title: Vaginal cones or balls to improve pelvic floor muscle performance and urinary continence in women post partum: A quantitative systematic review.
abstract: OBJECTIVE
  the vaginal use of cones or balls aims to increase muscle performance and thereby prevent or treat urinary incontinence. To date, no systematic review has focused on the effectiveness of these devices specifically during the postpartum period. The objectives of this review were: to compare the effectiveness of vaginal cones or balls for improvement of pelvic floor muscle performance and urinary continence in the postpartum period to no treatment, placebo, sham treatment or active controls; to gather information on effect on perineal descent or pelvic organ prolapse, adverse effects and economical aspects.
  
  
  METHODS
  quantitative systematic review.
  
  
  METHODS
  14 scientific databases (including PubMed and CINAHL) and the world-wide web; experts were contacted for published and unpublished data.
  
  
  METHODS
  studies had to be randomised/quasi-randomised trials and have female participants up to one year after childbirth. The intervention is compared to no treatment, placebo, sham treatment or active controls. Outcome measures relate to pelvic floor muscle performance or urinary incontinence. Studies were selected, 'risk of bias' assessed, and data extracted by two reviewers independently with inter-reviewer agreement.
  
  
  RESULTS
  one study met the inclusion criteria; its original data were re-analysed. In an intention-to-treat analysis, compared with the control group, the cone group showed a statistically significant lower rate of urinary incontinence; compared with the exercise group, the prevalence was similar. However, the validity of the analysis is limited.
  
  
  CONCLUSIONS
  the evidence gained from this systematic review is very limited. The use of cones may be helpful for urinary incontinence after childbirth, but further research is needed.
authors.affiliation: School of Health Sciences, Centre for Maternal and Child Health Research, Division of Midwifery and Radiography, City University London, 1 Myddelton Street, London EC1R 1UW, UK. Electronic address: Claudia.Oblasser.1@city.ac.uk.
authors.forename: Claudia
authors.initials: C
authors.lastname: Oblasser
authors.affiliation: School of Health Sciences, Early Years Division, City University London, 1 Myddelton Street, London EC1R 1UW, UK. Electronic address: janice.christie@manchester.ac.uk.
authors.forename: Janice
authors.initials: J
authors.lastname: Christie
authors.affiliation: School of Health Sciences, Centre for Maternal and Child Health Research, Division of Midwifery and Radiography, City University London, 1 Myddelton Street, London EC1R 1UW, UK. Electronic address: Christine.mccourt.1@city.ac.uk.
authors.forename: Christine
authors.initials: C
authors.lastname: McCourt
mesh_terms: D005081:Exercise Therapy / Q000295:instrumentation / Q000379:methods*; D005260:Female; D006801:Humans; D057194:Intention to Treat Analysis; D017773:Pelvic Floor / Q000503:physiopathology*; D049590:Postpartum Period; D016032:Randomized Controlled Trials as Topic; D014550:Urinary Incontinence, Stress / Q000534:rehabilitation*; D014621:Vagina / Q000503:physiopathology*
keywords: Health promotion; Pelvic floor; Postpartum period; Review; Urinary incontinence