Difference in pelvic floor muscle strength among pregnant women and its effect on labour and postpartum stress urinary incontinence

doi:10.3877/cma.j.issn.1674-0785.2023.03.005

Abstract

Abstract:

Objective

To investigate the difference in pelvic floor muscle strength among pregnant women and their mastery level of pelvic floor muscle training (PFMT) and explore the effect of pelvic floor muscle strength on labour and postpartum stress urinary incontinence (SUI).

Methods

A total of 220 singleton primiparae who received routine antenatal assessment and delivered in Peking University Shougang Hospital from September 2018 to March 2021 were selected. All participants underwent pelvic floor muscle strength assessment by vaginal palpation and PFMT instruction at the 28th week of gestation and were divided into a strong strength group (group A), a moderate strength group (group B), and a weak strength group (group C). Parameters related to muscle strength as well as correlation of muscle strength with delivery and SUI were analyzed in the three groups.

Results

Approximately 51.1% (113) of cases could perform PFMT correctly, while 18.2% (40 cases) could not , and the remaining 30.7% (67 cases) had weak muscle strength or insufficient endurance. Of the 220 women included, 135 had full-term vaginal delivery (group A, 75 cases; group B, 42 cases; group C, 18 cases), while 10 had premature vaginal delivery, and 75 had caesarean delivery. Body height was significantly higher in group A than in groups B and C (P＜0.05), while there were significant differences in pre-pregnancy body weight and body mass index (BMI) between groups A and C (P＜0.05). Pelvic floor muscle strength was positively correlated with body height, pre-pregnancy body weight, and BMI. Length of the first stage of labour in group A was shorter significantly than that in group C (P＜0.05). The incidence of SUI in women who underwent vaginal delivery did not differ significantly among the three groups (P＞0.05), but the incidence of SUI in women who underwent caesarean delivery in strong group was significantly lower in group A than in group B (P＜0.05).

Conclusion

There are individual differences in pelvic floor muscle strength among pregnant women, which may be related to body height, pre-pregnancy body weight, and BMI. Strong pelvic floor muscle strength could help shorten the first stage of labour and reduce the incidence of SUI after caesarean delivery. Accurate PFMT is of great clinical importance in these women.

Key words: Pelvic floor muscle strength, Pelvic floor muscle training, Labour, Stress urinary incontinence

Xiaoli Wang, Shaohua Lin, Yingying Liu, Ying Fan. Difference in pelvic floor muscle strength among pregnant women and its effect on labour and postpartum stress urinary incontinence[J]. Chinese Journal of Clinicians(Electronic Edition), 2023, 17(03): 260-265.

/ / Recommend

Add to citation manager EndNote|Ris|BibTeX

URL: https://zhlcyszz.cma-cmc.com.cn/EN/10.3877/cma.j.issn.1674-0785.2023.03.005

https://zhlcyszz.cma-cmc.com.cn/EN/Y2023/V17/I03/260

Figures/Tables 7

级别	指征
0	不懂得阴道收缩，只懂得腹部收缩
1	有肌肉颤动
2	有非震动样的弱压力，但不能将检查者手指顶起
3	检查者手指有弱顶举感
4	检查者手指被牢固的抓住并吸进
5	检查者手指被牢牢抓住并有明显的顶举感

指标	分组			F/χ²值	P值
指标	A组（113）	B组（67）	C组（40）	F/χ²值	P值
学历（例）				0.834	0.659
初中、中专	5	1	5
高中、大专	33	24	12
大学及以上	75	42	23
年龄（岁， $x ¯$ ±s）	29.40±4.13	30.11±3.27	29.56±2.99	0.317	0.729
胎儿体重（g， $x ¯$ ±s）	3328.00±499.24	3330.37±392.48	3040.00±504.22	2.472	0.090
身高（cm， $x ¯$ ±s）	163.62±5.15	160.48±4.67*	160.38±6.22^a	4.089	0.020
孕前体重（kg， $x ¯$ ±s）	58.48±9.37	55.51±8.05	54.44±12.32	1.422	0.247
产前体重（kg， $x ¯$ ±s）	72.46±10.07	69.64±8.57	69.12±13.40	0.949	0.391
孕前BMI（ $x ¯$ ±s）	21.77±2.87	21.61±2.88	21.14±3.93	0.253	0.777
产前BMI（ $x ¯$ ±s）	27.00±3.07	26.98±2.98	26.73±3.95	0.045	0.956

指标	分组			F/χ²值	P值
指标	A组（113）	B组（67）	C组（40）	F/χ²值	P值
学历（例）				0.834	0.659
初中、中专	5	1	5
高中、大专	33	24	12
大学及以上	75	42	23
年龄（岁， $x ¯$ ±s）	29.40±4.13	30.11±3.27	29.56±2.99	0.317	0.729
胎儿体重（g， $x ¯$ ±s）	3328.00±499.24	3330.37±392.48	3040.00±504.22	2.472	0.090
身高（cm， $x ¯$ ±s）	163.62±5.15	160.48±4.67*	160.38±6.22^a	4.089	0.020
孕前体重（kg， $x ¯$ ±s）	58.48±9.37	55.51±8.05	54.44±12.32	1.422	0.247
产前体重（kg， $x ¯$ ±s）	72.46±10.07	69.64±8.57	69.12±13.40	0.949	0.391
孕前BMI（ $x ¯$ ±s）	21.77±2.87	21.61±2.88	21.14±3.93	0.253	0.777
产前BMI（ $x ¯$ ±s）	27.00±3.07	26.98±2.98	26.73±3.95	0.045	0.956

指标	分组			F/χ²值	P值
指标	a组（75）	b组（42）	c组（18）	F/χ²值	P值
学历（例）				4.088	0.129
初中、中专	2	1	2
高中、大专	23	15	10
大学及以上	50	26	6
年龄（岁， $x ¯$ ±s）	29.97±3.83	30.65±3.26	28.71±2.98	0.736	0.484
胎儿体重（g， $x ¯$ ±s）	3277.00±493.40	3355.88±404.26	3150.00±305.94	0.535	0.589
身高（cm， $x ¯$ ±s）	163.87±4.75	160.71±4.87	161.86±3.48	2.601	0.084
孕前体重（kg， $x ¯$ ±s）	58.21±8.70	52.75±5.15*	49.36±6.41*	5.455	0.007
产前体重（kg， $x ¯$ ±s）	72.51±10.31	66.73±6.97	65.61±6.32	3.127	0.052
孕前BMI（ $x ¯$ ±s）	21.60±2.61	20.54±1.75	18.81±2.23*	4.387	0.017
产前BMI（ $x ¯$ ±s）	26.92±3.06	25.76±2.36	26.31±2.82	1.791	0.177

指标	分组			F/χ²值	P值
指标	a组（75）	b组（42）	c组（18）	F/χ²值	P值
学历（例）				4.088	0.129
初中、中专	2	1	2
高中、大专	23	15	10
大学及以上	50	26	6
年龄（岁， $x ¯$ ±s）	29.97±3.83	30.65±3.26	28.71±2.98	0.736	0.484
胎儿体重（g， $x ¯$ ±s）	3277.00±493.40	3355.88±404.26	3150.00±305.94	0.535	0.589
身高（cm， $x ¯$ ±s）	163.87±4.75	160.71±4.87	161.86±3.48	2.601	0.084
孕前体重（kg， $x ¯$ ±s）	58.21±8.70	52.75±5.15*	49.36±6.41*	5.455	0.007
产前体重（kg， $x ¯$ ±s）	72.51±10.31	66.73±6.97	65.61±6.32	3.127	0.052
孕前BMI（ $x ¯$ ±s）	21.60±2.61	20.54±1.75	18.81±2.23*	4.387	0.017
产前BMI（ $x ¯$ ±s）	26.92±3.06	25.76±2.36	26.31±2.82	1.791	0.177

产程	分组			F/χ²值	P值
产程	a组（75）	b组（42）	c组（18）	F/χ²值	P值
一程	5.00（3.88，7.67）	7.00（5.17，8.83）	9.00（5.00，15.50）^a	6.562	0.038
二程	0.64（0.39，1.10）	0.83（0.48，1.68）	0.67（0.47，1.42）	1.305	0.521
三程	0.08（0.08，0.08）	0.08（0.08，0.16）	0.08（0.08，0.13）	2.415	0.299

分组	例数	足月经阴道分娩（%）	χ²值	P值
A组	113	75（66.37）	2.657	0.265
B组	67	42（62.68）
C组	40	18（45）

分组	例数	SUI	非SUI	χ²值	P值	PFMT（%）	未PFMT（%）	χ²值	P值
强组	80	35（43.75）	45（56.25）	0.114	0.945	20（33.33）	60（16.67）	0.380	0.827
中组	45	17（37.78）	28（62.22）			10（22.22）	35（77.78）
弱组	18	7（38.88）	11（71.12）			3（16.67）	15（83.33）

分组	例数	SUI	非SUI	χ²值	P值	PFMT	未PFMT	χ²值	P值
强组	30	2（6.67）	28（93.33）	6.458	0.04	1（3.33）	29（96.67）	0.462	0.317
中组	20	5（25）	15（75）			2（10）	18（90）
弱组	20	7（35）^a	13（65%）			2（10）	18（90）

References 19

1	Van Geelen H, Ostergard D, Sand P. A review of the impact of pregnancy and childbirth on pelvic floor function as assessed by objective measurement techniques [J]. Int Urogynecol J, 2018, 29(3): 327-338.
2	Stroeder R, Radosa J, Clemens L, et al. Urogynecology in obstetrics: impact of pregnancy and delivery on pelvic floor disorders, a prospective longitudinal observational pilot study [J]. Arch Gynecol Obstet, 2021, 304(2): 401-408.
3	Woodley SJ, Hay-Smith EJC. Narrative review of pelvic floor muscle training for childbearing women-why, when, what, and how [J]. Int Urogynecol J, 2021, 32(7): 1977-1988.
4	Du Y, Xu L, Ding L, et al. The effect of antenatal pelvic floor muscle training on labor and delivery outcomes: a systematic review with meta-analysis [J]. Int Urogynecol J, 2015, 26(10): 1415-1427.
5	Dumoulin C, Hay-Smith J. Pelvic floor muscle training versus no treatment, or inactive control treatments, for urinary incontinence in women [J]. Cochrane Database Syst Rev, 2010, (1): CD005654.
6	海宁, 朱兰, 郎景和. 盆底障碍性疾病盆底自主收缩肌肉力量研究 [J]. 生殖医学杂志, 2008, (5): 321-324.
7	Ignácio Antônio F, Bø K, Pena CC, et al. Intravaginal electrical stimulation increases voluntarily pelvic floor muscle contractions in women who are unable to voluntarily contract their pelvic floor muscles: a randomised trial [J]. J Physiother, 2022, 68(1): 37-42.
8	Kegel AH, Powell TO. The physiologic treatment of urinary stress incontinence [J]. J Urol, 1950, 63(5): 808-814.
9	林红, 王旭东. 提肛运动源流考 [J]. 国际中医中药杂志, 2014, 36(5): 448-451.
10	Bump RC, Hurt WG, Fantl JA, et al. Assessment of Kegel pelvic muscle exercise performance after brief verbal instruction [J]. Am J Obstet Gynecol, 1991, 165(2): 322-327; discussion 327-329.
11	Mateus-Vasconcelos ECL, Brito LGO, Driusso P, et al. Effects of three interventions in facilitating voluntary pelvic floor muscle contraction in women: a randomized controlled trial [J]. Braz J Phys Ther, 2018, 22(5): 391-399.
12	Gümüşsoy S, Öztürk R, Kavlak O, et al. Investigating pelvic floor muscle strength in women of reproductive age and factors affecting it [J]. Clin Nurs Res, 2021, 30(7): 1047-1058.
13	Ghandour L, Minassian V, Al-Badr A, et al. Prevalence and degree of bother of pelvic floor disorder symptoms among women from primary care and specialty clinics in Lebanon: an exploratory study [J]. Int Urogynecol J, 2017, 28(1): 105-118.
14	Fang J, Ye J, Huang Q, et al. Risk factors of pelvic floor muscle strength in south Chinese women: A retrospective study [J]. BMC pregnancy and childbirth, 2022, 22(1): 624.
15	Aran T, Pekgöz I, Bozkaya H, et al. Association between preterm labour and pelvic floor muscle function [J]. J Obstet Gynaecol, 2018, 38(8): 1060-1064.
16	Blomquist JL, Carroll M, Muñoz A, et al. Pelvic floor muscle strength and the incidence of pelvic floor disorders after vaginal and cesarean delivery [J]. Am J Obstet Gynecol, 2020, 222(1): 62.e1-62, e8.
17	National Guideline Alliance (UK). Assessment in non-specialist care: Pelvic floor dysfunction: prevention and non-surgical management: Evidence review I [M]. London: National Institute for Health and Care Excellence (NICE); 2021 Dec.
18	Bø K, Fleten C, Nystad W. Effect of antenatal pelvic floor muscle training on labor and birth [J]. Obstet Gynecol, 2009, 113(6): 1279-1284.
19	Talasz H, Kremser C, Talasz HJ, et al. Breathing, (S)training and the pelvic floor-A basic concept [J]. Healthcare (Basel), 2022, 10(6): 1035.

[1]	Ning Li, Lin Ma, Yanmin Kan, Xiaosong Li, Jie Li. Value of transperineal ultrasonography in grading diagnosis of different degrees of stress urinary incontinence [J]. Chinese Journal of Medical Ultrasound (Electronic Edition), 2021, 18(01): 74-78.
[2]	Xuan Zheng, Yun Zhao. Research status of pelvic floor dysfunction diseases during pregnancy and postpartum and its prevention and treatment [J]. Chinese Journal of Obstetrics & Gynecology and Pediatrics(Electronic Edition), 2022, 18(03): 366-372.
[3]	Weimin Fan, Xiaohui Mei, Jina Chen, Fuyun Dong, Liwen Zhang, Yaping Chen, Jinhua Zhou, Rujun Chen. Clinical study of improvement on menopausal symptoms in middle aged and elderly women by pelvic floor muscle training [J]. Chinese Journal of Obstetrics & Gynecology and Pediatrics(Electronic Edition), 2022, 18(01): 94-101.
[4]	Hui Cheng, Jie Cheng, Bei Zhang, Yanling Zhang, Yanyu Li. Effects of pelvic floor muscle training combined with neuromuscular electrical stimulation in treatment of pelvic organ prolapse [J]. Chinese Journal of Obstetrics & Gynecology and Pediatrics(Electronic Edition), 2020, 16(01): 107-113.
[5]	Jing Xu, Aohua Zhang, Zeping Huang, Zhijuan Zheng, Manting Su, Xiangfu Zhou, Xinling Zhang. Study on the relationship between female urethral funneling and stress urinary incontinence [J]. Chinese Journal of Endourology(Electronic Edition), 2022, 16(06): 546-549.
[6]	Zhentao Gao, Xiangfu Zhou, Xuelian Chen, Yanshan Ding, Jing Gao, Qiuping Ma, Danling Rao, Bolong Liu. Clinical efficacy analysis of fractional CO₂ laser in the treatment of female with mild-to-moderate stress urinary incontinence [J]. Chinese Journal of Endourology(Electronic Edition), 2022, 16(01): 40-44.
[7]	Fanyou Bu, Xueshuang Dai, Yingyu Zhang, Zhilei Qiu, Miao Xin. Effect of acupuncture on urinary incontinence after laparoscopic radical prostatectomy under the guidance of enhanced recovery after surgery [J]. Chinese Journal of Endourology(Electronic Edition), 2022, 16(01): 31-34.
[8]	Limei Zhang, Biyan Wen, Huican Yu, Kun Bao, Shiju Huang, Shasha Li, Guili Chen, Youdi Cai. Effects of negative pressure therapy combined with pelvic floor muscle training on urinary continence and sexual function in patients after radical prostatectomy [J]. Chinese Journal of Endourology(Electronic Edition), 2022, 16(01): 28-30.
[9]	Rui Zeng, Yanxin Dong, Xiaokang Gao, Mingde Zhu, Shuangjin Huo, Dong Li, Nijat, Hui Fang. Extraperitoneal laparoscopic burch colposuspension in the treatment of recurrent stress urinary incontinence after tension-free vaginal tape-obturator (TVT-O): Initial experiences [J]. Chinese Journal of Endourology(Electronic Edition), 2021, 15(01): 51-54.
[10]	Xiangfu Zhou, Tengcheng Li, Hailun Zhan, Fei Yang, Jiarong Cai, Bolong Liu, Wengbiao Li. Anterior mesh vaginal wall repair for the treatment of cystocele: 19 cases report [J]. Chinese Journal of Endourology(Electronic Edition), 2018, 12(01): 35-38.
[11]	Weiying Cao, Shujuan Zhao. Analysis of the influencing factors of new stress urinary incontinence in patients with uterine prolapse after vaginal hysterectomy combined with anterior and posterior vaginal wall repair [J]. Chinese Journal of Hernia and Abdominal Wall Surgery(Electronic Edition), 2020, 14(01): 63-66.
[12]	Ran Zhang, Ming Zhang, Fengping Liu. Efficacy of magnetoelectric pelvic floor rehabilitation therapy in patients with postpartum stress urinary incontinence [J]. Chinese Journal of Clinicians(Electronic Edition), 2022, 16(11): 1103-1108.
[13]	Xiaoxia Yang, Huijin Yu, Jundi Sun, Xun Yang, Jiansheng Niu, Ting Da, Tengjiao Zhao, Yan Zhang. The efficacy of vaginal dumbbell training combined with pelvic floor muscle biofeedback in the treatment of stress urinary incontinence in elderly women [J]. Chinese Journal of Geriatrics Research(Electronic Edition), 2021, 08(03): 30-33.
[14]	Lianchao Jin, Bing Yang, Zhe Zhou, Dongliang Pan, Zunke Xie. Correlation of metabolic syndrome and stress urinary incontinence in women [J]. Chinese Journal of Obesity and Metabolic Diseases(Electronic Edition), 2023, 09(02): 109-113.
[15]	Jun Bai, Yujing Hao, Chen Chen, Xiaxia Cui, Yanping Gao. Effects of overweight and obesity on SUI model of SD rats and its molecular mechanism. [J]. Chinese Journal of Obesity and Metabolic Diseases(Electronic Edition), 2020, 06(02): 82-90.

Please choose a citation manager

Content to export