The effect of an antenatal exercise programme including diaphragmatic breathing with co-contraction of abdominal and pelvic floor muscles on stress urinary incontinence postpartum
Date
2016
Authors
Ebrahim, Tasneem Amin
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Abstract
Background: Stress urinary incontinence is a common problem during and after pregnancy. Pelvic floor muscle exercises have been shown to be an effective means to prevent and treat stress urinary incontinence. The literature has shown that abdominal muscles and the diaphragm work in tandem with pelvic floor muscles and co-contraction of all these muscles results in a stronger pelvic floor muscle contraction. However, this has not been tested in pregnant women with stress urinary incontinence and this relationship will be further investigated in this study. Therefore the overall aim of the study is to determine the effect of an antenatal exercise programme including diaphragmatic breathing with co-contraction of abdominal and pelvic floor muscles on stress urinary incontinence postpartum. The following objectives will be addressed:
1. To determine the influence of urinary incontinence on the prepartum quality of life (QOL) of pregnant women.
2. To establish the effect of antenatal co-contraction of pelvic floor and abdominal muscle exercises with diaphragmatic breathing on the amount of urine lost under stress.
3. To establish the effect of antenatal pelvic floor muscle exercises without diaphragmatic breathing and abdominal muscle co-contraction on the amount of urine lost under stress.
4. To determine the influence of urinary incontinence on QOL of pregnant women after the intervention.
5. To compare the effects of the two exercise programmes on urinary incontinence and QOL of pregnant women postpartum.
Method: The single blind randomised controlled trial was conducted with the help of a research assistant. Once ethical clearance was obtained from the Human Research Ethics Committee, participants were recruited from the antenatal clinic at Rahima Moosa Mother and Child Hospital, Crosby Clinic and Westbury Clinic in Gauteng province, Johannesburg, South Africa. Participants were randomised by computer generated randomisation and concealed allocation into the control group or the intervention group. At baseline all participants were requested to perform a modified 20 minute pad test and complete the King’s Health Questionnaire (KHQ). They received an educational talk which included the method of performing Kegel exercises and were given a home exercise programme. Participants in the intervention group were given an exercise diary and taught diaphragmatic breathing as well as co-contraction of the abdominal muscles while doing pelvic floor
exercises. Participants in the intervention group also received telephone calls every two weeks from baseline assessment until follow-up assessment to remind them to do the exercises and record them in their diaries. Re-assessment was conducted at the eight week follow-up assessment where the same questionnaire and pad test was performed again. Telephonic interviews were conducted for those participants who could not attend their follow-up assessments. The significance of the study was set at p=0.05. Two-sample t-tests and the Wilcoxon’s Rank Sum test were used to compare variables between groups and the Kendall’s Tau Correlation Coefficient and the Spearman’s Rank Correlation Coefficient were used to determine correlations between variables.
Results: Fifty-two participants were recruited. Most participants were between the ages of 21 and 30 years (59.6%, n=31) in their second trimester of pregnancy (53.9%, n=28) and most (42.3%, n=22) were experiencing symptoms of stress urinary incontinence for 1 to 2 months. No differences in quality of life were observed between groups at baseline for any part of the King’s Health Questionnaire (part one: p=0.31; part two: p= 0.33 and part three: p=0.46).
Stress incontinence score and pad test results were used as measures of urinary incontinence. There was no significant difference in the stress incontinence scores between groups at follow-up (p=0.58), there was also no significant difference in the pad test results between the control and the intervention group at follow-up (p=1.00). Correlations between the pad test results and the KHQ scores showed only weak correlations at baseline for both groups, but a non-significant strong correlation at follow-up for the intervention group for part one (Kendall’s tau= 0.83 and p=0.13) and part three (Kendall’s tau= 0.83 and p=0.15) of the KHQ. Correlations between the stress incontinence scores and the KHQ also showed weak non-significant correlations for all parts in both groups at baseline, while at follow-up only the intervention group showed a moderate non-significant correlation with part two of the KHQ (Part one: Spearman’s Rho=0.35, p=0.03; part two: Spearman’s Rho = 0.50, p= 0.25; part three: Spearman’s Rho = 0.36, p=0.01).
There were no differences in quality of life between groups at follow-up for any part of the King’s Health Questionnaire (part one: p=0.35; part two: p= 0.09 and part three: p=0.18). There was also no evidence that any of the demographic characteristics could be linked to stress incontinence, pad test scores or quality of life.
Conclusion: Although there were improvements in actual scores of the King’s Health Questionnaire and stress incontinence scores, there were no differences between the
control group and the intervention group and hence, a combination of diaphragmatic breathing and abdominal co-contraction and pelvic floor muscle exercises was not more effective than pelvic floor muscle exercises alone.
Keywords: : “urinary incontinence”; “pregnancy”; “pelvic floor exercises”; “abdominal and respiratory co-activation”; “abdomino-pelvic synergy”; “antenatal” ; “quality of life”
Description
This dissertation is submitted to the Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, in fulfillment of the requirements for the degree of Master of Science in Physiotherapy (dissertation)