Objective: To evaluate the effect of pelvic floor muscle exercises (PFME) for postpartum anal incontinence (AI).
Design: A parallel two-armed randomised controlled trial stratified on obstetrical anal sphincter injury with primary sphincter repair and hospital affinity.
Setting: Ano-rectal specialist out-patient clinics at two hospitals in Norway.
Population: One hundred and nine postpartum women with AI at baseline.
Methods: The intervention group received 6 months of individual physiotherapy-led PFME and the control group written information on PFME. Changes in St. Mark's scores and predictors of post-intervention AI were assessed by independent samples t-tests and multiple linear regression analyses, respectively. The study was not blind.
Main outcome measures: The primary outcome measure was change in AI symptoms on the St. Mark's score from baseline to post-intervention. Secondary outcome measures were manometry measures of anal sphincter length and strength, endoanal ultrasound (EAUS) defect score and voluntary pelvic floor muscle contraction.
Results: There was a significant difference in the reduction of St. Mark's scores from baseline to post-intervention in favour of the PFME group (-2.1 versus -0.8 points, P = 0.040). No differences in secondary outcome measures were found between groups. Baseline St. Mark's, PFME group affinity and EAUS defect score predicted post-intervention St. Mark's score in the imputed intention-to-treat analyses. The analysis on un-imputed data showed that women performing weekly PFME improved their AI scores more than women in the control group did.
Conclusions: Our results indicate that individually adapted PFME reduces postpartum AI symptoms.
Tweetable abstract: Performing regular pelvic floor muscle exercises may be an effective treatment for postpartum anal incontinence.
Keywords: Anal incontinence; pelvic floor muscle exercises; randomised controlled trial.
© 2016 Royal College of Obstetricians and Gynaecologists.