Effects of training interventions to treat postpartum urinary incontinence: a meta-analysis

Abstract

[Abstract] Background: Urinary incontinence (UI) is a common symptom after childbirth. Training interventions are recommended for its management.

Objectives: To evaluate the effects of abdominal and/or pelvic floor muscle training (PFMT) combined with other conservative tools.

Search strategy: The MEDLINE, Scopus, Cochrane Library, Web of Science and Physiotherapy Evidence Database (PEDro) databases were searched from inception to November 6th, 2024.

Selection criteria: Three reviewers independently reviewed titles, abstracts, and full texts.

Data collection and analysis: Experimental studies addressing the effects of training interventions on UI severity during the postpartum period were included. The Hartung-Knapp-Sidik-Jonkman method was used to calculate pooled estimates of the standardised mean differences (SMDs) and their respective 95% confidence intervals (CIs). Subgroup analyses and meta-regression models were performed according to population characteristics, intervention characteristics, and type of outcome measure. The protocol was registered on the International Prospective Register of Systematic Reviews (PROSPERO: CRD42023489312).

Main results: Nineteen published studies were included. There was no statistically significant difference in UI severity in the analyses comparing training interventions versus controls or education interventions (SMD = -1.08; 95% CI: -2.24 to 0.08). According to the pre-post analyses, PFMT (SMD = -1.45; 95% CI: -2.61 to -0.28), PFMT through electrical stimulation (ES)/biofeedback (BFB) (SMD = -2.16; 95% CI: -3.50 to -0.81), and PFMT combined with abdominal muscle training (AMT) (SMD = -1.73; 95% CI: -3.42 to -0.03) modalities showed a statistically significant reduction of UI in postpartum women.

Conclusions: This meta-analysis provides an overview of the evidence supporting PFMT alone or in combination with ES, BFB, or AMT as suitable conservative approaches for the treatment of UI in the postpartum period. Further studies are needed to establish recommendations for abdominal wall training alone in the treatment of UI.