Pelvic floor physiotherapy for the prevention and management of childbirth trauma

Abstract

Pregnancy and childbirth are known risk factors for weakening and injury to the perineum and pelvic floor muscles. Stretch and rupture of peripheral nerves, connective tissue and pelvic floor muscles may cause pelvic floor dysfunctions such as urinary and anal incontinence. Controlled trials have found pelvic floor muscle training to be effective in both prevention and treatment of incontinence. Common factors for all trials reporting a positive effect of pelvic floor muscle exercises (PFMT) in pregnancy or postpartum are found to be thorough clinical assessment of the women's ability to perform a voluntary pelvic floor muscle contraction, close individual or group follow-up, and high adherence to the exercise protocol. Symptoms of incontinence before or during pregnancy have been found to be the main risk factors for incontinence symptoms postpartum. Similarly, women with symptoms of incontinence in the first year after delivery have an increased risk of long term incontinence symptoms. The cost of incontinence-related illness is a substantial economic and human burden, highlighting the need for effective forms of prevention and management.