Perinatal Dönemde Pelvik Taban Kas Egzersizleri Üriner İnkontinansı Etkiler mi? Randomize Kontrollü Çalışmaların Sistematik İncelenmesi ve Meta-Analizi

Year 2024, Issue: 24, 1308 - 1320, 30.12.2024

Aysu Yıldız Karaahmet , Fatma Şule Bilgiç , Murat Ekmez

https://doi.org/10.38079/igusabder.1523341

Abstract

Amaç: Pelvik taban disfonksiyonu (PTD), idrar kaçırma (İK), anal inkontinans, pelvik organ prolapsusu ve cinsel işlev bozukluğundan oluşur. Bu çalışmada gebelik, doğum ve doğum sonrası dönemde kadınlara uygulanan pelvik taban kas egzersizlerinin üriner inkontinans semptom şiddeti ve yaşam kalitesini inceleyen randomize kontrollü çalışmaların sistematik derlemesi ve meta-analizinin yapılması amaçlandı.
Yöntem: PubMed, Cochrane Library ve Web of Science gibi veri tabanları, MeSH tabanlı anahtar kelimeler kullanılarak tarandı. Yalnızca randomize kontrollü çalışmalar (RKÇ) dahil edildi. Veriler Review Manager bilgisayar programı (Sürüm 5.3) kullanılarak analiz edildi.
Bulgular: Müdahale öncesi gruplar arasında inkontinans ortalamasında birleştirilmiş standartlaştırılmış farklar -0,09 idi (%95 GA: [-0,018, -0,00], p=0,04). Başlangıçta, egzersiz grubunun UDI-6'da ortalama puanları daha düşüktü (MD =-3.32 [-4.61-2.03], p<0.00001). MD egzersiz sonrasında daha yüksekti (MD = -2,85 [-3,10 -2,61], p<0,00001). ICIQ-SF ile ölçülen müdahaleler ve kontrol grupları arasında yaşam kalitesinde bir fark olmadığını gösteren çok az kanıt vardı. Başlangıçta egzersiz grubunun ICIQ-SF'de ortalama puanları daha düşüktü (MD = -0,07 [-0,21-0,08], p=0,37). MD egzersiz sonrası daha yüksekti (MD = -0,06 [-0,16-0,04]; p=0,45 ancak istatistiksel olarak anlamlı bir fark yoktu.
Sonuç: Kanıtlar, ilk doğum yapan kadınlarda pelvik taban kas eğitiminin idrar kaçırma ve postpartum dönemde yaşam kalitesi üzerinde etkili olduğunu göstermiştir. Ancak yüksek kalitede randomize kontrollü çalışmalara ihtiyaç vardır.

Keywords

Gebelik, doğum sonrası, idrar kaçırma, yaşam kalitesi, pelvik taban egzersizi

Does Perinatal Period Pelvic Floor Muscle Exercises Affect Urinary Incontinence? A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Abstract

Aim: Pelvic floor dysfunction (PFD) consists of urinary incontinence (UI), anal incontinence, pelvic organ prolapses, and sexual dysfunction. This study aimed to conduct a systematic compilation and meta-analysis of randomized controlled studies examining urinary incontinence symptom severity and quality of life of pelvic floor muscle exercises performed on women during pregnancy, birth, and postpartum period.
Method: Databases, including PubMed, Cochrane Library, and Web of Science, were scanned using MeSH-based keywords. Only randomized controlled trials (RCT) were included. The data were analyzed using the Review Manager computer program (Version 5.3).
Results: Pooled standardized differences in incontinence mean (SMD) between pre-intervention groups were -0.09 (95% CI: [-0.018, -0.00], p=0.04). Initially, the exercise group had lower average scores in UDI-6 (mean difference (MD) =-3.32 [-4.61-2.03], p<0.00001). MD was higher after exercise (MD = -2.85 [-3.10 -2.61], p<0.00001). There was little evidence of a difference in quality of life between the intervention and control groups as measured by ICIQ-SF. Initially, the exercise group had lower average scores on ICIQ-SF (MD = -0.07 [-0.21-0.08], p=0.37). MD was higher after exercise (MD = -0.06 [-0.16-0.04], p=0.45, but there was no statistically significant difference.
Conclusion: Evidence has shown an effect of pelvic floor muscle training on urinary incontinence and quality of life in the postpartum period in primiparous women. However, high-quality randomized controlled studies are needed.

Keywords

Pregnancy, postpartum, urinary incontinence, quality of life, pelvic floor exercise

References

• 1. Beji NK, Celebi EZ, Avci N. Birth and pelvic floor dysfunction. Journal of Istanbul Faculty of Medicine. 2021;84(2):269-274.
• 2. Bozkurt M, Ender Yumru A, Şahin L. Pelvic floor dysfunction, and effects of pregnancy and mode of delivery on pelvic floor. Taiwan J Obstet Gynecol. 2014;53(4):452-458.
• 3. Lipschuetz M, Cohen SM, Libergall-Wischnitzer M, et al. Degree of bother from pelvic floor dysfunction in women one year after first delivery. Eur J Obstet Gynecol Reprod Biol. 2015;191:90-4.
• 4. Santesso N, Glenton C, Dahm P, et al. GRADE Working Group. GRADE guidelines 26: Informative statements to communicate the findings of systematic reviews of interventions. Journal of Clinical Epidemiology. 2020;119:126-135.
• 5. Tahtinen RM, Carwright R, Tsui JF, et al. Long-term impact of mode of delivery on stress urinary incontinence and urgency urinary incontinence: A systematic review and meta-analysis. Eur Urol. 2016;70(1):148-58.
• 6. Lukacz ES, Santiago-Lastra Y, Albo ME, Brubaker L. Urinary incontinence in women: A review. JAMA. 2017;318(16):1592-1604.
• 7. Mota RL. Female urinary incontinence and sexuality. International Braz J Urol. 2017;43(1):20-28.
• 8. Kucukkaya B, Milk HK. Traditional and complementary treatments used in pelvic floor disorders. Ordu University Journal of Nursing Studies. 2020;3(1):44-53.
• 9. Woodley SJ, Lawrenson P, Boyle R, et al. Pelvic floor muscle training for preventing and treating urinary and faecal incontinence in antenatal and postnatal women. Cochrane Database Syst Rev. 2020;6;5(5):CD007471. doi: 10.1002/14651858.CD007471.
• 10. Rethlefsen ML, Kirtley S, Waffenschmidt S, et al. PRISMA-S: an extension to the PRISMA statement for reporting literature searches in systematic reviews. Systematic Reviews. 2021;10(1):1-19.
• 11. Deeks J, Higgins J, Altman SD. Greencochrane Handbook For Systematic Reviews Of Interventions Version 5.1. 0 The Cochrane Collaboration (Updated March 2011).
• 12. Yang S, Sang W, Feng J, 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):4537-4547.
• 13. Sacomori C, Zomkowski K, Dos Passos Porto I, et al. Adherence and effectiveness of a single instruction of pelvic floor exercises: A randomized clinical trial. International Urogynecology Journal. 2019;31(5):951-959.
• 14. Artymuk NV, Khapacheva SY. Device-assisted pelvic floor muscle postpartum exercise programme for the management of pelvic floor dysfunction after delivery. The Journal of Maternal-Fetal & Neonatal Medicine. 2022;35(3):481-485. doi: 2020.10.1080/14767058.2020.1723541.
• 15. Johannessen HH, Frøshaug BE, Lysåker PJG. Regular antenatal exercise including pelvic floor muscle training reduces urinary incontinence 3 months postpartum—Follow up of a randomized controlled trial. Acta Obstet Gynecol Scand. 2021;100:294–301. doi: 10.1111/aogs.14010.
• 16. Sigurdardottir T, Steingrimsdottir T, Geirsson RT. Can postpartum pelvic floor muscle training reduce urinary and anal incontinence? An assessor-blinded randomized controlled trial. Am J Obstet Gynecol. 2020;222:247.e1-8.
• 17. Wang X, Xu X, Luo J, et al. Effect of app-based audio guidance pelvic floor muscle training on treatment of stress urinary incontinence in primiparas: A randomized controlled trial. International Journal of Nursing Studies. 2020;104:103527. doi: 10.1016/j.ijnurstu.2020.103527.
• 18. Piernicka M, Błudnicka M, Kortas J, et al. High-impact aerobics programme supplemented by pelvic floor muscle training does not impair the function of pelvic floor muscles in active nulliparous women: A randomized control trial. Medicine. 2021;100:33(e26989).
• 19. Jaffar A, Mohd Sidik S, Foo CN, et al. Preliminary effectiveness of mhealth app-based pelvic floor muscle training among pregnant women to improve their exercise adherence: A pilot randomised control trial. Int. J. Environ. Res. Public Health. 2022:19;2332. doi: 10.3390/ ijerph19042332.
• 20. Sobhgol SS, Priddis H, Smith CA, Dahlent HG. Effect of pelvic floor muscle exercise on female sexual function during pregnancy and postpartum: A systematic review. Sex Med Rev. 2018;7(1):13-28.
• 21. Davenport MH, Nagpal TS, Mottola MF, et al. Prenatal exercise (including but not limited to pelvic floor muscle training) and urinary incontinence during and following pregnancy: A systematic review and meta-analysis. British Journal of Sports Medicine. 2018;52(21):1397-1404.
• 22. Soave I, Scarani S, Mallozzi M. Pelvic floor muscle training for prevention and treatment of urinary incontinence during pregnancy and after childbirth and its effect on urinary system and supportive structures assessed by objective measurement techniques. Arch Gynecol Obstet. 2019;299:609–623. doi: 10.1007/s00404-018-5036-6.
• 23. Zarawski M, Kołomańska-Bogucka D, Maj M, et al. The impact of pelvic floor exercises on the quality of life of women with urinary incontinence: Analysis of pregnancy and the postpartum period. Journal of Novel Physiotherapy and Physical Rehabilitation. 2017;4(2):144-47.
• 24. Pizzol D, Demurtas J, Celotto S, et al. Urinary incontinence and quality of life: A systematic review and meta-analysis. Aging Clin Exp Res. 2021;33(1):25-35.
• 25. Çiloglu D, Zaybak A. Coping behaviors and quality of life in individuals with urinary incontinence. Türkiye Klinikleri Journal of Nursing Sciences. 2020;12(1):64-71.
• 26. Yılmaz Bulut T, Altay B. Sleep quality and quality of life in older women with urinary incontinence residing in Turkey: A cross-sectional survey. J Wound Ostomy Continence Nurs. 2020;47(2):166-171.