Do pelvic floor muscle exercises reduce postpartum anal incontinence? A randomised controlled trial.
OBJECTIVE
To evaluate the effect of pelvic floor muscle exercises (PFME) for postpartum anal incontinence (AI).


METHODS
A parallel two-armed randomised controlled trial stratified on obstetrical anal sphincter injury with primary sphincter repair and hospital affinity.


METHODS
Ano-rectal specialist out-patient clinics at two hospitals in Norway.


METHODS
One hundred and nine postpartum women with AI at baseline.


METHODS
The intervention group received 6 months of individual physiotherapy-led PFME and the control group written information on PFME. Changes in St. Mark's scores and predictors of post-intervention AI were assessed by independent samples t-tests and multiple linear regression analyses, respectively. The study was not blind.


METHODS
The primary outcome measure was change in AI symptoms on the St. Mark's score from baseline to post-intervention. Secondary outcome measures were manometry measures of anal sphincter length and strength, endoanal ultrasound (EAUS) defect score and voluntary pelvic floor muscle contraction.


RESULTS
There was a significant difference in the reduction of St. Mark's scores from baseline to post-intervention in favour of the PFME group (-2.1 versus -0.8 points, P = 0.040). No differences in secondary outcome measures were found between groups. Baseline St. Mark's, PFME group affinity and EAUS defect score predicted post-intervention St. Mark's score in the imputed intention-to-treat analyses. The analysis on un-imputed data showed that women performing weekly PFME improved their AI scores more than women in the control group did.


CONCLUSIONS
Our results indicate that individually adapted PFME reduces postpartum AI symptoms.


CONCLUSIONS
Performing regular pelvic floor muscle exercises may be an effective treatment for postpartum anal incontinence.
Department of Physiotherapy, Østfold Hospital Trust, Grålum, Norway.
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Johannessen
Department of Cancer Research and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway.|Department of Surgery, St Olavs Hospital, Trondheim University Hospital, Trondheim, Norway.
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Wibe
Department of Surgery, Østfold Hospital Trust, Grålum, Norway.
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Stordahl
Centre of Biostatistics and Epidemiology, Oslo University Hospital, Oslo, Norway.
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Sandvik
Department of Public Health and General Practice, Norwegian University of Science and Technology, Trondheim, Norway.|Department of Clinical Services, St Olavs Hospital, Trondheim University Hospital, Trondheim, Norway.
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Mørkved
D000328:Adult; D001003:Anal Canal / Q000293:injuries* / Q000503:physiopathology; D036861:Delivery, Obstetric / Q000009:adverse effects; D005081:Exercise Therapy / Q000379:methods*; D005242:Fecal Incontinence / Q000209:etiology / Q000628:therapy*; D005260:Female; D006801:Humans; D008365:Manometry; D007744:Obstetric Labor Complications / Q000628:therapy*; D017773:Pelvic Floor / Q000503:physiopathology*; D049590:Postpartum Period; D011247:Pregnancy; D012720:Severity of Illness Index; D016896:Treatment Outcome
Anal incontinence; pelvic floor muscle exercises; randomised controlled trial