Pelvic Floor Exercises for Mothers during the Antenatal Period - Literature review Example

?Running head: PELVIC FLOOR EXERCISES Pelvic floor exercises for mothers during the antenatal period (school) Pelvic Floor Exercises for Mothers during the Antenatal Period Introduction The antenatal or the prenatal period represents a time critical to fetal development. It also represents a time when the pregnant mother experiences a lot of discomfort owing to her growing baby. There are various remedies that pregnant mothers can apply in order to manage the difficulties of pregnancy and to assist them in the eventual birthing process. This study shall discuss the importance of pelvic floor exercises for the antenatal mother. It shall consider literature on this topic on the benefits of pelvic floor exercises. It shall also discuss possible recommendations for the use of pelvic floor exercises in the future practice. This study is being carried out in order to establish a clear and comprehensive understanding of the current subject matter. Discussion In a paper by Reilly, et.al., (2003) the authors set out to establish whether the supervised pelvic floor exercises during the prenatal period would decrease postpartum stress incontinence in primigravida mothers with bladder neck mobility. Their study was carried out as a single blind and randomized controlled trial in the prenatal clinic in a UK NHS Trust Hospital. It covered about 260 primigravida mothers seeking prenatal care in the clinic at about 20 weeks gestation with bladder neck mobility (Reilly, et.al., 2003). The study called for the respondents to attend supervised pelvic floor exercises as assisted by a physiotherapist on a monthly basis from 20 weeks of pregnancy. The control group did not undergo any pelvic floor exercises. The study revealed that, as compared to the control group, less postpartum stress incontinence was reported by women who underwent supervised pelvic floor exercises. No change was seen in the bladder neck mobility for either group, however, those who developed postpartum stress incontinence had poorer perineometry scores as compared to those who were incontinent. All in all, this study established that supervised pelvic floor exercises potentially decreased the risk for postpartum stress incontinence among primigravida mothers (Reilly, et.al., 2003). In another study Morkved and colleagues (2003) set forth that urinary incontinence is a major health issue which often decreases the quality of people’s lives. Risk factors for this condition include pregnancy and vaginal delivery. Their study set out to establish whether intensive pelvic floor muscle training during pregnancy could prevent urinary incontinence. The authors carried out their study as a single-blind randomized controlled trial at the Trondheim University Hospital with about 300 nulliparous women who were assigned to undergo either pelvic floor exercises muscle training program or no pelvic floor training at all (Morkved, et.al., 2003). The study revealed that there were fewer women in the training group who experienced urinary incontinence at 36 weeks of pregnancy and 3 months after their delivery. The study established that the intensive pelvic floor exercises assisted in preventing urinary incontinence among women during and after pregnancy. In a study by Oliveira, et.al., (2007) the authors set out to assess the impact of pelvic floor muscle training among 46 pregnant women. The authors divided the women into 2 groups, the exercise and the control group. The assessment of the pelvic floor muscle was carried out through the digital vaginal palpation via the strength scale. The study revealed that the pelvic muscle strength became stronger for women in both groups during the pregnancy period; however it proved to be stronger among women in the exercise group (Oliveira, et.al., 2007). The authors concluded that through pelvic muscle floor training, an increase in the pelvic floor muscle pressure and strength at pregnancy was made possible. This is an important development for pregnant women because stronger pelvic muscles help ease the delivery process. Taskin, et.al., (2009) discussed the impact of episiotomy and Kegel exercises on the symptoms which indicate postpartum pelvic relaxation. They evaluated 100 first time pregnant women considered from a homogeneous patient group. The control group included 20 women calling for cesarean section prior to labor; 20 women in four groups were treated as follows: no episiotomy or Kegel, episiotomy but no Kegel, episiotomy plus postpartum Kegel, and episiotomy plus antepartum Kegel (Taskin, et.al., 2009). The study indicated that for the episiotomy group, there was a lower incidence of cystocele and rectocele; for the episiotomy plus antepartum Kegel group, no difference in relation with cesarean controls for defect of pelvic relaxation was seen. Moreover, this group produced no third-degree defects (Taskin, et.al., 2009). This study gave much support for the need to integrate Kegel exercises among prenatal women as part of their prenatal instruction in order to assist them in the relaxation and eventual birthing process. Mason, et.al., (2001) considered their study as a means of assessing whether there is a relationship between antenatal pelvic floor muscle exercises and post-partum stress incontinence. Questionnaires were sent out to women filling in the inclusion criteria and about 572 of these women were able to answer the questionnaires. The questionnaire basically evaluated then in terms of prevalence of reported symptoms of stress incontinence and the frequency (if at all) with which they carried out pelvic floor exercises (Mason, et.al., 2001). The study revealed that women carrying out antenatal pelvic floor exercises each week or on a daily basis had fewer reports of stress incontinence following their delivery, compared with women who did not exercise as much. The authors concluded that there is a relationship between antenatal pelvic floor exercises and post-partum stress incontinence with those carrying out pelvic floor exercises less likely to experience stress incontinence. Sampselle, et.al., (1998) carried out their study in order to assess the impact of pelvic muscle exercise on postpartum symptoms of stress urinary incontinence and pelvic muscle strength among first time pregnant mothers during and after their pregnancy. The study was carried out as a prospective randomized trial on pregnant women, grouping them into the treatment group (with pelvic floor exercises) or the control group (with routine care and without pelvic floor exercises) (Sampselle, et.al., 1998). The study revealed that for the treatment group, there were less symptoms of urinary incontinence and such effect was seen up to the 35th week of gestation, 6 weeks after delivery and 6 months postpartum. A relationship between time of exercise and treatment of urinary incontinence was also seen with longer time spent for pelvic floor exercises resulting in better treatment of urinary incontinence. The authors concluded that the application of pelvic muscle control exercises during the prenatal period led to lesser incidents of urinary incontinence during and after pregnancy (Sampsell, et.al., 1998). Agur, et.al., (2008) sought to establish the long-term efficacy of antenatal pelvic floor muscle training on stress urinary incontinence. The study was carried out as an eight year follow up of a randomized controlled trial in an acute NHS Teaching Trust. The respondents were asked about the stress incontinence and its impact on the quality of their lives and on the performance of pelvic floor exercises and subsequent deliveries (Agur, et.al., 2008). The study basically sought to measure the incidence of stress incontinence after 8 years. The study revealed that most of the respondents were still active in carrying out pelvic floor exercises, and about 38% of them carrying the exercises out about twice in a week. The study revealed that there was no difference in the outcomes for those who did not carry out the pelvic floor exercises and those who were still applying it in their lives. The quality of life for either group was more or less the same. The authors concluded that the initial benefits for pelvic floor exercises as far as stress incontinence was concerned were lost in the long-term setting. Such findings seem to indicate issues on the long-term efficacy of pelvic floor exercises (Agur, et.al., 2008). More studies in relation to this study were recommended by the authors. In a paper by Salvesen and Morkved (2004), the authors set out to evaluate the impact of pelvic muscle exercises during labor. The study was carried out as a randomized controlled trial in Trondheim University Hospital and three outpatient clinics under primary settings. It covered about 300 nulliparous women allocated to the training or the control groups (Salvesen and Morkved, 2004). After the study was carried out, the results established that women who underwent pelvic floor muscle training experienced a lower incidence rate of prolonged second stage labor as compared to women who did not undergo any pelvic floor muscle training. The authors concluded that implementing pelvic floor muscle training is an important aspect of the labor process because it potentially decreases active pushing in the second stage of labor (Salvesen and Morkved, 2004). This study points out the importance of pelvic floor exercises as a means of improving labor outcomes during deliveries, helping ease delivering mothers into the labor process and actual delivery. In a similar discussion, Nielsen, et.al., (1988) the authors studied the contractility and the trainability of the pelvic floor during pregnancy and after delivery in about 80 first time pregnant mothers. One group underwent training in pelvic floor exercises starting on their 33rd week of pregnancy, and the other group, was the control group which did not go through any pelvic floor exercises. The two groups were assessed through perineometry five times in their 33rd to their 39th week of pregnancy and after 8 weeks of delivery. At the start of the study, both groups exhibited equal strength in their pelvic floor. At their 8th week and month after delivery, the training group was able to contract their pelvic floor to a greater degree as compared to the non-training group (Nielsen, et.al., 1988). The training group was able to gain as much pelvic control as it had during the 33rd week of pregnancy, as compared to the control group which lost some of its pelvic control. In effect, better outcomes in pelvic control were seen in the training group as compared to the non-training group, highlighting the importance of pelvic floor training exercises in the prenatal period. In a recent paper by Bo, et.al., however (2009), different results were seen. This study sought to evaluate whether women carrying out pelvic floor muscle training before and during their pregnancy experienced a higher risk for perineal lacerations, episiotomy, vacuum/forceps delivery, or acute cesarean delivery. Respondents included about 18,000 primipara women in the Norwegian Mother and Child Cohort study. Data was collected through questionnaires at 17 and 30 weeks gestation. Pelvic floor exercises were carried out three times a week before and during the pregnancy (Bo, et.al., 2009). The study established that among women undergoing pelvic floor muscle exercises once in a week, 7.2% experienced third and fourth degree laceration in contrast to 6.3% of women who underwent pelvic muscle training atleast three times in a week (Bo, et.al., 2009). The amount of exercise was not related to third-degree and fourth-degree perineal lacerations, episiotomy, vacuum/forceps delivery, or acute cesarean delivery (Bo, et.al., 2009). All in all, this study revealed that pelvic floor muscle training before and during pregnancy does not significantly impact on labor and birth outcomes or on the presence or rates of birthing complications. This result is very much in contrast to previous studies which support the role of pelvic floor exercises in improving labor and birth outcomes. Harvey’s (2003) discussion sought to evaluate the literature on the origin, anatomical rationale, techniques, and efficacy of antenatal pelvic floor exercises in preventing pelvic floor issues like urinary and anal incontinence, and prolapse. This review covered databases Medline, EMBASE, CINAHL, and other scholarly databases. Searches in these databases included the use of keywords: fecal incontinence, urinary incontinence, exercise therapy, Kegel, muscle contraction, etc. A manual search of abstracts was also carried out (Harvey, 2003). Data was tabulated and integrated with its quality assessed through the Jadad scale. A meta-analysis was also carried out. The review revealed that antepartum pelvic floor exercises when taught by trained health personnel did not cause a significant impact on postpartum urinary incontinence or pelvic floor strength (Harvey, 2003). When these pelvic floor exercises are however carried out with a vaginal device, an apparent decrease of postpartum incontinence was seen, as well as an increase in pelvic floor strength. The simple reminders on the performance of Kegel exercises were not sufficient in the prevention of urinary incontinence. Moreover, the postpartum pelvic floor exercises were not seen to reduce the prevalence rate of anal incontinence. This study revealed that pelvic floor exercises are not effective in decreasing postpartum urinary incontinence (Harvey, 2003). Data on the impact of pelvic floor exercises on anal incontinence and on reducing the impact of prolapsed seems to be insufficient. Harvey (2003) recommends more studies to be carried out in this area of research. Recommendations The above studies portray the significant impact of pelvic floor exercises on pelvic floor muscle strengthening and the subsequent management of incontinence during the antenatal and the postnatal period. Recommendations on the future use of pelvic floor exercises based on the above results include the application of pelvic floor exercises for the pregnant mothers. These pelvic floor exercises must be carried out with the monitoring and the assistance of the physiotherapist and any other health professional with expert training in these exercises. Expert supervision is needed in order to prevent injury from befalling the mother and the fetus during this time, and to ensure that whatever processes are applied would be effective for pelvic floor strengthening. This review suggests that pelvic floor exercises be started as early as possible for the pregnant mother and on a daily or atleast a thrice weekly basis. With more frequent sessions, more strength can be gained by the pelvic floor and better birth and labor outcomes can be gained by the mother. Pelvic floor exercises, based on studies above assist in reducing urinary incontinence when carried out in the prenatal period. This study recommends that this be continued even in the postnatal period in order to prevent incontinence. More studies however have to be carried out in order to establish the actual impact and applicability of pelvic floor exercises on the outcomes of labor and deliveries. Conclusion The above studies indicate the relevance of pelvic floor exercises during the antenatal period in preventing and managing incontinence and in assisting in the labor process. These studies mostly indicate that pelvic floor exercises improve maternal and labor outcomes as they help ease the labor process and they help in the management of incontinence during and after the delivery process. Some studies however also point out that these pelvic floor exercises have no significant impact on the outcome of delivery and on pelvic floor strengthening. These conflicts imply a need to carry out more studies on the subject matter with a particular emphasis on the impact of pelvic floor exercises on anal incontinence and on the prevention of prolapsed. Additional researches in this regard can help resolve the issues raised by this study. Works Cited Agur, W., Steggles, P., Waterfield, M., & Freeman, R. (2008). The long-term effectiveness of antenatal pelvic floor muscle training: eight-year follow up of a randomised controlled trial. BJOG: An International Journal of Obstetrics & Gynaecology, volume 115(8), pp. 985–990. Bo, K., Fleten, C. & Nystad, W. (2009). Effect of antenatal pelvic floor muscle training on labor and birth. J Obstet Gynaecol Can., volume 113(6): pp. 1279-84 Harvey, M. (2003). Pelvic floor exercises during and after pregnancy: a systematic review of their role in preventing pelvic floor dysfunction. J Obstet Gynaecol Can., volume 25(6): pp. 487-98. Mason, L., Glenn, S., Walton, I. & Hughes, C. (2001). The Relationship between Ante-natal Pelvic Floor Muscle Exercises and Post-partum Stress Incontinence. Physiotherapy, volume 87(12), pp. 651-661 Morkved, S., Bo, K., Schei, B., & Salvesen, K. (2003). Pelvic Floor Muscle Training During Pregnancy to Prevent Urinary Incontinence: A Single-Blind Randomized Controlled Trial. Obstetrics & Gynecology, volume 101(2), pp. 313-319 Nielsen, C., Sigsgaard, I., Olsen, M., Tolstrup, M., Danneskiold-Samsoee, B., & Bock, J. (1988). Trainability of the pelvic floor. A prospective study during pregnancy and after delivery. Acta Obstet Gynecol Scand, volume 67: pp. 437-40. Oliveira, C., Lopes, M., Pereira, L. & Zugaib, M. (2007). Effects of pelvic floor muscle training during pregnancy. Clinics, volume 62(4) Reilly, E., Freeman, R., Waterfield, A., Steggles, P., & Pedlar, F. (2002). Prevention of postpartum stress incontinence in primigravidae with increased bladder neck mobility: a randomised controlled trial of antenatal pelvic floor exercises. BJOG: An International Journal of Obstetrics & Gynaecology, volume 109(1), pp. 68–76. Salvesen, K. & Morkved, S. (2004). Randomised controlled trial of pelvic floor muscle training during pregnancy. BMJ, volume 329: pp. 378–80 Sampselle C., Miller, J., Mims, B., Dlancey, J., Asthon-Miller, J., & Antonakos, C. (1998). Effect of pelvic muscle exercise on transient incontinence during pregnancy and after birth. Obstet Gynecol., volume 91: pp. 406-12. Taskin, O., Wheeler, J., Yalcinoglu, I., & Coksenim, S. (1996). The Effects of Episiotomy and Kegel Exercises on Postpartum Pelvic Relaxation: A Prospective Controlled Study. Journal of Gynecologic Surgery, volume 12(2): pp. 123-127. Read More