The PFM’s are comprised of three layers of muscle which act together to provide a mass contraction described as an inward lift and squeeze around the urethra, vagina and rectum to which it gives structural support. In 1948 an American gynecologist Arnold Kegel was the first to introduce PFME to treat stress urinary incontinence (SUI) (Neumann et al. 2006). These exercises were devised to reinnervate, regenerate and re-educate the muscles of the pelvic floor (Mason et al. 2001).
Exercising the PFM’s can restore the tone of the urethral striated muscle and strengthen the levator ani muscle which increases support to the urethra and bladder neck and may elevate them into the intra-abdominal cavity, thus improving the pressure transmission during period of stress (Herschorn 2004). (See Appendix A for pelvic floor anatomy). Knowing the benefits of strengthening the PFM’s, it seems preferable to exercise in order to prevent SI rather than having to suffer the symptoms.
Not all women however suffer from SI following childbirth and it is difficult to predict who will develop the condition. Prevention is therefore dependent on the individual recognising it as a potential threat and having impetus to do something about it. Strength training aims to change the morphology of muscle by increasing its cross-sectional area (Fisher and Riolo 2004). There is evidence to suggest that strength training can increase connective tissue mass (Fisher et al. 2004).
In order to get effective muscle strengthening in skeletal muscle exercise physiologists recommend three sets of 8-12 slow velocity close to maximal contraction 2-4 days a week (Pollock et al. 1998). As the PFM are regular skeletal muscles, recommendations for PFM training should be no different from other skeletal muscles. During pregnancy every women has access to a midwife. A midwife is usually the first and main contact for the expectant mother during her pregnancy, and throughout labour and postnatal period.
The National Institute of the Centre of Excellence (NICE) guidelines (2006) states that, “PFM training should be offered to women in their first pregnancy as a preventive strategy for UI”. According to the Royal college of Midwives (2007) there is no set protocol about teaching PFME to pregnant women and it is dependant on the midwife whether or not information regarding pelvic floor exercises gets passed on. This literature review will look into current research on the use of PFME’s to prevent (UI) post pregnancy.
The most recent evidence will be looked at, with some reference to previous ones. EMBASE, CINAHL, British Library Publication Holdings and Chartered Society of Physiotherapy journal holdings were searched for evidenced based data. A comprehensive literature search was performed to find all studies that involved the use of antepartum and/or peripartum and/or postpartum PFME. For the database searches (1995-2007) the following key words were used: urinary incontinence (prevention and control), pelvic floor muscle, pregnancy, rehabilitation, kegel and bladder.