Pelvic Floor Muscle Strength and Bothersome Urinary Incontinence After Pregnancy: A Cohort Study.

Abstract

Introduction and hypothesis: Postpartum urinary incontinence (UI) is prevalent, and women with bothersome UI tend to seek more help. This study was aimed at evaluating the association between pelvic floor muscle (PFM) strength and bothersome UI in the 1st year postpartum.

Methods: A prospective cohort study was conducted with 504 participants. UI was evaluated by the International Consultation on Incontinence Questionnaire Short Form (online) and PFM strength was assessed via vaginal palpation (Modified Oxford Scale, MOS), at 3, 6, 9, and 12 months postpartum. Logistic regression analysis was used to analyze the data.

Results: At 3 months postpartum, 52% of women had a PFM strength of ≥ 3 MOS, increasing to 84% at 12 months. 42% of women reported UI at 3 months, which remained unchanged by 12 months. PFM strength ≥ 3 MOS was moderately associated with less UI at 3 months (OR = 0.63, 95% CI 0.42-0.94) and at timepoints 6, 9, and 12 months. Antepartum UI was strongly associated with postpartum UI at all time points: 3 months (OR = 10.23, 95% CI 4.90-21.37), 6 months (OR = 7.75, 95% CI 3.95-15.21), 9 months (OR = 9.95, 95% CI 4.61-21.47), and 12 months (OR = 4.55, 95% CI 2.29-9.04). Grade 2 perineal tears were moderately associated with UI at 9 months postpartum (OR = 1.82, 95% CI 1.11-3.0).

Conclusions: A stronger pelvic floor was associated with less bothersome UI in the 1st year postpartum. UI during pregnancy was most strongly associated with bothersome UI after childbirth. Antenatal screening for UI and promoting PFM training may be warranted to support postpartum recovery and minimize UI.