Physical therapy treatment for pelvic floor strengthening in women after vaginal delivery: A systematic review

Abstract

Introduction: Pregnancy and vaginal birth are considered risk factors for pelvic floor dysfunction (PFD) development, as urinary incontinence (UI), fecal incontinence (FI), pelvic organ prolapse (POP) and sexual dysfunction. Pelvic floor muscle training (PFMT) is a physiotherapeutic resource for PFD treatment, considered UI golden standard treatment with benefits also proven in postpartum women. Though, the lack of standardization of protocols brings gaps in scientific knowledge. Objective: To answer the question “Postpartum pelvic floor muscle training affects pelvic floor muscle strength, urinary function and sexual function?”. Methods: systematic review involving randomized clinical trials. Databases: PubMed, Cochrane Central Register of Controlled Trials, PEDro, LILACS, SciELO, EMBASE e MEDLINE, beyond gray literature. Two reviewers selected the studies through the Rayyan program. Were included studies conducted with primiparous women up to one year after childbirth that used the following resources: vaginal cones or balls, electric stimulation, biofeedback, and PFMT, that have compared resources to usual care, placebo, or other treatment. The risk of bias was assessed using the PEDro Scale by two reviewers. Results: 1.381 articles were found, with 508 duplicates. After titles and abstract reading 79 were included for complete reading, then only eight were included for analysis. Most articles compared PFMT and PFMT instructions. Using the PEDro Scale, three included articles scored 8, one scored 7, one scored 6, two scored 5 and only one study scored 4. The main outcomes assessed were PFM contraction strength, endurance time, UI, and sexual function. Strength was mainly assessed by manometry and Oxford Scale, UI by questionnaires and Pad Test, and sexual function by questionnaires. Five studies showed improvement in PFM strength in the intervention group, two studies showed improvement in UI in the intervention group, and two studies showed improvement in sexual function in the intervention group. Conclusion: PFMT was beneficial for primiparous women up to one year after vaginal delivery, improving PFM strength, UI, and sexual function. Nevertheless, more studies with greater quality and greater homogeneity of the protocols and populations are needed.