Table 4

Studies assessing the effect of pelvic floor muscle exercises after delivery to treat urinary incontinence including only women with urinary incontinence at inclusion

AuthorDesignSubjectsTraining protocolLosses to follow-up/adherenceOutcomes (numbers and percentage (%))
Wilson and Herbison432-arm RCT
1. Control (n=117): Standard postnatal PFM exercises
2. Intervention (n=113): 12 weeks of intensive PFMT
N=230 women with UI 3-month postpartum.
Single centre, New Zealand
1. Control: standard postnatal PFM exercises
2. Intervention: instructions by physiotherapist (80–100 fast/slow contractions daily) 3, 4, 6 and 9-month postpartum. Use of perineometer to teach awareness of VPFMC. Three groups:
  1. 39 women performed only PFMT

  2. 36 women only trained with

  3. vaginal cones 15 min/day

  4. 38 women used both a and b

Losses to follow-up 12-month outcome assessment: 36.9%
1. Control: 91/117
2. Intervention: 54/113 Adherence to PFMT:
Last month :89%
Every day: 48%
  • ▸ 12 months postnatally was mean number of VPFMC 86 in the intervention group and 35 in the control group

Self-reported UI at 12-month postpartum:
3. Control: 69/91 (76%)
4. Intervention: 27/54 (50%) p=0.003 Pad test: NS difference
Perineometry: NS difference
Glazener et al42
Glazener et al44
2-arm RCT1. Control (n=376): no visit2. Intervention (n=371): Advice+visits3 centres: Aberdeen, Birmingham, Dunedin6-year follow-up
1. Control: n=253
2. Intervention: n=263
N=747 women with UI 3 months postnatally
Multicentre trial, New Zealand, UK
N=516
1. Control: no visit
2. Intervention: assessment of UI, with advice on PFMT (80–100 fast/slow contractions daily) followed up 5, 7, and 9 months after delivery supplemented by bladder training if appropriate at 7 and 9 months 
Lost to follow-up at 12 months: 31%
1. Control: 35%
2. Intervention: 25%Adherence to PFMT:
  • ▸ In the 11th postnatal months had 78% in the intervention group (mean 20 VPFMC) and 48% in the control group (mean 5 VPFMC) done some PFMT.

ITT analysis
Lost to follow-up: 30%
Performing any PFMT:
1. Control: 50%
2. Intervention: 50%
Self-reported UI at 12-month postpartum:Any UI
1. Control: 169/245 (69%)
2. Intervention: 167/279 (59.9%) p=0.037Severe UI:
1. Control: 78/245 (31.8%)
2. Intervention: 55/279 (19.7%) p=0.002Severe UI at 6 year follow-up:
1. Control: 99/253 (39%)
2. Intervention: 100/263 (38%) p=0.867
Dumoulin et al41
Elliott et al(abstract)20
3-arm RCT
1. Control (n=20) 2. PFM rehabilitation (n=21)
3. PFM rehabilitation+training of deep abdominal muscles (n=23)
A 7-year follow-up
Combination of the previous two PFM rehabilitation groups (n=35)
N=64 parous women under 45 years, still presenting symptoms of SUI at least once per week 3 months or more after their last delivery. Recruited during annual gynaecological visit at an obstetric clinic, Canada1. Control: 8 weekly sessions of massage
2. PFM rehabilitation: Weekly sessions supervised by physiotherapist for 8 weeks: 15 min electrical stimulation+25 min PFMT with biofeedback+home training 5 days/week.
3. PFM rehabilitation as group 2+30 min of deep abdominal muscle training 
Losses to follow-up: 3%
Adherence rate not stated
Adverse events not stated
ITT analysis
Performing any PFMT:
54%
Self-reported UI after the intervention period:
Objective cure (less than 2 g urine on pad test):
1. Control: 0/19
2. PFM rehabilitation: 14/20
3. PFM rehabilitation+training of deep abdominal muscles: 17/23Sign difference in favour of the intervention groups (p=0.001)
NS difference between the two intervention groups
Incontinence Impact Questionnaire: Sign difference in favour of the intervention groups
PFM strength: NS difference
Objective cure (less than 2 g urine on pad test)
(performed by 26 out of 35 women):
14/26 53%
Incontinence Impact Questionnaire: sign. Better than at baseline
Kim et al242-arm RCT1. Control intervention (n=10)2. Intervention (n=10) N=20
Postpartum women with UI
Single centre, Korea
4. Control intervention: unsupervised PFMT5. Intervention: supervised PFMTLosses to follow-up: 2/20
Adherence: ?
Adverse events not stated
No ITT analysis
Significant difference in favour of the supervised PFMT group on after the intervention period:
  • ▸ Bristol Female Lower urinary tract Symptoms

  • ▸ Vaginal squeeze pressure

  • ITT,  intention to treat analysis; NS, non significant; PFM, pelvic floor muscles; PFMT, pelvic floor muscle training; RCT, randomised controlled trial; RR, relative risk; SUI, stress urinary incontinence; UI, urinary incontinence; VPFMC, voluntary pelvic floor muscle contraction.