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Meta-Analysis
. 2020 May 6;5(5):CD007471.
doi: 10.1002/14651858.CD007471.pub4.

Pelvic floor muscle training for preventing and treating urinary and faecal incontinence in antenatal and postnatal women

Stephanie J Woodley  1 , Peter Lawrenson  1 , Rhianon Boyle  2 , June D Cody  3 , Siv Mørkved  4 , Ashleigh Kernohan  5 , E Jean C Hay-Smith  6
Affiliations
Meta-Analysis

Pelvic floor muscle training for preventing and treating urinary and faecal incontinence in antenatal and postnatal women

Stephanie J Woodley et al. Cochrane Database Syst Rev. .

Abstract

Background: About one-third of women have urinary incontinence (UI) and up to one-tenth have faecal incontinence (FI) after childbirth. Pelvic floor muscle training (PFMT) is commonly recommended during pregnancy and after birth for both preventing and treating incontinence. This is an update of a Cochrane Review previously published in 2017.

Objectives: To assess the effects of PFMT for preventing or treating urinary and faecal incontinence in pregnant or postnatal women, and summarise the principal findings of relevant economic evaluations.

Search methods: We searched the Cochrane Incontinence Specialised Register, which contains trials identified from the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, MEDLINE In-Process, MEDLINE Epub Ahead of Print, CINAHL, ClinicalTrials.gov, WHO ICTRP, and handsearched journals and conference proceedings (searched 7 August 2019), and the reference lists of retrieved studies.

Selection criteria: We included randomised or quasi-randomised trials in which one arm included PFMT. Another arm was no PFMT, usual antenatal or postnatal care, another control condition, or an alternative PFMT intervention. Populations included women who, at randomisation, were continent (PFMT for prevention) or incontinent (PFMT for treatment), and a mixed population of women who were one or the other (PFMT for prevention or treatment).

Data collection and analysis: We independently assessed trials for inclusion and risk of bias. We extracted data and assessed the quality of evidence using GRADE.

Main results: We included 46 trials involving 10,832 women from 21 countries. Overall, trials were small to moderately-sized. The PFMT programmes and control conditions varied considerably and were often poorly described. Many trials were at moderate to high risk of bias. Two participants in a study of 43 pregnant women performing PFMT for prevention of incontinence withdrew due to pelvic floor pain. No other trials reported any adverse effects of PFMT. Prevention of UI: compared with usual care, continent pregnant women performing antenatal PFMT probably have a lower risk of reporting UI in late pregnancy (62% less; risk ratio (RR) 0.38, 95% confidence interval (CI) 0.20 to 0.72; 6 trials, 624 women; moderate-quality evidence). Antenatal PFMT slightly decreased the risk of UI in the mid-postnatal period (more than three to six months' postpartum) (29% less; RR 0.71, 95% CI 0.54 to 0.95; 5 trials, 673 women; high-quality evidence). There was insufficient information available for the late postnatal period (more than six to 12 months) to determine effects at this time point (RR 1.20, 95% CI 0.65 to 2.21; 1 trial, 44 women; low-quality evidence). Treatment of UI: compared with usual care, there is no evidence that antenatal PFMT in incontinent women decreases incontinence in late pregnancy (very low-quality evidence), or in the mid-(RR 0.94, 95% CI 0.70 to 1.24; 1 trial, 187 women; low-quality evidence), or late postnatal periods (very low-quality evidence). Similarly, in postnatal women with persistent UI, there is no evidence that PFMT results in a difference in UI at more than six to 12 months postpartum (RR 0.55, 95% CI 0.29 to 1.07; 3 trials; 696 women; low-quality evidence). Mixed prevention and treatment approach to UI: antenatal PFMT in women with or without UI probably decreases UI risk in late pregnancy (22% less; RR 0.78, 95% CI 0.64 to 0.94; 11 trials, 3307 women; moderate-quality evidence), and may reduce the risk slightly in the mid-postnatal period (RR 0.73, 95% CI 0.55 to 0.97; 5 trials, 1921 women; low-quality evidence). There was no evidence that antenatal PFMT reduces the risk of UI at late postpartum (RR 0.85, 95% CI 0.63 to 1.14; 2 trials, 244 women; moderate-quality evidence). For PFMT started after delivery, there was uncertainty about the effect on UI risk in the late postnatal period (RR 0.88, 95% CI 0.71 to 1.09; 3 trials, 826 women; moderate-quality evidence). Faecal incontinence: eight trials reported FI outcomes. In postnatal women with persistent FI, it was uncertain whether PFMT reduced incontinence in the late postnatal period compared to usual care (very low-quality evidence). In women with or without FI, there was no evidence that antenatal PFMT led to a difference in the prevalence of FI in late pregnancy (RR 0.64, 95% CI 0.36 to 1.14; 3 trials, 910 women; moderate-quality evidence). Similarly, for postnatal PFMT in a mixed population, there was no evidence that PFMT reduces the risk of FI in the late postnatal period (RR 0.73, 95% CI 0.13 to 4.21; 1 trial, 107 women, low-quality evidence). There was little evidence about effects on UI or FI beyond 12 months' postpartum. There were few incontinence-specific quality of life data and little consensus on how to measure it.

Authors' conclusions: This review provides evidence that early, structured PFMT in early pregnancy for continent women may prevent the onset of UI in late pregnancy and postpartum. Population approaches (recruiting antenatal women regardless of continence status) may have a smaller effect on UI, although the reasons for this are unclear. A population-based approach for delivering postnatal PFMT is not likely to reduce UI. Uncertainty surrounds the effects of PFMT as a treatment for UI in antenatal and postnatal women, which contrasts with the more established effectiveness in mid-life women. It is possible that the effects of PFMT might be greater with targeted rather than mixed prevention and treatment approaches, and in certain groups of women. Hypothetically, for instance, women with a high body mass index (BMI) are at risk of UI. Such uncertainties require further testing and data on duration of effect are also needed. The physiological and behavioural aspects of exercise programmes must be described for both PFMT and control groups, and how much PFMT women in both groups do, to increase understanding of what works and for whom. Few data exist on FI and it is important that this is included in any future trials. It is essential that future trials use valid measures of incontinence-specific quality of life for both urinary and faecal incontinence. In addition to further clinical studies, economic evaluations assessing the cost-effectiveness of different management strategies for FI and UI are needed.

Trial registration: ClinicalTrials.gov NCT00740428 NCT00617149 NCT02865954 NCT00551551 NCT01069484 NCT01155804 NCT01672697 NCT01578369 NCT00476567 NCT01243554 NCT01696201 NCT03041246 NCT00763984 NCT02270008 NCT02334397 NCT02420288 NCT02682212 NCT03247660 NCT02513420.

PubMed Disclaimer

Conflict of interest statement

In accordance with Cochrane's Commercial Sponsorship Policy, the following declarations are applicable for the three years prior to the publication date of this review.

SW: none known. PL: none known. RB: none known. JC: none known. SM: was an investigator on three of the included trials in the review and had no role in screening, risk of bias assessment or data extraction for these trials. AK: none known JHS: none known.

Figures

1
1
PRISMA study flow diagram ‐ search for clinical effectiveness studies
2
2
PRISMA study flow diagram ‐ search for economic evaluations for the BEC
3
3
'Risk of bias' summary: review authors' judgements about each risk of bias item for each included study.
4
4
'Risk of bias' graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.
1.1
1.1. Analysis
Comparison 1: Antenatal pelvic floor muscle training (PFMT) versus control for prevention of incontinence, Outcome 1: Urinary incontinence in late pregnancy
1.2
1.2. Analysis
Comparison 1: Antenatal pelvic floor muscle training (PFMT) versus control for prevention of incontinence, Outcome 2: Urinary incontinence early postnatal period (0‐3 months)
1.3
1.3. Analysis
Comparison 1: Antenatal pelvic floor muscle training (PFMT) versus control for prevention of incontinence, Outcome 3: Urinary incontinence mid‐postnatal period (> 3‐6 months)
1.4
1.4. Analysis
Comparison 1: Antenatal pelvic floor muscle training (PFMT) versus control for prevention of incontinence, Outcome 4: Urinary incontinence late postnatal period (> 6‐12 months)
1.5
1.5. Analysis
Comparison 1: Antenatal pelvic floor muscle training (PFMT) versus control for prevention of incontinence, Outcome 5: Urinary incontinence long term (> 5 years)
1.6
1.6. Analysis
Comparison 1: Antenatal pelvic floor muscle training (PFMT) versus control for prevention of incontinence, Outcome 6: Urinary incontinence‐specific quality of life
1.8
1.8. Analysis
Comparison 1: Antenatal pelvic floor muscle training (PFMT) versus control for prevention of incontinence, Outcome 8: Loss of urine under stress test late pregnancy
1.9
1.9. Analysis
Comparison 1: Antenatal pelvic floor muscle training (PFMT) versus control for prevention of incontinence, Outcome 9: Loss of urine under stress test early postnatal period (0‐3 months)
1.11
1.11. Analysis
Comparison 1: Antenatal pelvic floor muscle training (PFMT) versus control for prevention of incontinence, Outcome 11: Delivery outcome: caesarean section
2.1
2.1. Analysis
Comparison 2: Antenatal pelvic floor muscle training (PFMT) versus control for treatment of incontinence, Outcome 1: Urinary incontinence late pregnancy
2.2
2.2. Analysis
Comparison 2: Antenatal pelvic floor muscle training (PFMT) versus control for treatment of incontinence, Outcome 2: Urinary incontinence early postnatal period (0‐3 months)
2.3
2.3. Analysis
Comparison 2: Antenatal pelvic floor muscle training (PFMT) versus control for treatment of incontinence, Outcome 3: Urinary incontinence mid‐postnatal period (> 3‐6 months)
2.4
2.4. Analysis
Comparison 2: Antenatal pelvic floor muscle training (PFMT) versus control for treatment of incontinence, Outcome 4: Urinary incontinence late postnatal period (> 6‐12 months)
2.5
2.5. Analysis
Comparison 2: Antenatal pelvic floor muscle training (PFMT) versus control for treatment of incontinence, Outcome 5: Urinary incontinence‐specific quality of life
3.1
3.1. Analysis
Comparison 3: Antenatal pelvic floor muscle training (PFMT) versus control for (mixed) prevention or treatment of incontinence, Outcome 1: Urinary incontinence late pregnancy
3.2
3.2. Analysis
Comparison 3: Antenatal pelvic floor muscle training (PFMT) versus control for (mixed) prevention or treatment of incontinence, Outcome 2: Urinary incontinence early postnatal period (0‐3 months)
3.3
3.3. Analysis
Comparison 3: Antenatal pelvic floor muscle training (PFMT) versus control for (mixed) prevention or treatment of incontinence, Outcome 3: Urinary incontinence mid‐postnatal period (> 3‐6 months)
3.4
3.4. Analysis
Comparison 3: Antenatal pelvic floor muscle training (PFMT) versus control for (mixed) prevention or treatment of incontinence, Outcome 4: Urinary incontinence late postnatal period (> 6‐12 months)
3.5
3.5. Analysis
Comparison 3: Antenatal pelvic floor muscle training (PFMT) versus control for (mixed) prevention or treatment of incontinence, Outcome 5: Urinary incontinence long term (> 5 years)
3.6
3.6. Analysis
Comparison 3: Antenatal pelvic floor muscle training (PFMT) versus control for (mixed) prevention or treatment of incontinence, Outcome 6: Faecal incontinence late pregnancy
3.7
3.7. Analysis
Comparison 3: Antenatal pelvic floor muscle training (PFMT) versus control for (mixed) prevention or treatment of incontinence, Outcome 7: Faecal incontinence early postnatal period (0‐3 months)
3.8
3.8. Analysis
Comparison 3: Antenatal pelvic floor muscle training (PFMT) versus control for (mixed) prevention or treatment of incontinence, Outcome 8: Urinary incontinence‐specific quality of life late pregnancy
3.9
3.9. Analysis
Comparison 3: Antenatal pelvic floor muscle training (PFMT) versus control for (mixed) prevention or treatment of incontinence, Outcome 9: Urinary incontinence‐specific quality of life early postnatal period (0‐3 months)
3.10
3.10. Analysis
Comparison 3: Antenatal pelvic floor muscle training (PFMT) versus control for (mixed) prevention or treatment of incontinence, Outcome 10: Urinary incontinence‐specific quality of life mid postnatal period (> 3‐6 months)
3.11
3.11. Analysis
Comparison 3: Antenatal pelvic floor muscle training (PFMT) versus control for (mixed) prevention or treatment of incontinence, Outcome 11: Urinary incontinence‐specific quality of life late postnatal period (> 6‐12 months)
3.12
3.12. Analysis
Comparison 3: Antenatal pelvic floor muscle training (PFMT) versus control for (mixed) prevention or treatment of incontinence, Outcome 12: Faecal incontinence‐specific quality of life early postnatal period (0‐3 months)
3.17
3.17. Analysis
Comparison 3: Antenatal pelvic floor muscle training (PFMT) versus control for (mixed) prevention or treatment of incontinence, Outcome 17: Delivery outcome: caesarean section
4.1
4.1. Analysis
Comparison 4: Postnatal pelvic floor muscle training (PFMT) versus control for treatment of incontinence, Outcome 1: Urinary incontinence late postnatal period (> 6‐12 months)
4.2
4.2. Analysis
Comparison 4: Postnatal pelvic floor muscle training (PFMT) versus control for treatment of incontinence, Outcome 2: Urinary incontinence long term (> 5‐10 years)
4.3
4.3. Analysis
Comparison 4: Postnatal pelvic floor muscle training (PFMT) versus control for treatment of incontinence, Outcome 3: Urinary incontinence very long term (> 10 years)
4.4
4.4. Analysis
Comparison 4: Postnatal pelvic floor muscle training (PFMT) versus control for treatment of incontinence, Outcome 4: Faecal incontinence late postnatal period (> 6‐12 months)
4.5
4.5. Analysis
Comparison 4: Postnatal pelvic floor muscle training (PFMT) versus control for treatment of incontinence, Outcome 5: Faecal incontinence long term (> 5‐10 years)
4.6
4.6. Analysis
Comparison 4: Postnatal pelvic floor muscle training (PFMT) versus control for treatment of incontinence, Outcome 6: Faecal incontinence very long term (> 10 years)
4.7
4.7. Analysis
Comparison 4: Postnatal pelvic floor muscle training (PFMT) versus control for treatment of incontinence, Outcome 7: Urinary incontinence‐specific quality of life
5.1
5.1. Analysis
Comparison 5: Postnatal pelvic floor muscle training (PFMT) versus control for (mixed) prevention or treatment of incontinence, Outcome 1: Urinary incontinence early postnatal period (0‐3 months)
5.2
5.2. Analysis
Comparison 5: Postnatal pelvic floor muscle training (PFMT) versus control for (mixed) prevention or treatment of incontinence, Outcome 2: Urinary incontinence mid‐postnatal period (> 3‐6 months)
5.3
5.3. Analysis
Comparison 5: Postnatal pelvic floor muscle training (PFMT) versus control for (mixed) prevention or treatment of incontinence, Outcome 3: Urinary incontinence late postnatal period (> 6‐12 months)
5.4
5.4. Analysis
Comparison 5: Postnatal pelvic floor muscle training (PFMT) versus control for (mixed) prevention or treatment of incontinence, Outcome 4: Faecal incontinence early postnatal period (0‐3 months)
5.5
5.5. Analysis
Comparison 5: Postnatal pelvic floor muscle training (PFMT) versus control for (mixed) prevention or treatment of incontinence, Outcome 5: Faecal incontinence late postnatal period (> 6‐12 months)
5.6
5.6. Analysis
Comparison 5: Postnatal pelvic floor muscle training (PFMT) versus control for (mixed) prevention or treatment of incontinence, Outcome 6: Urinary incontinence‐specific quality of life
5.8
5.8. Analysis
Comparison 5: Postnatal pelvic floor muscle training (PFMT) versus control for (mixed) prevention or treatment of incontinence, Outcome 8: Loss of urine under stress test postpartum
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References

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Hyakutake 2018 {published data only}
    1. Han V, Hyakutake M, Cundiff G, Koenig N, Baerg L, Lee T, et. Pregnancy-associated pelvic floor health knowledge and reduction of symptoms: the PREPARED trial (Abstract number O-GYN-JM-017). Journal of Obstetrics and Gynaecology Canada 2016;38(5):487. [NCT02947282] [TrialID.PREPARED.] [sr-incont76174] - PubMed
    1. Hyakutake MT, Han V, Baerg L, Koenig NA, Cundiff GW, Lee T, et al. Pregnancy-associated pelvic floor health knowledge and reduction of symptoms: the PREPARED randomized controlled trial. Journal of Obstetrics and Gynaecology Canada 2018;40(4):418-25. [NCT02947282] [TrialID.PREPARED.] [sr-incont78398] - PubMed
    1. Koenig N, NCT02947282. PREgnancy-associated Pelvic Floor Health Knowledge And REDuction of Symptoms: the PREPARED trial. clinicaltrials.gov/show/NCT02947282 Date first received: 27 October 2016. [NCT02947282] [TrialID.PREPARED.] [sr-incont74043]
Kim 2012 {published data only}
    1. Kim EY, Kim SY, Oh DW. Pelvic floor muscle exercises utilizing trunk stabilization for treating postpartum urinary incontinence: randomized controlled pilot trial of supervised versus unsupervised training. Clinical Rehabilitation 2012;26(2):132-41. [sr-incont44514] - PubMed
Ko 2011 {published data only}
    1. Ko PC, Liang CC, Chang SD, Lee JT, Chao AS, Cheng PJ. A randomized controlled trial of antenatal pelvic floor exercises to prevent and treat urinary incontinence. International Urogynecology Journal 2011;22(1):17-22. [sr-incont41029] - PubMed
    1. Liang C, Ko P, Lin Y, Tseng L, Lo T, Wang AC. Effect of antenatal pelvic floor muscle exercises in prevention and treatment of urinary incontinence: a randomized controlled trial (Abstract number 208). Neurourology and Urodynamics 2010;29(6):1105-6. [sr-incont40157]
Kocaoz 2013 {published data only}
    1. Kocaoz S, Eroglu K, Sivaslioglu AA. Role of pelvic floor muscle exercises in the prevention of stress urinary incontinence during pregnancy and the postpartum period. Gynecologic and Obstetric Investigation 2013;75(1):34-40. [sr-incont49319] - PubMed
Kou 2013 {published data only}
    1. Kou J-L, Dang L-J, Feng X-Q. Clinical study on the treatment of postpartum rehabilitation to improve the pelvic floor function. Medical Innovation of China 2013;10(25):55-7. [sr-incont70278]
Liu 2011 {published data only}
    1. Liu X-B. Pelvic floor muscle training for prevention and treatment of postpartum urinary incontinence clinical observation. Guide of China Medicine 2011;9(2):21-2. [sr-incont70276]
Meyer 2001 {published data only}
    1. Meyer S, Hohlfeld P, Achtari C, De Grandi P. Pelvic floor education after vaginal delivery. Obstetrics and Gynecology 2001;97(5 Pt 1):673-7. [SR-INCONT12119] - PubMed
    1. Meyer S, Hohlfeld P, De Grandi P, Megalo A. Is pelvic floor reeducation after vaginal delivery effective? A prospective double-blind randomized study in primiparae (Abstract). International Urogynecology Journal and Pelvic Floor Dysfunction 1999;10 Suppl 1:39-40. [SR-INCONT9846]
    1. Meyer S, Hohlfeld P, De Grandi P, Megalo A. Is pelvic floor re-education after vaginal delivery effective? A prospective double-blind randomized study in primiparae (Abstract). Neurourology and Urodynamics 1999;18(4):290. [SR-INCONT9941]
Miquelutti 2013 {published data only}
    1. Miquelutti MA, Cecatti JG, Makuch MY. Developing strategies to be added to the protocol for antenatal care: an exercise and birth preparation program. Clinics (Sao Paulo, Brazil) 2015;70(4):231-6. [sr-incont69188] - PMC - PubMed
    1. Miquelutti MA, Cecatti JG, Makuch MY. Evaluation of a birth preparation program on lumbopelvic pain, urinary incontinence, anxiety and exercise: a randomized controlled trial. BMC Pregnancy and Childbirth 2013;13:154. [DOI: 10.1186/1471-2393-13-154] [NCT01155804] [sr-incont59873] - DOI - PMC - PubMed
    1. Miquelutti MA, Cecatti JG, Makuch MY. Evaluation of the efficacy of an antenatal birth preparation program (Abstract number O431). International Journal of Gynaecology and Obstetrics 2012;119(Suppl 3):S414. [sr-incont64222]
    1. Miquelutti MA. Evaluating of an Antenatal Education Program [PhD thesis]. Campinas, São Paulo: Universidade Estadual de Campinas, Faculdade de Ciências Médicas, 2012. [sr-incont46712]
Mørkved 2003 {published data only}
    1. Mørkved S, Bø K, Schei B, Salvesen KÅ. Pelvic floor muscle training during pregnancy to prevent urinary incontinence: a single-blind randomized controlled trial. Obstetrics and Gynecology 2003;101(2):313-9. [SR-INCONT15816] - PubMed
    1. Mørkved S, Rommen K, Schei B, Salvesen KÅ, Bø K. No difference in urinary incontinence between training and control group six years after cessation of a randomized controlled trial, but improved sexual satisfaction in the training group (Abstract number 50). Neurourology and Urodynamics 2007;26(5):667. [sr-incont23748]
    1. Mørkved S, Salvesen KÅ, Scheil B, Bø K. Prevention of urinary incontinence during pregnancy - a randomized controlled trial of primiparous women (Abstract). International Urogynecology Journal and Pelvic Floor Dysfunction 2001;12 Suppl 3:1. [SR-INCONT15713]
    1. Mørkved S, Salvesen KÅ. Does pelvic floor muscle training during pregnancy have an effect on labour? (Abstract). Neurourology and Urodynamics 2004;23(5/6):410-1. [SR-INCONT19001]
    1. Salvesen KÅ, Mørkved S. Randomised controlled trial of pelvic floor muscle training during pregnancy. BMJ 2004;329(7462):378-80. [SR-INCONT17558] - PMC - PubMed
Oakley 2016 {published data only}
    1. Oakley SH, Ghodsi VC, Crisp CC, Estanol MV, Westermann LB, Novicki KM, et al. Effects of physical therapy on pelvic floor symptoms and quality of life in postpartum women following severe perineal trauma: a randomized controlled trial. Female Pelvic Medicine and Reconstructive Surgery 2015;21(5 Suppl 1):S18. [NCT01672697] [sr-incont72724]
    1. Oakley SH, Ghodsi VC, Crisp CC, Estanol MV, Westermann LB, Novicki KM, et al. Impact of pelvic floor physical therapy on quality of life and function after obstetric anal sphincter injury: a randomized controlled trial. Female Pelvic Medicine and Reconstructive Surgery 2016;22(4):205-13. [NCT01672697] [sr-incont72183] - PubMed
Peirce 2013 {published data only}
    1. O'Herlihy C. Early home feedback physiotherapy compared with pelvic floor exercises soon after third degree perineal tear: a randomised trial (Abstract number 63). International Urogynecology Journal and Pelvic Floor Dysfunction 2012;23(2 Suppl 1):S107. [sr-incont67239]
    1. Peirce C, Murphy C, Fitzpatrick M, Cassidy M, Daly L, O'Connell P, et al. Randomised controlled trial comparing early home biofeedback physiotherapy with pelvic floor exercises for the treatment of third-degree tears (EBAPT Trial). BJOG 2013;120(10):1240-7. [sr-incont48563] - PubMed
    1. Peirce C, O'Herlihy C, Murphy C, Fitzpatrick M, Cassidy M, Daly L, et al. Randomized trial comparing early home biofeedback physiotherapy with pelvic floor exercises following third degree perineal tears (Abstract). American Journal of Obstetrics and Gynecology 2012;206(1 Suppl 1):S298-9. [sr-incont46739] - PubMed
Pelaez 2014 {published data only}
    1. Pelaez M, Gonzalez-Cerron S, Montejo R, Barakat R. Pelvic floor muscle training included in a pregnancy exercise program is effective in primary prevention of urinary incontinence: a randomized controlled trial. Neurourology and Urodynamics 2014;33(1):67-71. [NCT01578369] [sr-incont50396] - PubMed
Reilly 2002 {published data only}
    1. Agur WI, Steggles P, Waterfield M, Freeman RM. The long-term effectiveness of antenatal pelvic floor muscle training: eight-year follow up of a randomised controlled trial. BJOG 2008;115(8):985-90. [sr-incont27527] - PubMed
    1. Reilly EIL, Freeman RM, Waterfield MR, Waterfield AE, Steggles P, Pedlar F. Can post partum stress incontinence be prevented? (Abstract). International Urogynecology Journal 2001;12 Suppl 3:1. [SR-INCONT15712]
    1. Reilly ET, Freeman RM, Waterfield MR, Waterfield AE, Steggles P, Pedlar F. Prevention of postpartum stress incontinence in primigravidae with increased bladder neck mobility: a randomised controlled trial of antenatal pelvic floor exercises. BJOG 2002;109(1):68-76. [SR-INCONT12890] - PubMed
    1. Reilly ETC, Pedler F, Steggles P, Waterfield AE, Freeman RM. Prevention of postpartum stress incontinence in at risk primigravidae (Abstract). International Urogynecology Journal and Pelvic Floor Dysfunction 1999;10 Suppl 1:2. [SR-INCONT9837]
    1. Udayasankar VJ, Steggles P, Freeman RM, Waterfield M, Adekanmi OA, Reilly ET. Prevention of stress incontinence by ante-natal pelvic floor exercises in primigravidae with bladder neck mobility: a three year follow-up (Abstract). International Urogynaecology Journal 2002;13 Suppl 1:57-8. [SR-INCONT16343]
Sacomori 2019 {published data only}
    1. Sacomori C, Sperandio F, RBR-53wq87. Orientation of perineal exercises during postpartum to prevent urinary loss [Study about the influence of pelvic floor exercises orientation regarding urinary loss prevention on postpartum period]. ensaiosclinicos.gov.br/rg/RBR-53wq87/ Date first received: 7 October 2011. [RBR-53wq87] [sr-incont64551]
    1. Sacomori C, Zomkowski K, dos Passos Porto I, Cardoso FL, Sperandio FF. Adherence and effectiveness of a single instruction of pelvic floor exercises: a randomized clinical trial. International Urogynecology Journal 2019 Jun 28 [ePub ahead of print]. [DOI: 10.1007/s00192-019-04032-6] [RBR-53wq87] [U1111–1125-1467] [sr-incont78510] - DOI - PubMed
Sampselle 1998 {published data only}
    1. Sampselle C, Miller J. Personal communication 2006.
    1. Sampselle CM, Miller JM, Mims BL, Delancey JO, Ashton-Miller JA, Antonakos CL. Effect of pelvic muscle exercise on transient incontinence during pregnancy and after birth. Obstetrics and Gynecology 1998;91(3):406-12. [SR-INCONT5452] - PubMed
Sangsawang 2016 {published data only}
    1. Sangsawang B, Sangsawang N. Is a 6-week supervised pelvic floor muscle exercise program effective in preventing stress urinary incontinence in late pregnancy in primigravid women?: a randomized controlled trial. European Journal of Obstetrics, Gynecology, and Reproductive Biology 2016;197:103-10. [sr-incont70455] - PubMed
Skelly 2004 {published data only}
    1. Skelly J, Rush J, Eyles P, Burlock S, Morrow C, Fedorkow D. Postpartum urinary incontinence: regional prevalence and the impact of teaching pelvic muscle exercises to pregnant women with UI (Abstract number 552). In: 34th Annual Meeting of the International Continence Society and the International Urogynecology Association; 2004 Aug 23-27; Paris. 2004. [sr-incont19071]
Sleep 1987 {published data only}
    1. Sleep J, Grant A. Pelvic floor exercises in postnatal care. Midwifery 1987;3(4):158-64. [SR-INCONT2623] - PubMed
Stafne 2012 {published data only}
    1. Gustafsson MK, Stafne SN, Romundstad PR, Mørkved S, Salvesen K, Helvik AS. The effects of an exercise programme during pregnancy on health-related quality of life in pregnant women: a Norwegian randomised controlled trial. BJOG 2016;123(7):1152-60. [sr-incont69900] - PubMed
    1. Hellenes OM, Vik T, Løhaugen GC, Salvesen KÅ, Stafne SN, Mørkved S, et al. Regular moderate exercise during pregnancy does not have an adverse effect on the neurodevelopment of the child. Acta Paediatrica 2015;104(3):285-91. [sr-incont69901] - PubMed
    1. Mørkved S. Effects of regular exercise during pregnancy [Training during pregnancy - effects of regular exercise during pregnancy in prevention of pregnancy-related diseases and complications during labour. A randomised clinical trial]. clinicaltrials.gov/show/NCT00476567 Date first received: 22 May 2007. [NCT00476567] [sr-incont47816]
    1. Salvesen KÅ, Stafne SN, Eggebo TM, Mørkved S. Does regular exercise in pregnancy influence duration of labor? A secondary analysis of a randomized controlled trial. Acta Obstetricia et Gynecologica Scandinavica 2014;93(1):73-9. [sr-incont61153] - PubMed
    1. Songøygard KM, Stafne SN, Evensen KA, Salvesen KÅ, Vik T, Mørkved S. Does exercise during pregnancy prevent postnatal depression? A randomized controlled trial. Acta Obstetricia et Gynecologica Scandinavica 2012;91(1):62-7. [sr-incont69903] - PubMed
Stothers 2002 {published data only}
    1. Stothers L. A randomized controlled trial to evaluate intrapartum pelvic floor exercise as a method of preventing urinary incontinence (Abstract). Journal of Urology 2002;167(4 Suppl):106. [SR-INCONT17623]
Sut 2016 {published data only}
    1. Kahyaoglu Sut H, Balkanli Kaplan P. Effect of pelvic floor muscle exercise on pelvic floor muscle activity and voiding functions during pregnancy and the postpartum period. Neurourology and Urodynamics 2016;35(3):417-22. [sr-incont72124] - PubMed
Szumilewicz 2019 {published data only}
    1. Szumilewicz A, Dornowski M, Piernicka M, Worska A, Kuchta A, Kortas J, et al. High-low impact exercise program including pelvic floor muscle exercises improves pelvic floor muscle function in healthy pregnant women: a randomized control trial. Frontiers in Physiology 2019;9:1867. [DOI: 10.3389/fphys.2018.01867] [ISRCTN92265528] [sr-incont78375] - DOI - PMC - PubMed
Torsdatter Markussen 2017 {published data only}
    1. Garnæs KK, Mørkved S, Salvesen Ø, Moholdt T. Exercise training and weight gain in obese pregnant women: a randomized controlled trial (ETIP Trial). PLOS Medicine 2016;13(7):e1002079. [DOI: 10.1371/journal.pmed.1002079] [NCT01243554] [TRIALID.ETIP] [sr-incont75278] - DOI - PMC - PubMed
    1. Garnæs KK, Nyrnes SA, Salvesen KÅ, Salvesen Ø, Mørkved S, Moholdt T. Effect of supervised exercise training during pregnancy on neonatal and maternal outcomes among overweight and obese women. Secondary analyses of the ETIP trial: a randomised controlled trial. PLoS ONE 2017;12(3):e0173937. [DOI: 10.1371/journal.pone.0173937] [NCT01243554] [TRIALID.ETIP] [sr-incont75272] - DOI - PMC - PubMed
    1. Markussen, LT. Effects of pelvic floor muscle training in pregnancy on pelvic floor muscle strength, urinary- and anal incontinence: a randomized controlled trial in overweight and obese women [Masters thesis]. Trondheim, Norway: Faculty of Medicine and Health Sciences, Institute of Medical Imaging and Circulation, Norwegian University of Science and Technology, 2017. [NCT01243554] [TrialID.ETIP] [sr-incont78511]
    1. Moholdt TT, Salvesen K, Ingul CB, Vik T, Oken E, Mørkved S. Exercise training in pregnancy for obese women (ETIP): study protocol for a randomised controlled trial. Trials 2011;12(1):154. [DOI: 10.1186/1745-6215-12-154] [NCT01243554] [TRIALID.ETIP.] [sr-incont41703] - DOI - PMC - PubMed
    1. NCT01243554, Moholdt TT, Mørkved S. Exercise training in pregnancy for obese mothers [Exercise training in pregnancy. Good for the mother - good for the child?]. clinicaltrials.gov/show/NCT01243554 Date first received: 18 November 2010. [NCT01243554] [TrialID.ETIP]
Wen 2010 {published data only}
    1. Wen X-H, Shi S-Q, Wang J-Y. Pelvic muscles exercise for postpartum stress urinary incontinence. China Practical Medicine 2010;5(15):72-3. [sr-incont70270]
Wilson 1998 {published data only}
    1. Wilson D, Herbison P, Borland M, Grant AM. A randomised controlled trial of physiotherapy treatment of postnatal urinary incontinence. In: 26th Congress of Obstetrics and Gynaecology; 1992 Jul 7-10; Manchester (UK). 1992:162. [sr-incont6209]
    1. Wilson PD, Herbison GP. A randomized controlled trial of pelvic floor muscle exercises to treat postnatal urinary incontinence. International Urogynecology Journal and Pelvic Floor Dysfunction 1998;9(5):257-64. [sr-incont6657] - PubMed
Woldringh 2007 {published data only}
    1. Woldringh C, den Wijngaart M, Albers-Heitner P, Lycklama à Nijeholt AA, Lagro-Janssen T. Pelvic floor muscle training is not effective in women with UI in pregnancy: a randomised controlled trial. International Urogynecology Journal and Pelvic Floor Dysfunction 2007;18(4):383-90. [DOI: 10.1007/s00192-006-0175-x] [sr-incont23007] - DOI - PubMed
Yang 2017 {published data only}
    1. Yang S, Sang W, Feng J, Zhao H, Li X, Li P, et al. The effect of rehabilitation exercises combined with direct vagina low voltage low frequency electric stimulation on pelvic nerve electrophysiology and tissue function in primiparous women: a randomised controlled trial. Journal of Clinical Nursing 2017;26(23-24):4537-47. [sr-incont74511] - PubMed

References to studies excluded from this review

Agur 2005 {published data only}
    1. Agur W, Freeman R. Do antenatal pelvic floor training affect the outcome of labour? A randomised controlled trial (Abstract). Neurourology and Urodynamics 2005;24(5/6):510-1. [SR-INCONT20969]
Assis 2013 {published data only}
    1. Assis TR, Sa AC, Amaral WN, Batista EM, Formiga CK, Conde DM. The effect of an exercise program to strengthen pelvic floor muscles in multiparous women [Portuguese]. Revista Brasileira de Ginecologia e Obstetricia 2013;35(1):10-5. - PubMed
Barakat 2014 {published data only}
    1. Barakat R, Perales M, Bacchi M, Coteron J, Refoyo I. A program of exercise throughout pregnancy. Is it safe to mother and newborn? American Journal of Health Promotion 2014;29(1):2-8. - PubMed
    1. Barakat R, Perales M. Effect of a supervised exercise program during whole pregnancy on outcomes and level of depression. A randomized controlled trial. clinicaltrials.gov/show/NCT01696201 Date first received: 28 September 2012. [NCT01696201]
    1. Perales M, Cordero Y, Vargas M, Lucia A, Barakat R. Exercise and depression in overweight and obese pregnant women: a randomised controlled trial. Archivos de Medicina del Sport 2015;32(3):70-7.
Barakat 2016 {published data only}
    1. Barakat R, Pelaez M, Cordero Y, Perales M, Lopez C, Coteron J, et al. Exercise during pregnancy protects against hypertension and macrosomia: randomized clinical trial. American Journal of Obstetrics and Gynecology 2016;214(5):649-8. - PubMed
Barakat 2018 {published data only}
    1. Barakat R, Franco E, Perales M, Lopez C, Mottola MF. Exercise during pregnancy is associated with a shorter duration of labor. A randomized clinical trial. European Journal of Obstetrics, Gynecology, and Reproductive Biology 2018;224:33-40. - PubMed
Brik 2019 {published data only}
    1. Brik M, Fernandez-Buhigas I, Martin-Arias A, Vargas-Terrones M, Barakat R, Santacruz B. Does exercise during pregnancy impact on maternal weight gain and fetal cardiac function? A randomized controlled trial. Ultrasound in Obstetrics and Gynecology 2019;53(5):583-9. - PubMed
Chen 2018 {published data only}
    1. Chen Z, Huang H, Chen QY. Effect of modified Buzhong Yiqi decoction combined with pelvic floor muscle exercise-biofeedback-electrical stimulation on early stage postpartum pelvic floor dysfunction. Zhongguo Zhongyao Zazhi (China Journal of Chinese Materia Medica) 2018;43(11):2391-5. - PubMed
Culligan 2005 {published data only}
    1. Culligan P, Blackwell L, Murphy M, Ziegler C, Heit M. A blinded, sham-controlled trial of postpartum extracorporeal magnetic innervation to restore pelvic muscle strength in primiparous patients (Abstract). Neurourology and Urodynamics 2004;23(5/6):451. [SR-INCONT19008] - PubMed
    1. Culligan PJ, Blackwell L, Murphy M, Ziegler C, Heit MH. A randomized, double-blinded, sham-controlled trial of postpartum extracorporeal magnetic innervation to restore pelvic muscle strength in primiparous patients. American Journal of Obstetrics and Gynecology 2005;192(5):1578-82. - PubMed
Dannecker 2004 {published data only}
    1. Dannecker C. The effect of the pelvic floor training device Epi-No on the maternal pelvic floor function six months after childbirth - follow-up study of a randomised controlled trial [Einfluss des Geburtstrainers Epi-No auf die mutterliche Beckenbodenfunktion sechs Monate nech Entbinding - follow-up einer prospektiven und randomisierten Studie]. Geburtshilfe und Frauenheilkunde 2004;64(11):1192-8. [SR-INCONT21149]
Dias 2011 {published and unpublished data}
    1. Dias LA, Driusso P, Aita DL, Quintana SM, Bø K, Ferreira CH. Effect of pelvic floor muscle training on labour and newborn outcomes: a randomized controlled trial. Revista Brasileira de Fisioterapia 2011;15(6):487-93. [SRINCONT42964] - PubMed
Dias 2018 {published data only}
    1. Dias NT, Ferreira LR, Fernandes MG, Resende AP, Pereira-Baldon VS. A Pilates exercise program with pelvic floor muscle contraction: is it effective for pregnant women? A randomized controlled trial. Neurourology and Urodynamics 2018;37(1):379-84. - PubMed
Dieb 2017 {published data only}
    1. Dieb AS, NCT03287258. Perineal preparation for pregnant ladies [Digital perineal massage and pelvic floor muscle exercise as an antenatal program for prevention of perineal trauma in elderly women, a randomized controlled trial]. clinicaltrials.gov/show/NCT03287258 Date first received: 19 September, 2017. [NCT03287258]
Dietz 2014 {published data only}
    1. Dietz HP, Langer S, Kamisan Atan I, Shek KL, Caudwell-Hall J, Guzman Rojas R. Does the Epi-No prevent pelvic floor trauma? A multicentre randomised controlled trial (Abstract number 394). Neurourology and Urodynamics 2014;33(6):853-5.
Domingues 2015 {published data only}
    1. Domingues MR, Bassani DG, da Silva SG, Vargas Nunes Coll C, da Silva BG, Hallal PC. Physical activity during pregnancy and maternal-child health (PAMELA): study protocol for a randomized controlled trial. Trials 2015;16:227. [DOI: 10.1186/s13063-015-0749-3] - DOI - PMC - PubMed
Dougherty 1989 {published data only}
    1. Dougherty MC, Abrams RM, Batich CD, Bishop KR, Gimptty P. Effect of exercise on the circumvaginal muscles (CVM) (Abstract). Neurourology and Urodynamics 1987;6(3):189-90. [SR-INCONT16393]
    1. Dougherty MC, Bishop KR, Abrams RM, Batich CD, Gimotty PA. The effect of exercise on the circumvaginal muscles in postpartum women. Journal of Nurse-Midwifery 1989;34(1):8-14. [SR-INCONT454] - PubMed
El‐Shamy 2018 {published data only}
    1. El-Shamy FF, Abd El Fatah E. Effect of antenatal pelvic floor muscle exercise on mode of delivery: a randomized controlled trial. Integrative Medicine International 2018;4(3-4):187-97.
Fynes 1999 {published data only}
    1. Fynes M, Marshall K, Cassidy M, O'Connell R, O'Herlihy C. A prospective randomised study comparing the effect of augmented biofeedback with sensory biofeedback alone on faecal incontinence following obstetric trauma. 28th Annual Meeting of the International Continence Society (ICS); 1998 Sept 14-17; Jerusalem, Israel 1998:151. [SR-INCONT5691]
    1. Fynes MM, Marshall K, Cassidy M, Behan M, Walsh D, O'Connell PR, et al. A prospective, randomized study comparing the effect of augmented biofeedback with sensory biofeedback alone on fecal incontinence after obstetric trauma. Diseases of the Colon and Rectum 1999;42(6):753-8. [sr-incont8121] - PubMed
Golmakani 2015 {published data only}
    1. Golmakani N, Zare Z, Khadem N, Shareh H, Shakeri MT. The effect of pelvic floor muscle exercises program on sexual self-efficacy in primiparous women after delivery. Iranian Journal of Nursing and Midwifery Research 2015;20(3):347-53. [IRCT2013062313750N1] [PMC4462060] [sr-incont67962] - PMC - PubMed
    1. Zare Z, Golmakani N, Khadem N, Shareh H, Shakeri MT. The effect of pelvic floor muscle exercises on sexual quality of life and marital satisfaction in primiparous women after childbirth. Iranian Journal of Obstetrics, Gynecology and Infertility 2014;17(103):21-32.
Gouldthorpe 2003 {published data only}
    1. Gouldthorpe H. A physiotherapy abdominal muscle assessment during and after pregnancy: Part 4 (Abstract). Australian and New Zealand Continence Journal 2003;9(4):92. [SR-INCONT17166]
Han 2018 {published data only}
    1. Han W, Wang Y, Qi S, Li T, Cao J, Zheng T, et al. Observation of the effect of physical rehabilitation therapy combined with the medication on pelvic floor dysfunction. Experimental and Therapeutic Medicine 2018;15(2):1211-6. - PMC - PubMed
Hou 2010 {published data only}
    1. Hou S-X. The clinical effects on biofeedback combined with electrical stimulation used in pelvic muscle recover therapy. Guide of China Medicine 2010;8(17):28-9. [sr-incont70279]
Huang 2014 {published data only}
    1. Huang J. Effects of exercise of pelvic floor on childbirth outcome and pelvic floor function in primiparas. Hebei yi xue (Hebei Medicine) 2014;20(3):513-6.
Iervolino 2017 {published data only}
    1. Iervolino SA, Pezzella M, Passaretta A, Torella M, Colacurci N. Postpartum female sexual dysfunction: effects of two different degrees of pelvic floor muscle exercises. Neurourology and Urodynamics 2017;36(Suppl S2):S37-8.
Johannessen 2017 {published data only}
    1. Johannessen HH, Wibe A, Stordahl A, Sandvik L, Mørkved S. Do pelvic floor muscle exercises reduce postpartum anal incontinence? A randomised controlled trial. BJOG 2017;124(4):686-94. - PubMed
Kamisan Atan 2016 {published data only}
    1. Kamisan Atan I, Shek KL, Langer S, Guzman Rojas R, Caudwell-Hall J, Daly JO, et al. Does the Epi-No(©) birth trainer prevent vaginal birth-related pelvic floor trauma? A multicentre prospective randomised controlled trial. BJOG 2016;123(6):995-1003. - PubMed
Khorasani 2017 {published data only}
    1. Khorasani F, Ghaderi F, IRCT2017050618760N4. The effects of stabilization exercises focusing on pelvic floor on stress urinary incontinence and low back pain in postpartum women. [Iranian Registry of Clinical Trials] irct.ir/searchresult.php?id=18760&number=4 Date first received: 27 June 2017. [IRCT2017050618760N4]
Lekskulchai 2014 {published data only}
    1. Lekskulchai O, Wanichsetakul P. Effect of pelvic floor muscle training (PFMT) during pregnancy on bladder neck descend and delivery. Journal of the Medical Association of Thailand 2014;97(Suppl 8):S156-63. - PubMed
    1. Lekskulchai O. Effect of antenatal pelvic floor exercises on bladder neck descent in nulliparous pregnant women (Abstract number 105). Neurourology and Urodynamics 2011;30(6):949-50. [SRINCONT42182]
Leon‐Larios 2017 {published data only}
    1. Leon-Larios F, Corrales-Gutierrez I, Casado-Mejia R, Suarez-Serrano C. Influence of a pelvic floor training programme to prevent perineal trauma: a quasi-randomised controlled trial. Midwifery 2017;50:72-7. - PubMed
Li 2010 {published data only}
    1. Li Y, Liu H-S, Guo X-J, Mai F-M. Effect of functional exercise of prenatal pelvic floor muscles on pregnancy outcome. Xian Dai Sheng Wu Yi Xue Jin Zhan (Progress in Modern Biomedicine) 2010;10(11):2129-31.
Liu 2013 {published data only}
    1. Liu Y-L, Zhou Y-H, Ding H, Peng J, Chen S-Q, Zhang J-P. Effect of pelvic muscle training on pelvic floor function during pregnancy. Zhongshan da xue xue bao. Yi xue ke xue ban (Journal of Sun Yat-sen University. Medical Sciences) 2013;34(5):777-81. [sr-incont70267]
Mahmoodi 2014 {published data only}
    1. Mahmoodi F, Mobaraki A. Assessment of effects of Kegel exercises on reduction of perineal pain after episiotomy in primiparous women. Iranian Journal of Obstetrics, Gynecology and Infertility 2014;17(95):18-25.
Mahony 2004 {published data only}
    1. Mahony R, Malone P, Nalty J, Cassidy M, O'Connell PR, O'Herlihy C. Prospective randomized comparison of intra-anal electromyographic biofeedback and intra-anal electromyographic biofeedback augmented with electrical stimulation of the anal sphincter. American Journal of Obstetrics and Gynecology 2003;189(6 Suppl):71. - PubMed
    1. Mahony RT, Malone PA, Nalty J, Behan M, O'Connell PR, O'Herlihy C. Randomized clinical trial of intra-analysis electromyographic biofeedback physiotherapy with intra-anal electromyographic biofeedback augmented with electrical stimulation of the anal sphincter in the early treatment of postpartum fecal incontinence. American Journal of Obstetrics and Gynecology 2004;191(3):885-90. - PubMed
Mason 1999 {published data only}
    1. Mason M. A multicentre study to evaluate different pelvic floor exercise regimes. National Research Register 1999. [SR-INCONT6662]
Mason 2010 {published data only}
    1. Mason L, Roe B, Wong H, Davies J, Bamber J. The role of antenatal pelvic floor muscle exercises in prevention of postpartum stress incontinence: a randomised controlled trial. Journal of Clinical Nursing 2010;19(19-20):2777-86. [SRINCONT40375] - PubMed
Min 2019 {published data only}
    1. Min L. A randomized controlled trial for intra-vaginal electrical stimulation with pelvic muscle exercises in the early treatment of postpartum pelvic organ prolapse. [Chinese Clinical Trial Registry] chictr.org.cn/showproj.aspx?proj=35452 Date first received: 6 March 2019.
Morin 2015 {published data only}
    1. Morin M, Kruger J, Wong V, Girard I, Sherburn M, Dumoulin C. Effect of physiotherapy on pelvic floor morphometry in women with and without avulsion injury of the puborectalis muscle after vaginal delivery: a randomised pilot study (Abstract number 15). Neurourology and Urodynamics 2015;34(S3):S39-40.
Nielsen 1988 {published data only}
    1. Nielsen CA, Sigsgaard I, Olsen M, Tolstrup M, Danneskiold-Samsoee B, Bock JE. Trainability of the pelvic floor. A prospective study during pregnancy and after delivery. Acta Obstetricia et Gynecologica Scandinavica 1988;67(5):437-40. [SR-INCONT7395] - PubMed
Norton 1990 {published data only}
    1. Norton P, Baker J. Randomized prospective trial of vaginal cones versus Kegel exercises in postpartum primiparous women. In: 11th Annual Meeting of the American Urogynecology Society; 1990 Oct 31-Nov 3; Tarpon Springs (FL). 1990. [SR-INCONT14572]
    1. Norton P, Baker J. Randomized prospective trial of vaginal cones vs Kegel exercises in postpartum primiparous women (Abstract). Neurourology and Urodynamics 1990;9(4):434-5. [SR-INCONT5116]
Oblasser 2016 {published data only}
    1. Oblasser C, McCourt C, Hanzal E, Christie J. Vibrating vaginal balls to improve pelvic floor muscle performance in women after childbirth: a protocol for a randomised controlled feasibility trial. Journal of Advanced Nursing 2016;72(4):900-14. - PubMed
Okido 2015 {published data only}
    1. Okido MM, Valeri FL, Martins WP, Ferreira CH, Duarte G, Cavalli RC. Assessment of foetal wellbeing in pregnant women subjected to pelvic floor muscle training: a controlled randomised study. International Urogynecology Journal 2015;26(10):1475-81. - PubMed
Perales 2015 {published data only}
    1. Barakat R, Perales M. Effect of a supervised exercise program in obese and overweight pregnant women on outcomes and level of depression. A randomized controlled trial. clinicaltrials.gov/show/NCT01753622 Date first received: 20 December 2012. [NCT01753622]
    1. Perales M, Cordero Y, Vargas M, Lucia A, Barakat R. Exercise and depression in overweight and obese pregnant women: a randomised controlled trial. Archivos de Medicina del Sport 2015;32(3):70-7.
Perales 2016 {published data only}
    1. Barakat R, Perales M. Effect of a specific exercise program during whole pregnancy on fetal heart rate response to maternal effort in third trimester. A randomised controlled trial. clinicaltrials.gov/show/NCT01723293 Date first received: 7 November 2012. [NCT01723293]
    1. Perales M, Santos-Lozano A, Sanchis-Gomar F, Luaces M, Pareja-Galeano H, Garatachea N, et al. Maternal cardiac adaptations to a physical exercise program during pregnancy. Medicine and Science in Sports and Exercise 2016;48(5):896-906. - PubMed
Pourkhiz 2017 {published data only}
    1. Pourkhiz Z, Mohammad-Alizadeh-Charandabi S, Mirghafourvand M, Haj-Ebrahimi S, Ghaderi F. Effect of pelvic floor muscle training on female sexual function during pregnancy and postpartum: a randomized controlled trial. Iranian Red Crescent Medical Journal 2017;19(10):e63218. [DOI: 10.5812/ircmj.63218] - DOI
Ruiz 2013 {published data only}
    1. Ruiz JR, Perales M, Pelaez M, Lopez C, Lucia A, Barakat R. Supervised exercise-based intervention to prevent excessive gestational weight gain: a randomized controlled trial. Mayo Clinic Proceedings 2013;88(12):1388-97. - PubMed
Santos‐Rocha 2015 {published data only}
    1. Santos-Rocha R, Portela C, Santos T. Active pregnancy: effects of a physical exercise and nutritional counselling program on pregnant women' lifestyle and new-born's health (pilot study) (Abstract number O-0149). Journal of Perinatal Medicine 2015;43(S1):no pagination.
Siva 2014 {published data only}
    1. Siva PR, Kokila V, Kanchana MK, Suresh KS. Effectiveness of antenatal motor relearning approach of diaphragm, deep abdominal and pelvic floor muscles versus Kegels exercises on postpartum pelvic floor muscle strength. Indian Journal of Physiotherapy and Occupational Therapy 2014;8(1):193-7. [sr-incont67960]
Taskin 1996 {published data only}
    1. Taskin O, Wheeler JM, Yalcinoglu AI, Coksenim S. The effects of episiotomy and Kegel exercises on postpartum pelvic relaxation: a prospective controlled study. Journal of Gynecologic Surgery 1996;12(2):123-7. [SRINCONT18347]
Teymuri 2018 {published data only}
    1. Teymuri Z, Hosseinifar M, Sirousi M. The effect of stabilization exercises on pain, disability and pelvic floor muscle function in postpartum lumbopelvic pain: a randomized controlled trial. American Journal of Physical Medicine and Rehabilitation 2018;97(12):885-91. - PubMed
Thorp 1994 {published data only}
    1. Thorp JM, Stephenson H, Jones LH, Cooper G. Pelvic floor (Kegel) exercises: a pilot study in nulliparous women. International Urogynecology Journal 1994;5(2):86-9.
Wang 2014 {published data only}
    1. Wang X, Li G-Y, Deng M-L. Effect of persistent guidance of pelvic floor muscle training on the delivery outcome and pelvic muscle strength. Zhonghua Hu Li za Zhi [Chinese Journal of Nursing] 2013;48(4):308-10.
    1. Wang X, Li G-Y, Deng M-L. Pelvic floor muscle training as a persistent nursing intervention: effect on delivery outcome and pelvic floor myodynamia. International Journal of Nursing Sciences 2014;1(1):48-52.
Wilson 2015 {published data only}
    1. Wilson J. Evaluating Web-based Pelvic Floor Muscle Education for Pregnant Women [PhD thesis]. Fremantle (Australia): The University of Notre Dame (Fremantle Campus), 2015.
Zhu 2012 {published data only}
    1. Zhu X-M, Jiang L-Q. Effect of exercises and electrical stimulation of pelvic floor muscles on postpartum incontinence. Journal of Nursing (China) 2012;19(2A):49-51.

References to studies awaiting assessment

Hoseinkhani 2018 {published data only}
    1. Hoseinkhani M, Taghian F. Effects of Kegel, central, and combined stability exercises on the central muscle endurance and quality of life of primiparous women after episiotomy. Iranian Journal of Obstetrics, Gynecology and Infertility 2018;21(2):60-8. [sr-incont78077]
Longo 2013 {published data only}
    1. Longo F, Montironi PL, Bar E, Frigerio S. Effects of pelvic floor muscle training during pregnancy. Techniques in Coloproctology 2013;17(1):143-4. [sr-incont61867]
Ngugi 2015 {published data only}
    1. Ngugi S, Kamanda C, Miheso J. Effect of pelvic floor muscle training among pregnant black African population on the risk of postpartum urinary incontinence, a single blind randomized control trial. pactr.samrc.ac.za/TrialDisplay.aspx?TrialID=834 [Pan African Clinical Trials Registry (PACTR)] Date first received: 22 May 2014. [PACTR201407000834391] [sr-incont64511]
    1. Ngugi S. Effect of Pelvic Floor Muscle Training Among Pregnant Black African Population on the Risk of Postpartum Urinary Incontinence, a Single Blind Randomized Control Trial [Masters dissertation]. Nairobi (Kenya): Department of Obstetrics and Gynaecology, Aga Khan University, 2015. [PACTR201407000834391] [sr-incont76175]
Sun 2015 {published data only}
    1. Sun Z, Zhu L, Lang J, Zhang Y, Liu G, Chen X, et al. Postpartum pelvic floor rehabilitation on prevention of female pelvic floor dysfunction: a multicenter prospective randomized controlled study. [Chinese]. Chung-Hua Fu Chan Ko Tsa Chih [Chinese Journal of Obstetrics and Gynecology] 2015;50(6):420-7. - PubMed
    1. Zhu L, Wang Y, Zhang X, Gong J. The effect of postpartum pelvic floor rehabilitation in prevention and treatment of pelvic floor dysfunction [The effect of postpartum pelvic floor rehabilitation in prevention and treatment of pelvic floor dysfunction- a multiple centers cooperation research]. clinicaltrials.gov/show/NCT01926314 Date first received: 20 August, 2013. [NCT01926314]
Zhou 2009 {published data only}
    1. Zhou Y-H. The Function of the Pregnancy on the Female Pelvic Floor and Study on the Effect of Pelvic Floor through Pelvic Floor Muscle Training During the Pregnancy [Masters thesis]. Guangzhou, Guangdong (China): Sun Yat-Sen University, 2009. [sr-incont70268]

References to ongoing studies

ACTRN12609001005246 {published data only}
    1. Ferreira CH, Cavalcanti DL. Effects of pelvic floor muscle training on pelvic floor muscle function in women during their first pregnancies measured by perineometer. anzctr.org.au/ACTRN12609001005246.aspx Date first received: 10 October 2009. [ACTRN12609001005246] [sr-incont64574]
Buen 2014 {published data only}
    1. Buen M. Clinical trial: influence of the practice of Pilates on the incidence of urinary incontinence, perineal strength low back pain in the third trimester. ensaiosclinicos.gov.br/rg/RBR-4wkr8y/ Date first received: 9 April 2014. [RBR-4wkr8y] [sr-incont64504]
Haruna 2014 {published data only}
    1. Haruna M, Asai Y, UMIN000015878. Effect of postpartum pelvic floor muscle training with ultrasound biofeedback on recovery of pelvic floor muscle function: a randomized controlled trial. UMIN Clinical Trials Registry (UMIN-CTR) ( https://upload.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R00001...) Date first received: 8 December 2014. [UMIN000015878] [sr-incont66324]
Haruna 2016 {published data only}
    1. Haruna M, UMIN000025165. A randomized controlled trial of transabdominal ultrasound biofeedback in postpartum pelvic floor muscle training for primiparous and multiparous women. (Sango-PFMT Trial). upload.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000028948 Date first recieved: 6 December, 2016. [UMIN000025165] [sr-incont76219]
Hendler 2017 {published data only}
    1. Hendler I, Mohr-Sasson A, NCT03041246. Manual fascial manipulation in pregnant women [The influence of manual fascial manipulation on the function of the pelvic floor in pregnant women]. clinicaltrials.gov/show/NCT03041246 Date first received: 2 February 2017. [3722-16-SMC] [NCT03041246] [sr-incont78303]
Lijun 2018 {published data only}
    1. Lijun R. Clinical study of pelvic floor electrical stimulation combined with traditional Chinese medicine and acupoint sticking in the treatment of postpartum urinary incontinence. [Chinese Clinical Trial Registry] chictr.org.cn/showproj.aspx?proj=24515 Date first received: 7 January 2018. [ChiCTR1800014351 ] [sr-incont78278]
Mesk 2018 {published data only}ISRCTN13224744
    1. Mesk Z, Abdul Manaf R, Juni MH, Kadir Shahar H, Mohd Nazan AI, Amro AA. Effectiveness of theory based intervention using social media to reduce urinary incontinence among postpartum women in Hebron city hospitals: protocol for randomize control trial. JMIR Research Protocols 2019 Aug 13 [Preprint ahead of print available at preprints.jmir.org/preprint/13514] (accessed 9 January 2020). [DOI: 10.2196/13514] [DOI: ] - DOI
    1. Mesk Z. The effectiveness of theory based intervention using social media to reduce urinary incontinence among postpartum women in Hebron city hospitals. isrctn.com/ISRCTN13224744 Date first received: 26 July, 2018. [ISRCTN13224744] [sr-incont78325]
Moossdorf‐Steinhauser 2019 {published data only}
    1. Berghmans B. Long term effects of multidisciplinary assessment and pre- and post partum Pelvic Floor Muscle Group Treatment in primigravid with stress urinary incontinence compared to care-as-usual: a randomised controlled trial - motherfit. trialregister.nl/trial/5816 Date first received: 18 July 2016. [NL5816] [NTR5971] [sr-incont74038]
    1. Moossdorff-Steinhauser HF, Bols, EMJ, Spaanderman ME, Dirksen CD, Weemhoff M, Nieman FH, et al. Long-term effects of motherfit group therapy in pre-(MOTHERFIT1) and post-partum women (MOTHERFIT2) with stress urinary incontinence compared to care-as-usual: study protocol of two multi-centred, randomised controlled trials. Trials 2019;20(1):237. [NL5816] [NTR5971] [sr-incont-ee2692] - PMC - PubMed
NCT00763984 {published data only}
    1. Sampselle C, Davis CK. PERL 4: Promoting Effective Recovery from Labour. Self-care to prevent birth-related urinary incontinence in diverse women. clinicaltrials.gov/show/NCT00763984 Date first received: 1 October 2008. [NCT00763984] [sr-incont47852]
NCT02270008 {published data only}
    1. Karp D, Huber SA, Martinuzzi K. Reducing perinatal anal incontinence through early pelvic floor muscle training: a prospective pilot study. clinicaltrials.gov/show/NCT02270008 Date first received: 21 October 2014. [NCT02270008] [sr-incont67524]
NCT02334397 {published data only}
    1. Lewicky-Gaupp C, Alverdy A. Bump on the ball: impact of a prenatal exercise & education program on birth outcomes & maternal quality of life. clinicaltrials.gov/show/NCT02334397 Date first received: 8 January 2015. [NCT02334397] [sr-incont65526]
NCT02420288 {published data only}
    1. Barakat R, Vargas M, Brik M, Fernandez I, Gil J, Coteron J, et al. Does exercise during pregnancy affect placental weight?: a randomized clinical trial. Evaluation and the Health Professions 2017;41(3):400-14. [NCT02420288] [sr-incont78271] - PubMed
    1. Barakat RO, Vargas Terrones M. Effect of physical exercise program on fetoplacental growth: a randomized controlled trial. clinicaltrials.gov/show/NCT02420288 Date first received: 17 April 2015. [NCT02420288] [sr-incont67550]
    1. Vargas-Terrones M, Barakat R, Santacruz B, Fernandez-Buhigas I, Mottola MF. Physical exercise programme during pregnancy decreases perinatal depression risk: a randomised controlled trial. British Journal of Sports Medicine 2019;53(6):348-53. [ NCT02420288] - PubMed
NCT02682212 {published data only}
    1. Steingrimsdottir T, Geirsson RT, Bø K. Obstetric perineal trauma, pelvic floor symptoms and early physiotherapy intervention. clinicaltrials.gov/show/NCT02682212 Date first received: 15 February 2016. [NCT02682212] [sr-incont71364]
NCT03247660 {published data only}
    1. Torres-Lacomba M, Navarro-Brazalez B. Perineal physiotherapy in postpartum [Effectiveness of the perineal physiotherapy in the prevention and treatment of pelvic floor dysfunction in postpartum]. clinicaltrials.gov/show/NCT03247660 Date first received: 14 August 2017. [21/2013] [NCT03247660] [sr-incont77783]
Schreiner 2016 {published data only}
    1. Schreiner L. Impact of pelvic floor physiotherapy during pregnancy in urinary incontinence and delivery. ensaiosclinicos.gov.br/rg/RBR-8nv3fg/ Date first received: 2 July 2016. [RBR-8nv3fg] [sr-incont74033]
Sobhgol 2019 {published data only}
    1. Dahlen H. For primiparous women, do the antenatal pelvic floor muscle exercises improve female sexual function during pregnancy and the first three months following birth when compared with standard antenatal care alone? A randomised controlled trial. [Australia New Zealand Clinical Trials Registry] anzctr.org.au/ACTRN12617001030369.aspx Date first received: 21 June 2017. [ACTRN12617001030369] [UTN - U1111-1197-6617] [sr-incont77743]
    1. Sobhgol SS, Priddis H, Smith CA, Dahlen HG. Evaluation of the effect of an antenatal pelvic floor muscle exercise programme on female sexual function during pregnancy and the first 3 months following birth: study protocol for a pragmatic randomised controlled trial. Trials [Electronic Resource] 2019;20(1):144. [ACTRN12617001030369] [sr-incont78373] - PMC - PubMed
Torabipour 2019 {published data only}
    1. Torabipour MA, Hajihashemi M, IRCT20160521027998N7. Determine the effect of physiotherapy in women's sexual function and incontinence after first child birth. en.irct.ir/trial/37576 Date first received: 13 March 2019. [IRCT20160521027998N7] [sr-incont78381]
Vasconcelos 2018 {published data only}
    1. Vasconcelos CT, Saboia DM. Prevention of urinary incontinence in postpartum women. [Brazillian Registry of Clinical Trials] ensaiosclinicos.gov.br/rg/RBR-5634jr/ Date first received: 21 April 2018. [RBR-5634jr] [UTN Number: U1111-1212-6567] [sr-incont78383]
Velez‐Sanchez 2015 {published data only}
    1. Velez-Sanchez D, Veloz MG. Perineal muscle training versus usual prenatal care in the incidence of avulsion of the levator ani muscle at first birth of Mexican women: randomized control trial. clinicaltrials.gov/show/NCT02513420 Date first received: 31 July 2015. [NCT02513420] [sr-incont68795]

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References to other published versions of this review

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