy and postpartum are periods of life during which pelvic floor disorders (PFD) can occur.

PURPOSE

The aim of this review is to make an inventory of what women in the perinatal period know about PFD, their risk factors and preventive measures.

DOCUMENTARY SOURCES

We performed a systematic review of the literature in PubMed, Cochrane Library, LISSA and Kinédoc databases by using the keywords "knowledge", "awareness", "beliefs", "pelvic floor", "postpartum" and "pregnancy". We included studies written in English or French, assessing women's knowledge using a questionnaire and published up to May 2020 with no restriction on start date.

SELECTION OF STUDIES

A total of 14 cross-sectional studies were selected from 240 studies, with a sample size of 3950 participants.

RESULTS

The topics covered in the questionnaires were anatomy, pelvic floor function, all PFD, risk factors and preventive measures. Overall, women's knowledge of the perinatal period is limited. It has also been shown that education of women on risk factors and preventive measures regarding the occurrence of PFD was incomplete.

CONCLUSION

To conclude, the knowledge of women in the perinatal period about PFD is limited.

Importance of a pelvic floor lifestyle program in women with pelvic floor dysfunctions: A pilot study

OBJECTIVE

We aimed to assess the impact of an educational program on the symptoms and quality of life of patients undergoing supervised pelvic floor muscle training (PFMT). Secondary objectives included: baseline assessment of patients' knowledge of the pelvic floor; and patient satisfaction and symptom improvement after the entire PFMT program.

MATERIAL AND METHODS

An observational questionnaire-based study in women attending a PFMT program consisting of four educational sessions, one visual feedback session, and five personalized training sessions. The patients completed the questionnaire at baseline, after the four educational sessions and then after completion of program. The questionnaires included the ICIQ-SF, USP, Contilife, PFDI 20, Kess and Wexner scores. Additional questions were added before treatment about the patient's knowledge of the pelvic floor.

RESULTS

Seventy-nine women were included. Improvement in symptoms was significant after the four educational sessions: mean PFDI-20 score decreased from 68.5-29.5 (p < 0.05); ICIQ-SF score from 8.0-3.1 (p < 0.05), Wexner and Kess scores from 8.2-6.5 and from 13.3-10 (p < 0.05). Symptom scores were also all significantly improved on completion of the program. After the four educational sessions, 50 of the 68 patients (73.5 %) with complete questionnaires reported feeling better or much better. Only 12 (15.2 %) women overall located the pelvic floor across the entire bottom of the pelvis.

CONCLUSION

This preliminary study suggests that four educational sessions can improve symptoms and quality of life before PFM reinforcement itself. If confirmed by larger prospective studies, a solid educational element should be systematically integrated in all PFMT programs.

Perineal massage and training reduce perineal trauma in pregnant women older than 35 years: a randomized controlled trial

INTRODUCTION AND HYPOTHESIS

The aim of this study was to evaluate the effectiveness of perineal massage, pelvic floor muscle training (PFMT) and a pelvic floor dysfunction (PFD) prevention educational program in pregnant women above the age of 35 years to prevent perineal tear and episiotomy.

METHODS

A randomized parallel assignment study involved two groups of pregnant women at the obstetrics outpatient clinic 4 weeks prior to their due date. The first group (n = 200) was educated to do digital perineal massage and pelvic floor muscle training and received an educational PFD prevention program. The second group (n = 200) received only the prevention education program. Occurrence of perineal laceration was reported at time of delivery as a primary outcome. Statistical analysis was done using the IBM SPSS computer program (Statistical Package for the Social Sciences; IBM Corp, Armonk, NY, USA), release 22 for Microsoft Windows.

RESULTS

Delivery was significantly less complicated by perineal tear, episiotomy and postnatal pain in the first than in the second group (p < 0.05). Grades of perineal tear were mostly of first and second degree in the first group compared with the second group. We found a significantly lower need for analgesia and fewer ampoules required during the hospital stay in the first group (p < 0.001, 0.002, respectively).

CONCLUSIONS

Performing antenatal digital perineal massage and PFMT in addition to health education is recommended to reduce perineal complications.

Is Something Missing From Antenatal Education? A Survey of Pregnant Women's Knowledge of Pelvic Floor Disorders

OBJECTIVE

This study aimed to describe the knowledge on pelvic floor disorders among a cross section of pregnant women.

STUDY DESIGN

This was an institutional review board-approved cross-sectional survey study of pregnant women with a gestational age of more than 18 weeks at a single tertiary care institution. Participants completed the validated 24-item Prolapse and Incontinence Knowledge Questionnaire, and responses were graded to determine a raw accuracy score (0-100%). Proficiency in the topic was defined as a score greater than 80% on the urinary scale and greater than 50% on the prolapse scale.

RESULTS

Four hundred two women completed the survey. Mean ± SD raw accuracy in urinary incontinence was 66% ± 12%, and mean ± SD raw accuracy in pelvic organ prolapse was 41% ± 17%. These results were not significantly different among age or ethnic groups. Pregnant women were more likely to know that delivery could lead to incontinence (62%) than to pelvic organ prolapse (42%; P = 0.02), and 83% knew that pelvic floor exercises could prevent urinary incontinence. Proficiency was low among the population on both scales.

CONCLUSIONS

Pregnant women have limited knowledge about pelvic floor dysfunction despite being at increased risk for these conditions during and after their pregnancies. This is an area where patient education and empowerment during routine prenatal care could improve.

Women's knowledge, attitude and practice related to urinary incontinence: systematic review

INTRODUCTION

Knowledge, attitude and practice (KAP) investigations lead to an understanding of what a particular population group knows, thinks and does in relation to a certain subject.

METHODS

This systematic review was conducted to identify women's KAP related to urinary incontinence (UI) described in the literature and the measurement/evaluation instruments used. A literature search, up to July 2017, was conducted in PUBMED, SCOPUS and BVS (Virtual Health Library) for articles dealing with women's KAP related to UI that described the validation procedure of any data collection instrument. Articles that investigated exclusively male subjects, provider performance or academic teaching strategies were excluded. Relevant studies were analyzed and briefly summarized.

RESULTS

Initially, 799 articles were retrieved. After applying the inclusion and exclusion criteria, 19 remained for reading and summarizing. There has been interest in identifying and evaluating some of the KAP elements related to UI since 1994, with a wide variety of validated instruments used. Knowledge was evaluated in 15 articles and all concluded that there was misinformation about UI in the populations studied. Seven articles studied the intention to seek healthcare for UI, among which only one evidenced an adequate attitude in more than 70% of the participants. All the articles that investigated practice revealed low rates of seeking care.

CONCLUSIONS

The KAP elements are influenced by specific questions in each of the studied populations, leading to unique results, which indicates the importance of investigations using standardized data collection instruments that have psychometric validity tested in the target populations.

Pregnancy-Associated Pelvic Floor Health Knowledge and Reduction of Symptoms: The PREPARED Randomized Controlled Trial

OBJECTIVES

Pregnancy and childbirth can lead to pelvic floor disorders, yet this topic is not routine in antenatal education. We aimed to determine the impact of a pregnancy workshop on women's postpartum pelvic floor health knowledge, performance of pelvic floor muscle exercises (PFME), symptoms, condition-specific quality of life, mode of delivery, and satisfaction.

METHODS

This was a RCT. Pregnant primiparous women in a tertiary care centre received a pelvic floor health workshop intervention versus routine prenatal care. Thirty-six participants/group were needed to detect a significant knowledge difference (power = 0.80, α = 0.05). Participants completed questionnaires at recruitment and six weeks postpartum. Main outcome measures were: difference between groups in knowledge scores; PFME-specific knowledge and practice; pelvic symptoms and condition-specific quality of life; and mode of and satisfaction with delivery.

RESULTS

Fifty women were recruited per group; 40 attended the workshop. Women were Caucasian (72%), college educated (96%), mean age 33.2. Mean demographics did not differ. Postpartum data were available for 37 women per group. The intervention group scored higher on a pelvic floor knowledge questionnaire (mean score 31.2/39 vs. 29.3/39, P = 0.02, 95% CI 0.3, 3.6). 58.3% of intervention participants reported daily performance of PFME compared with 22.9% of controls (P = 0.002) and rated higher confidence in correct performance (P = 0.004). The intervention group reported fewer bowel symptoms (P = 0.046). There were no differences in urinary or prolapse symptoms, mode of delivery, complications, or satisfaction.

CONCLUSION

A pelvic floor health workshop improves postpartum knowledge, performance of PFME, and bowel-specific quality of life.

Pelvic Floor Health Education: Can a Workshop Enhance Patient Counseling During Pregnancy?

OBJECTIVES

Pelvic floor disorders commonly affect women's quality of life. Their etiology is multifactorial, yet pregnancy and vaginal delivery (VD) are major inciting risk factors. Our objectives were to assess pelvic floor health information given by maternity providers to their pregnant patients, to create a pelvic floor health information workshop, and to determine its impact on women's preferences for mode of delivery.

METHODS

This descriptive study recruited primiparous women with a singleton gestation at St Paul's Hospital in Vancouver, Canada. Participants received a 2-hour workshop describing pelvic floor disorders and pregnancy, modes of delivery, as well as strategies for maintaining pelvic floor health and preventing disease. Women completed questionnaires assessing baseline knowledge and level of comfort with different modes of delivery before and after the workshop.

RESULTS

Forty participants completed the workshop. Seventy percent had an obstetrician, 20% had a midwife, and 10% had a family physician. Five percent of the participants reported receiving information regarding pelvic organ prolapse as well as urinary and fecal incontinence. The workshop did not influence women's preferred mode of delivery, including VD (P = 1.00), forceps-assisted VD (P = 0.48), vacuum-assisted VD (P = 0.68), postlabor cesarean delivery (P = 0.32), and elective cesarean delivery (P = 0.86).

CONCLUSIONS

Current antenatal care is lacking in the area of pelvic floor health education. Patient counseling can be enhanced via a standard workshop. Concerns about negatively influencing women's preferences for mode of delivery are unwarranted, as the pelvic floor health workshop, given during pregnancy, did not significantly change participants' preferences.

Effect of a Video-Assisted Teaching Program for Kegel's Exercises on Women's Knowledge About Urinary Incontinence

PURPOSE

The aim of this study was to assess community-dwelling women's knowledge about urinary incontinence (UI) and the effectiveness of a Video Assisted Teaching Program for Kegel's Exercises (VATPKE) in increasing their knowledge.

METHODS

A cross-sectional design was used to collect data from 598 community-dwelling women. A pre-/posttest design was then used to assess the effectiveness of the VATPKE in improving knowledge about UI in women with self-reported UI (202) and without UI (396). Data were analyzed using independent and paired t tests.

RESULTS

Of the 598 participants, 33.8% self-reported having UI. The majority of women with UI (90%) and without UI (90%) had inadequate knowledge. The mean post-VATPKE knowledge levels of women with and without UI were higher than pre-VATPKE mean scores. Differences in knowledge levels in women with and without UI were statistically significant (P < .001).

CONCLUSION

Most of the women at risk or already affected with UI have inadequate knowledge about the condition. In a resource-poor setting with limited health care human resources to provide one-on-one health education, interventions such as the VATPKE may help improve knowledge about UI among the large numbers of affected and at-risk women.

Knowledge of pelvic floor problems: a study of third trimester, primiparous women

INTRODUCTION AND HYPOTHESIS

Pelvic floor problems in women (urinary incontinence, faecal incontinence, uterovaginal prolapse) are common, and have an adverse effect on quality of life. We hypothesized that there is low knowledge of these problems amongst primiparous women in their third trimester of pregnancy.

METHODS

We conducted a cross-sectional study in antenatal clinics of three hospitals in London, UK, from 2011 to 2013. Primiparous women aged ≥18 years and in the third trimester of pregnancy answered questions on pelvic floor problems. Knowledge scores were calculated based on the proportion of questions answered correctly.

RESULTS

A total of 249 women completed the question set. The average knowledge score across all domains was low at 45 %. Scores were lowest for the less common problems of faecal incontinence (35 %) and prolapse (36 %). The score for urinary incontinence was higher at 63 %, but low when questions explored more detailed levels of knowledge (41 %). Knowledge scores were positively associated with both education to tertiary level and the use of books as the information source on pregnancy and delivery. Only 35 % of women cited antenatal classes as a source.

CONCLUSIONS

Knowledge of pelvic floor problems is low amongst third-trimester, primiparous women in this London-based population. Adequate knowledge of these problems is important for women to be able to make informed choices about their antenatal care and to seek help if problems arise. The data suggest scope for health-care professionals to raise these issues early during pregnancy, and to help women access accurate sources of information.

Racial Disparities in Knowledge of Pelvic Floor Disorders Among Community-Dwelling Women

OBJECTIVE

To evaluate racial and ethnic differences in knowledge about preventative and curative treatments for pelvic floor disorders (PFD).

METHODS

The is a secondary analysis of responses from 416 community-dwelling women, aged 19 to 98 years, living in New Haven County, CT, who completed the Prolapse and Incontinence Knowledge Questionnaire. Associations between race/ethnicity (categorized as white, African American, and other women of color [combined group of Hispanic, Asian or "other" women] and knowledge proficiency about modifiable risk factors and treatments for PFD were evaluated. Associations were adjusted for age, marital status, socioeconomic status, education, working in a medical field, and PFD history.

RESULTS

Compared to white women, African American women were significantly less likely to recognize childbirth as a risk factor for urinary incontinence (UI) and pelvic organ prolapse (POP), to know that exercises can help control leakage, and to recognize pessaries as a treatment option for POP. Other women of color were also significantly less likely to know about risk factors, preventative strategies, and curative treatment options for POP and UI; however, these findings may not be generalizable given the heterogeneity and small size of this group.

CONCLUSIONS

Significant racial disparities exist in women's baseline knowledge regarding risk factors and treatment options for POP and UI. Targeted, culturally sensitive educational interventions are essential to enhancing success in reducing the personal and economic burden of PFD, which have proven negative effects on women's quality of life.

Correct performance of pelvic muscle exercises in women reporting prior knowledge

OBJECTIVES

This study aimed to assess correct performance of pelvic muscle exercises (PMEs) in women presenting for urogynecologic care who express prior PME knowledge and to identify optimal instruction.

METHODS

New patients referred to urogynecology clinic reporting knowledge of PME or Kegels were asked to complete a questionnaire concerning knowledge, prior instruction, and current use of PME. During examination, the participants were asked to perform their PME or Kegel. Initial levator strength was documented by Oxford Scale. Randomized-order instructions were then given to educate women who contracted incorrectly. The participants completed a postexamination questionnaire. Analyses described percentage of women who were able to perform a correct contraction on initial attempt and factors associated with correct performance. Standard statistical methods were used to assess factors associated with correct PME performance and initial strength.

RESULTS

Two hundred fifty eligible participants completed the questionnaires. Sixty (24%) participants were unable to correctly perform a PME initially. Of the 83 participants reporting current practice of PME, 23% performed them incorrectly. Prior instruction (odds ratio, 3.0; 95% confidence interval, 1.6-5.7; P < 0.01) and prior feedback (odds ratio, 3.5; 95% confidence interval, 1.0-12.0; P < 0.05) were associated with correct PME performance. In women who performed PME incorrectly at the initial assessment, "Squeeze the vaginal muscles you use to hold your urine" resulted in correct PME performance most often.

CONCLUSIONS

Women reporting prior knowledge of PME may still perform them incorrectly. Providing instruction and feedback is strongly associated with correct performance and can be easily incorporated into pelvic examination. This may improve PME use and effectiveness to control symptoms of pelvic floor disorders.

Continence and pelvic floor status in nulliparous women at midterm pregnancy

INTRODUCTION AND HYPOTHESIS

A Cochrane review recommends antenatal pelvic floor muscle training (PFMT) in urinary incontinence (UI) prevention. The aim of the study was to investigate nulliparous pregnant women's knowledge about and practising of PFMT, their pelvic floor muscle (PFM) function, and ability to contract correctly. It was hypothesized that continent women had higher PFM strength and endurance than women with UI.

METHODS

Three hundred nulliparous women at gestational week 18-22 were included in a cross-sectional study. Vaginal resting pressure, maximum voluntary contraction, and PFM endurance were measured by manometer. UI was assessed by International Consultation on Incontinence Questionnaire Urinary Incontinence Short Form (ICIQ-UI-SF). Comparisons of PFM function in continent women and women with UI were analyzed using independent-samples t test. Mean differences with 95 % confidence interval (CI) are presented.

RESULTS

Of 300 women, 89 % had heard of PFMT at mid pregnancy, and 35 % performed PFMT once or more a week. After thorough instruction 4 % were unable to contract correctly. Thirty-five percent reported UI, of whom 48 % performed PFMT once or more a week. Continent women had significantly higher PFM strength and endurance when compared with women having UI, with mean differences of 6.6 cmH(2)O (CI 2.3-10.8, p = 0.003), and 41.5 cmH(2)Osec (CI 9.8-73.1, p = 0.010), respectively. No difference was found for vaginal resting pressure (p = 0.054).

CONCLUSIONS

Most nulliparous pregnant women knew about PFMT. Thirty-five percent performed PFMT once or more a week. Incontinent nulliparous pregnant women had weaker PFM than their continent counterparts. More emphasis on information regarding PFM function and PFMT is warranted during pregnancy.

Stress urinary incontinence and counseling and practice of pelvic floor exercises postpartum in low-income Hispanic women

The purpose of the study was to provide estimates of stress urinary incontinence (SUI) and practice of pelvic floor muscle training (PFMT) postpartum as well as counseling during and after pregnancy among Hispanic women. Two hundred Hispanic women were surveyed 6 months postpartum. Twenty-three percent had SUI with onset primarily during pregnancy (70%). Only 20% had received information regarding SUI and PFMT during pregnancy or postpartum. Most women not counseled wished they were (81%). Less counseling occurred among Hispanic women with lower levels of education (odds ratio [OR]= .39; 95% confidence interval [CI]=0.19-0.82; p=0.02) and those whose primary language was Spanish (OR= .36; 95% CI=0.15-0.87; p=0.02), while higher rates occurred among women with a forceps delivery (OR=2.94; 95% CI=1.06-7.78; p=0.03). Fifty-seven percent of women counseled practiced the exercises. Primary reasons for noncompliance were belief that PFMT would not help (47%), and not understanding the instructions (39%). SUI and PFMT counseling is low among Hispanic women. Most women desire such information, and improvement in performance of PFMT among this group is possible.

Which women do pelvic floor muscle exercises six months' postpartum?

OBJECTIVES

This study was undertaken to estimate the association between pelvic floor muscle training and demographic and health related factors that may influence pelvic floor muscle training postpartum.

STUDY DESIGN

This analysis includes the first 17,978 women enrolled in the Norwegian Mother and Child Cohort Study who answered questions about pelvic floor muscle training (n = 17,744). We used logistic regression analyses, and the results are presented as crude and adjusted odds ratios with 95% CI.

RESULTS

Women doing regular pelvic floor muscle training were more educated, likely to participate in general fitness activities, and had more children. Women experiencing urinary leakage and pelvic girdle pain postpartum were also more likely to do pelvic floor muscle training (adjusted odds ratio = 1.26, 95% CI 1.18-1.35; adjusted odds ratio = 1.31, 95% CI 1.23-1.39). Those who smoked daily or were delivered by cesarean were less likely to do pelvic floor muscle training (adjusted odds ratio = 0.81, 95% CI 0.72-0.91; adjusted odds ratio = 0.56, 95% CI 0.51-0.61).

CONCLUSION

There is a need for more research concerning effective strategies to enhance postpartum pelvic floor muscle training.

Teaching and practicing of pelvic floor muscle exercises in primiparous women during pregnancy and the postpartum period

OBJECTIVE

The purpose of this study was to describe the teaching and practicing of pelvic floor muscle exercise (PFME) before and after delivery.

STUDY DESIGN

This was a secondary data analysis from a prospective multicenter cohort study, the Childbirth and Pelvic Symptoms study, by the Pelvic Floor Disorders Network. Primiparous women (n = 759) with term singleton delivery were interviewed 6 months after delivery.

RESULTS

Sixty-four percent of the women had been taught PFME, most with verbal (76%) and/or written instructions (55%) and a few (10%) during pelvic examination. Women with anal sphincter tears were not more likely to receive instruction or reminders after delivery. More white women (75%) were taught PFME than were Asian women (48%), African American women (36%), or Hispanic women (39%; P < .0001). More women with college education (74%) were taught, compared with women without a college education (37%; P < .0001). Of those women who were taught, 68% performed PFME after delivery, and 63% were still performing the exercises 6 months after delivery.

CONCLUSION

Results reveal tremendous potential for the improvement of PFME education and targeting at-risk women in the peripartum period.

Do pregnant women exercise their pelvic floor muscles?

The aims of the present study were to assess the number of women performing pelvic floor muscle training (PFMT) during pregnancy and to compare the background variables in those exercising and in those who did not. Four hundred and sixty-seven pregnant women (response rate 84%), mean age 31.5 years (range 20-49), answered a questionnaire on general physical activity level during pregnancy including PFMT. The questionnaire was sent out in week 32 of gestation and answered within week 36. Twenty-four percent reported problems with urinary incontinence and 9% flatus/fecal incontinence. The percentages of pregnant women performing PFMT at least once a week before pregnancy and during trimesters 1, 2, and 3 were 7, 12.9, 17.6, and 17.4%, respectively. More women with lower prepregnancy BMI and with present and past pelvic girdle pain were performing regular PFMT. No significant differences were found in any other background variables. It is concluded that relatively few women perform regular PFMT during pregnancy. In conclusion, only 17% of pregnant Norwegian women reported performing PFMT during pregnancy.