Urinary incontinence (UI) exerts a detrimental impact on women`s quality of life. Pregnancy and delivery are recognized as substantial risk factors for this condition, and it is estimated that up to one third of postpartum women are affected1. Pelvic floor muscle training (PFMT) is acknowledged as a first-line intervention in patients with UI and also recommended for prevention of postpartum UI2. It likely provides additional benefits in preventing prolapse, improving sexual function, addressing anal incontinence, and enhancing delivery outcomes3. There is a growing global momentum in raising awareness about pelvic floor problems through social media and awareness campaigns. However, it is currently unclear whether raising awareness to perform PFMT among parturient women results in increased compliance and adherence to this therapeutic modality and whether it prevent or alleviate urinary symptoms in these women.  
This randomized controlled study aims to investigate the effect of targeted awareness-raising intervention on performing PFMT and its effect on UI symptoms among parturient women.

A randomized controlled trial conducted between January to May 2023, at a university-affiliated hospital. Postpartum women were randomized to receive `usual care` (control group) or to a structural video tutorial of PFMT sent every month (intervention group).  Symptoms and demographic variables were recorded at recruitment, 6 weeks, and 6 months postpartum, using UDI-6 and IIQ-7 questionnaires and a structured Awareness Questionnaire (AQ) (Table 1) to assess awareness levels and internal and external factors influencing their decision to perform PFMT. Given a confidence level of 95%, a power of 80%, and assuming an effect size 0f 0.5, a sample size of 64 women in each group was needed. Since postpartum studies often face a loss to follow-up challenges, methods of Simple-Mean-Imputation and Last Observation Carried Forward (LOCF) Imputation were utilized.

At baseline 195 participants were available for analysis. Demographics, clinical background didn’t vary between the intervention and the control group. The UDI-6 and IIQ-7 scores improved with time among both groups. Although the changes in both UDI-6 and IIQ-7 scores from the baseline were more prominent in the intervention group, these differences reached statistical significance only for the 6 weeks postpartum IIQ-7 score (Table 2). Individual items in the awareness questionnaire (items 3, 4 and 9) showed significant correlation with the UDI-6 and IIQ-7 scores (p=0.018, p=0.0017 and p=0.022, respectively), while other items were not statistically correlated.

The prevalence of urinary complaints among women nearing childbirth is substantial. Equipping women with supportive aids for conducting pelvic floor physiotherapy exercises has proven beneficial at least in part. The group engaging in PFMT demonstrated a significant clinical improvement, although not reached statistical significance in all domains. To enhance awareness and elevate the quality of life for women after childbirth, it is advisable to incorporate thorough education as well as provision of auxiliary tools.

Postpartum awareness raising intervention for PFMT seem to correlate, (at least in part) with improved UI symptoms and quality of life. Further clinical trials are needed in order to support this conclusion.

1.	Hallock JL, Handa VL. The epidemiology of pelvic floor disorders and childbirth: an update. Obstet Gynecol Clin North Am. 2016;43(1):1-13. doi:10.1016/j.ogc.2015.10.00
2.	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;5:CD007471. doi:10.1002/14651858.CD007471.pub4
3.	Schreiner L, Crivelatti I, de Oliveira JM, Nygaard CC, Dos Santos TG. Systematic review of pelvic floor interventions during pregnancy. Int J Gynaecol Obstet. 2018;143(1):10-18. doi:10.1002/ijgo.12513

Continence 12S (2024) 101657
DOI: 10.1016/j.cont.2024.101657