title: Does pelvic floor muscle contraction early after delivery cause perineal pain in postpartum women?
abstract: OBJECTIVE
  Pelvic floor muscle training is effective and necessary in the prevention and treatment of pelvic floor dysfunction during pregnancy and after childbirth. But because of the high prevalence of perineal pain observed in women after childbirth, many women and caregivers fear to start pelvic floor muscle training immediately after childbirth. However, it is unknown whether pelvic floor muscle contractions (PFMC) provoke perineal pain in women shortly after childbirth. Therefore, the main objective is to study whether PFMC performed immediately after childbirth is painful or not.
  
  
  METHODS
  Observational longitudinal study. Perineal pain was assessed (1-6 days and 9 weeks postpartum) using a visual analogue scale (VAS 0-10) during PFMC and during several activities of daily living (ADL), during micturition and defecation. Descriptive statistics, Wilcoxon and McNemar tests were used.
  
  
  RESULTS
  A total of 233 women participated (148 primiparous and 85 multiparous). Immediately postpartum the prevalence and intensity of pain during ADL (73%; VAS 4.9 (±2.3)), micturition (47%; VAS 3.4 (±1.7)) and defecation (19%; VAS 3.6 (±2.2)) were significantly higher (all p<0.000) than during PFMC (8%; VAS 2.2 (±0.9)). At 9 weeks postpartum, 30% experienced perineal pain during sexual intercourse (VAS 4.6 +/- 2.3) and 18% during defecation (VAS 4.7 +/- 2.3), but none during PFMC.
  
  
  CONCLUSIONS
  Perineal pain is highly prevalent immediately after childbirth during ADL, micturition and defecation, but not during PFMC (only 8%). In case perineal pain occurs during PFMC, the intensity of pain is low (VAS 2). These results show that fear of perineal pain should not discourage women to start pelvic floor muscle training shortly after childbirth.
authors.affiliation: Department Rehabilitation Sciences and Physiotherapy, University of Antwerp, Wilrijk, Belgium; Department of Urology, Antwerp University Hospital, Edegem, Belgium. Electronic address: hedwig.neels@uantwerpen.be.
authors.forename: Hedwig
authors.initials: H
authors.lastname: Neels
authors.affiliation: Department of Urology, Antwerp University Hospital, Edegem, Belgium; Department of Urology, University of Antwerp, Wilrijk, Belgium.
authors.forename: Stefan
authors.initials: S
authors.lastname: De Wachter
authors.affiliation: Department of Urology, University of Antwerp, Wilrijk, Belgium.
authors.forename: Jean-Jacques
authors.initials: JJ
authors.lastname: Wyndaele
authors.affiliation: Department of Urology, University of Antwerp, Wilrijk, Belgium.
authors.forename: Michel
authors.initials: M
authors.lastname: Wyndaele
authors.affiliation: Department Rehabilitation Sciences and Physiotherapy, University of Antwerp, Wilrijk, Belgium; Department of Urology, Antwerp University Hospital, Edegem, Belgium.
authors.forename: Alexandra
authors.initials: A
authors.lastname: Vermandel
mesh_terms: D000203:Activities of Daily Living; D000328:Adult; D001530:Belgium / Q000453:epidemiology; D003672:Defecation; D004414:Dyspareunia / Q000453:epidemiology / Q000209:etiology; D053159:Dysuria / Q000453:epidemiology / Q000209:etiology; D005081:Exercise Therapy / Q000009:adverse effects*; D005260:Female; D006785:Hospitals, University; D006801:Humans; D008137:Longitudinal Studies; D009119:Muscle Contraction; D009437:Neuralgia / Q000453:epidemiology / Q000209:etiology*; D009775:Obstetrics and Gynecology Department, Hospital; D010147:Pain Measurement; D017773:Pelvic Floor / Q000503:physiopathology*; D059952:Pelvic Floor Disorders / Q000453:epidemiology / Q000503:physiopathology / Q000517:prevention & control*; D010502:Perineum; D011181:Postnatal Care; D015995:Prevalence; D012307:Risk Factors; D055815:Young Adult
keywords: Pelvic floor muscle contraction; Pelvic floor muscle training; Perineal pain; Postpartum