Unassisted pelvic floor exercises for postnatal women : a systematic review

Aim. This paper is a report of a systematic review on unassisted pelvic floor exercises for postnatal stress incontinence to identify effective interventions and highlight areas for further research. Background. Stress incontinence is a common and embarrassing problem. Childbirth is a major cause and problems can be persistent for some. However women are often reluctant to seek help. Method. We conducted a systematic literature search in December 2006 using the CINAHL, Medline and Cochrane Library databases, hand-searching of selected textbooks, checking reference lists and contacting experts. There were no date restrictions. The review included randomized controlled trials, published in English, of unassisted pelvic floor exercises in postnatal women. Two reviewers independently extracted data and assessed study quality. Main outcomes were reduction in symptoms of incontinence, patient satisfaction and quality of life. Results. Four randomized controlled trials met the inclusion criteria. Interventions ranged from written information to structured exercise classes, while usual care varied from a leaflet to group sessions with a midwife. Three out of four studies demonstrated short-term improvement in incontinence symptoms, which was statistically significant in two. However, at later follow-up there was no longer a statistically significant effect on continence. All trials found that women in the intervention group were more likely to do the exercises. Conclusion. We found few trials, quality was variable, and comparisons were difficult because of variations in interventions and outcomes measured. Further high quality evaluations are needed, using standardized interventions and outcome measures, patient-relevant outcomes such as quality of life, and follow-up periods that enable evaluation of long-term effectiveness.