Wu You Maria, McInnes Natalia, Leong Yvonne
Female Pelvic Med Reconstr Surg. 2018 Mar/Apr;24(2):142-149. doi: 10.1097/SPV.0000000000000513.
Pelvic floor muscle training (PFMT) is often recommended to treat postpartum urinary incontinence (UI). However, the role of postpartum PFMT in pelvic organ prolapse (POP), sexual function, and anal incontinence (AI) remains unclear. We therefore aim to assess the efficacy of postpartum PFMT on these pelvic floor disorders.
This study is a meta-analysis consisting of randomized controlled trials (RCTs). We searched databases including CENTRAL, MEDLINE, EMBASE, CINAHL, and PEDro. We also sought after grey literature including conference proceedings. We included RCTs comparing PFMT versus watchful waiting in women with stage II or less POP within 1 year postpartum. Two authors independently performed study screening, risk of bias assessments, and data extraction.
Fifteen RCTs (3845 patients) were included. Women undergoing PFMT less likely report bothersome POP symptoms (risk ratio [RR], 0.48 [0.30-0.76]; very low-quality evidence). There is no significant difference in the number of women with stage II or greater POP (RR, 0.74 [0.45-1.24]; moderate-quality evidence). Fewer women receiving PFMT report the presence of sexual dysfunction (RR, 0.48 [0.30-0.77]; low-quality evidence). There is no significant difference in AI symptoms (RR, 1.11 [0.82-1.51]), but PFMT may be more beneficial for women with anal sphincter injuries (standardized mean differencein AI scores, -0.57 [-1.12 to -0.02]; low-quality evidence). Women receiving PFMT less likely report UI (RR, 0.44 [0.25-0.75]; moderate-quality evidence) with a more pronounced effect on stress UI (SUI).
At present, it remains uncertain whether postpartum PFMT improves POP symptoms because of very low-quality evidence, and more high-quality RCTs are needed in this area. The POP staging will likely not change with postpartum PFMT. The PFMT may result in improved postpartum sexual function compared to watchful waiting, and may provide benefit for AI in women with anal sphincter injuries. Postpartum PFMT likely reduces the risk of UI, particularly stress urinary incontinence symptoms. There is currently little evidence about postpartum PFMT and long-term pelvic floor function.
盆底肌训练（PFMT）常被推荐用于治疗产后尿失禁（UI）。然而，产后PFMT在盆腔器官脱垂（POP）、性功能及肛门失禁（AI）方面的作用仍不明确。因此，我们旨在评估产后PFMT对这些盆底功能障碍的疗效。
本研究是一项包含随机对照试验（RCT）的荟萃分析。我们检索了CENTRAL、MEDLINE、EMBASE、CINAHL和PEDro等数据库。我们还查找了包括会议论文集在内的灰色文献。我们纳入了产后1年内比较PFMT与观察等待对II期及以下POP女性疗效的RCT。两位作者独立进行研究筛选、偏倚风险评估及数据提取。
纳入了15项RCT（3845例患者）。接受PFMT的女性报告烦人的POP症状的可能性较小（风险比[RR]，0.48[0.30 - 0.76]；极低质量证据）。II期及以上POP女性的数量无显著差异（RR，0.74[0.45 - 1.24]；中等质量证据）。接受PFMT的女性报告存在性功能障碍的较少（RR，0.48[0.30 - 0.77]；低质量证据）。AI症状无显著差异（RR，1.11[0.82 - 1.51]），但PFMT可能对有肛门括约肌损伤的女性更有益（AI评分的标准化均值差，-0.57[-1.12至-0.02]；低质量证据）。接受PFMT的女性报告UI的可能性较小（RR，0.44[0.25 - 0.75]；中等质量证据），对压力性尿失禁（SUI）的影响更显著。
目前，由于证据质量极低，产后PFMT是否能改善POP症状仍不确定，该领域需要更多高质量的RCT。产后PFMT可能不会改变POP分期。与观察等待相比，PFMT可能会改善产后性功能，且可能对有肛门括约肌损伤的女性的AI有益。产后PFMT可能会降低UI的风险，尤其是压力性尿失禁症状。目前关于产后PFMT与长期盆底功能的证据很少。
