Randomized controlled trial of postpartum pelvic floor muscle training in women with injured and non-injured pelvic floor muscles.

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Collagen weakening during pregnancy and birth injuries to the pelvic floor muscles (PFM), peripheral nerves and fascias may lead to urinary incontinence (UI), fecal incontinence, pelvic organ prolapse (POP), sensory and emptying abnormalities of the lower urinary tract, defecatory dysfunction, sexual dysfunction and chronic pain syndromes. The aim of the present study is to follow primiparous women prospectively from week 18 till 12 months postpartum measuring PFM function, and to conduct a single blind r andomized controlled trial to evaluate the effect of postpartum PFM training on pelvic floor injury recovery and urinary incontinence. Cohort study: Approximately 1000 primiparous women giving birth at Akershus university hospital will be followed from ge station week 18 till 12 months postpartum with assessments at 6 weeks, 6 months and 12 months postpartum. Outcome measures will be 2,3 and 4D perineal ultrasound to measure hiatus diamensions, PFM length and volume, bladder neck position and automaic func tion during cough and huff. POP will be assessed with POP-Q and PFM strength with vaginal manometry. Symptoms of pelvic floor dysfunction will be assessed by validated questionnaire. Randomized controlled trial: This is a single blind randomized controlle d trial evaluating the effect of a 3 month PFM training program on postpartum pelvic floor anatomy, UI and POP in primiparous women stratifed on degree of pelvic floor avulsion. Power calculation is based on the results of a former matched controlld tria l. With 80% power and 5% significance level it is estimated a minimal sample of 80 women (40 with and 40 without avulsion) in each arm. Since we also want to evaluate other pelvic floor symptoms all women fulfilling inclusion criteria are invited to parti cipate. The training protocol includes weekly assessment and training with physiotherapists + 8-12 contractions x 3 per day at home following an exercise dvd. Outcome measures: the same as for the cohort study.