Physical activity and urinary incontinence during pregnancy and postpartum: A systematic review and meta-analysis

Prevalence and Spatial Distribution Characteristics of Female Stress Urinary Incontinence in Mainland China

Background and objective

Stress urinary incontinence (SUI) in women is a common condition that affects middle-aged and elderly women. Currently, there are still many limitations in the epidemiological research on SUI. This study aims to address the gap in the prevalence of female SUI in mainland China and provide theoretical support for the prevention and treatment of SUI.

Methods

A comprehensive literature search was conducted on the prevalence of female SUI in mainland China, systematically searching Chinese and English databases including PubMed, Web of Science, Embase, Cochrane Library, China National Knowledge Infrastructure (CNKI), Wanfang Database, and Weipu Database as of April 1, 2024. Detailed criteria for screening and exclusion were established. The prevalence of SUI in the selected studies was synthesized using Stata MP (version 15) software, and a multisubgroup analysis, a sensitivity analysis, and publication bias detection of the prevalence of SUI were also performed using the software. Additionally, ArcGIS software (version 10.8) and Geoda software (version 1.2) were utilized to explore the geographical distribution characteristics of the prevalence of female SUI in mainland China.

Key findings and limitations

A total of 688 articles were screened, and finally 85 articles were included. The overall rate of female SUI in mainland China was 24.5% (95% confidence interval: 22.5-26.5%). The heterogeneity of the study is statistically significant (I2 = 99.0%, p < 0.001). Based on significant heterogeneity, a multisubgroup analysis was conducted. The results showed that the prevalence of SUI varies among different publication years, literature quality scores, investigators, study settings, sampling methods, provinces, regions, coastal or inland areas, and rural or urban areas. A spatial econometric analysis indicated that the incidence of SUI in the east-west distribution showed a downward trend, while in the north-south distribution, the incidence rate of SUI showed a trend of first increasing and then decreasing. Additionally, a spatial metrology analysis showed similar trends in the distribution of SUI incidence.

Conclusions and clinical implications

The high incidence rate of female SUI in mainland China and the regional differences observed indicate the need for further rigorous epidemiological investigation in the future.

Patient summary

Stress urinary incontinence (SUI) is common among middle-aged and elderly women. The high prevalence of SUI in mainland China and the differences across regions emphasize the need for conducting more robust epidemiological studies in the future.

Influence of pelvic floor muscle training alone or as part of a general physical activity program during pregnancy on urinary incontinence, episiotomy and third- or fourth-degree perineal tear: Systematic review and meta-analysis of randomized clinical trials

INTRODUCTION

The complex process of pregnancy and childbirth significantly influences the well-being of both mother and child. Today all pregnant women without medical contraindications are recommended to start or continue regular aerobic and strength training for at least 150 min per week to prevent pregnancy-related diseases and conditions. Urinary incontinence in pregnancy, episiotomy and third- or fourth-degree perineal tear during labor can greatly impact womens' health, quality of life and ability to be physically active. The aim of this study was to examine the efficacy of pelvic floor muscle training (PFMT) during pregnancy in the prevention of urinary incontinence, episiotomy, and third- or fourth-degree perineal tear.

MATERIAL AND METHODS

A systematic review and meta-analysis (CRD42022370600) was performed. Only randomized clinical trials published between 2010 and 2023 were included. The following databases were examined: EBSCO (including Academic Search Premier, Education Resources Information Center, MEDLINE, SPORTDiscus and OpenDissertations databases), Clinicaltrials.gov, Web of Science, Scopus, Cochrane Database of Systematic Reviews and Physiotherapy Evidence Database (PEDro). Three meta-analyses to investigate the effect of PFMT exclusively or implemented as a section within a physical activity program during pregnancy on urinary incontinence, episiotomy, and third- or fourth-degree perineal tear were conducted.

RESULTS

Thirty studies were analyzed (N = 6691). An effective preventive action of PFMT was found for urinary incontinence (z = 3.46; p < 0.0005; relative risk [RR] = 0.72, 95% confidence interval [CI]: 0.59, 0.87, I2 = 59%) and third- or fourth-degree perineal tear (z = 2.89; p = 0.004; RR = 0.50, 95% CI: 0.31, 0.80, I2 = 48%) but not for episiotomy (z = 0.80; p = 0.42; RR = 0.95, 95% CI: 0.85, 1.07, I2 = 75%).

CONCLUSIONS

PFMT during pregnancy proves to be an effective preventive intervention for reducing the risk of urinary incontinence and the occurrence of third- or fourth-degree perineal tears. These findings highlight the importance of incorporating PFMT into antenatal care and training programs to improve maternal well-being and overall childbirth outcomes.

Effects of Pelvic Floor Muscle Training on Urinary Incontinence During the Third Trimester of Nulliparous Pregnant Women: a Randomized Controlled Trial

INTRODUCTION AND HYPOTHESIS

The objective was to investigate the effects of pelvic floor muscle training (PFMT) on urinary incontinence (UI) and quality of life (QoL) during the late third trimester of pregnancy.

METHODS

A total of 131 singleton nulliparous women without pre-existing UI who attended the antenatal clinic at Rajavithi Hospital between August 2019 and May 2020 were randomly allocated into PFMT (n=63) or usual care (n=68; controls). The PFMT group watched the video education and was taught to contract the pelvic floor muscle. The control group received standard routine care. Baseline characteristics were recorded. At the gestational age of 36-38 weeks before delivery, UI was evaluated using the Urogenital Distress Inventory (UDI-6), and a score of at least 16.7 was used as a cut-off for diagnosing UI. Incontinence-related QoL was evaluated by the Incontinence Impact Questionnaire (IIQ-7).

RESULTS

Baseline characteristics between groups were similar. The mean age of women in the PFMT group was 23.7 years versus 24.1 years in the control group. Pre-pregnancy body mass index was 21.1 kg/m2 and 21.3 kg/m2 in the PFMT and control groups respectively. The PFMT group reported fewer UI than the control group (20.6% vs 94.1%, p<0.001). The PFMT group also had a lower UDI-6 score (5.5 vs 27.7, p<0.001) and lower IIQ-7 score (0 vs 14.3, p<0.001) compared with the control group.

CONCLUSIONS

From this study, the PFMT program is effective at preventing UI in the late third trimester of pregnancy and improves QoL. Therefore, we encourage PFMT to be implemented in clinical practice.

Current opinion: postpartum urinary disorders

PURPOSE OF REVIEW

The aim of this study was to describe the common postpartum urinary sequelae including urinary retention and incontinence, and to summarize the management of these conditions.

RECENT FINDINGS

Despite the high frequency of urinary disorders in obstetrics, screening and management protocols are rarely utilized by providers. Large variation exists in the literature regarding assessment of postpartum urinary retention, values of postvoid residuals and management of indwelling catheters in the immediate postpartum population. Recent expert guidance outlines a strategy for managing this condition.Research also highlights that screening for peripartum urinary incontinence is not a routine practice. The diagnosis is made more challenging by the fact that patients commonly understate and over-normalize their symptoms. Emerging studies have found that pelvic floor muscle training is cost-effective, preventive, and may improve symptoms in the postpartum setting.

SUMMARY

Increased awareness of urinary disorders in pregnancy and postpartum is imperative for appropriate diagnosis and management. Instituting standardized voiding protocols postpartum will allow providers to avoid undiagnosed postpartum urinary retention and its repercussions. Improved screening and education regarding urinary incontinence in the peripartum is important for early management, such as pelvic floor muscle training, and improved quality of life.

Effectiveness of exercise interventions on urinary incontinence and pelvic organ prolapse in pregnant and postpartum women: umbrella review and clinical guideline development

INTRODUCTION AND AIMS

Dysfunction related to pelvic floor muscles (PFM) is common among pregnant and postpartum women and can cause symptoms such as urinary incontinence or pelvic organ prolapse (POP). As part of developing a nationwide clinical practice guideline for nursing in Finland, the aim of this umbrella review is to summarize the existing evidence about the effectiveness of exercise interventions on urinary incontinence and POP in pregnant and postpartum women. To promote knowledge translation, recommendations for health care professionals are presented.

METHODS

We conducted an umbrella review to summarize the existing evidence. The JBI methodology for umbrella reviews was used to guide the review. The level of evidence was evaluated using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach, and recommendations based on the evidence were formulated by a clinical guideline working group.

RESULTS

Altogether, 9 systematic reviews, reporting findings from 89 original studies, were included. The methodological quality of the reviews was evaluated using JBI's checklist. The highest level of evidence was found for preventing the symptoms of postpartum urinary incontinence through exercise and pelvic floor muscle training (PFMT) during pregnancy. Moderate-level evidence showed that exercise and PFMT are likely to reduce the symptoms and severity of urinary incontinence, but the level of evidence was low on PFMT reducing the symptoms of POP.

CONCLUSION

We recommend encouraging and guiding pregnant and postpartum women to exercise and train PFM. We also recommend identifying pregnant and postpartum women with symptoms of PFM dysfunction and directing them to a physiotherapist or other health care professional specializing in pelvic floor function.

Current Resources for Evidence-Based Practice, March 2022

An extensive review of new resources to support the provision of evidence-based care for women and infants. The current column includes a discussion of systemic racism and its effect on maternal health in the United States and commentaries on reviews focused on barriers and facilitators to HPV vaccination and delayed cord clamping in preterm infants.