Adherence and effectiveness of a single instruction of pelvic floor exercises: a randomized clinical trial

  • Cinara Sacomori
  • Kamilla Zomkowski
  • Isabela dos Passos Porto
  • Fernando Luiz Cardoso
  • Fabiana Flores Sperandio
Original Article


Introduction and hypothesis

In Brazil there are limited knowledge and education about preventative exercises for pelvic floor muscles (PFMs). We hypothesised that a single pelvic floor muscle exercise (PFME) session immediately postpartum would be effective in preventing urinary incontinence (UI) in a 3-month postpartum period with good adherence rates.


Two hundred two women were approached for this randomised controlled trial and randomly assigned to two groups: the control group and experimental group. The intervention comprised a visual assessment of PFM contraction, a single PFME instruction session supervised by a physical therapist, and an educational approach through distribution of brochures about home-based PFME exercises (without supervision). Involuntary urinary loss and quality of life (QoL) were evaluated using the International Consultation on Incontinence Questionnaire Short Form (main outcome). Sociodemographic and clinical information was collected. Adherence and barriers were assessed via telephone/mobile phone surveys (secondary outcomes).


The adherence rate was 85.1%; only 37% of the women reported having some knowledge about PFME prior to participating in this study. The main barriers to PFME mentioned were forgetfulness (61.2%), lack of time (52.2%), and the need to take care of the baby (56.7%). One instruction session on postnatal PFME delivered in the immediate postpartum period was ineffective for improving urinary symptoms such as frequency of leakage (p = 0.821), amount of leakage (p = 0.746), and influence of leakage on QoL (p = 0.823). In addition, there was no difference in QoL 3 months post-partum (p = 0.872).


Although the proposed intervention did not prevent UI symptoms, the adherence rate to PFME was high.


Exercise therapy Pelvic floor Postpartum period Public health Randomised clinical trial Urinary incontinence 



This research was conducted with the support of Leonice Boer and Camila Aguiar Fritzen.

Compliance with ethical standards

Conflicts of interest


Supplementary material

192_2019_4032_MOESM1_ESM.pdf (412 kb)
ESM 1 (PDF 411 kb)


  1. 1.
    Haylen BT, de Ridder D, Freeman RM, et al. An International Urogynecological Association (IUGA)/International Continence Society (ICS) joint report on the terminology for female pelvic floor dysfunction. Neurourol Urodyn. 2009;29:5–26. Scholar
  2. 2.
    Smith AP. Female urinary incontinence and wellbeing: results from a multi-national survey. BMC Urol. 2016;16:22. Scholar
  3. 3.
    Thüroff JW, Abrams P, Andersson K-E, et al. EAU guidelines on urinary incontinence. Eur Urol. 2011;59:387–400. Scholar
  4. 4.
    Deffieux X, Vieillefosse S, Billecocq S, et al. Rééducation périnéale et abdominale dans le post-partum : recommandations. J Gynécologie Obs Biol la Reprod. 2015;44:1141–6. Scholar
  5. 5.
    Woodley SJ, Boyle R, Cody JD, Mørkved S, Hay-Smith EJC. Pelvic floor muscle training for prevention and treatment of urinary and faecal incontinence in antenatal and postnatal women. Cochrane Database of Systematic Reviews 2017, Issue 12. Art. No.: CD007471.
  6. 6.
    Hilde G, Stær-Jensen J, Siafarikas F, et al. Postpartum pelvic floor muscle training and urinary incontinence. Obstet Gynecol. 2013;122:1231–8. Scholar
  7. 7.
    Bo K, Frawley HC, Haylen BT, et al. An International Urogynecological Association (IUGA)/International Continence Society (ICS) joint report on the terminology for the conservative and nonpharmacological management of female pelvic floor dysfunction. Neurourol Urodyn. 2017;36:221–44. Scholar
  8. 8.
    KEGEL AH. Progressive resistance exercise in the functional restoration of the perineal muscles. Am J Obstet Gynecol. 1948;56:238–48.CrossRefPubMedGoogle Scholar
  9. 9.
    Battut A, Nizard J. Impact of pelvic floor muscle training on prevention of perineal pain and dyspareunia in postpartum. Prog Urol. 2016;26:237–44. Scholar
  10. 10.
    Hay-Smith J, Dean S, Burgio K, et al. Pelvic-floor-muscle-training adherence "modifiers": a review of primary qualitative studies-2011 ICS state-of-the-science seminar research paper III of IV. Neurourol Urodyn. 2015;34:622–31. Scholar
  11. 11.
    Berzuk K, Shay B. Effect of increasing awareness of pelvic floor muscle function on pelvic floor dysfunction: a randomized controlled trial. Int Urogynecol J. 2015;26:837–44. Scholar
  12. 12.
    Dumoulin C, Hay-Smith J, Frawley H, et al. 2014 consensus statement on improving pelvic floor muscle training adherence: international continence society 2011 state-of-the-science seminar. Neurourol Urodyn. 2015;34:600–5. Scholar
  13. 13.
    Frawley HC, Dean SG, Slade SC, Hay-Smith EJC. Is pelvic-floor muscle training a physical therapy or a behavioral therapy? A call to name and report the physical, cognitive, and behavioral elements. Phys Ther. 2017;97:425–37. Scholar
  14. 14.
    Furlanetto DLC, Pinho DLM, Parreira CMSF. Re-orientation of human resources for health: a great challenge for the Brazilian National Health System. Public Health. 2015;129:1166–71. Scholar
  15. 15.
    Alewijnse D, Mesters I, Metsemakers J, van den Borne B. Predictors of long-term adherence to pelvic floor muscle exercise therapy among women with urinary incontinence. Health Educ Res. 2003;18:511–24.CrossRefPubMedGoogle Scholar
  16. 16.
    Tamanini JTN, Dambros M, D'Ancona CAL, et al. Validation of the “International Consultation on Incontinence Questionnaire - Short Form”. (ICIQ-SF) for Portuguese. Rev Saude Publica. 2004; 38:438-44.
  17. 17.
    Avery K, Donovan J, Peters TJ, et al. ICIQ: a brief and robust measure for evaluating the symptoms and impact of urinary incontinence. Neurourol Urodyn. 2004;23:322–30. Scholar
  18. 18.
    Slieker-ten Hove MCP, Pool-Goudzwaard AL, Eijkemans MJC, et al. Face validity and reliability of the first digital assessment scheme of pelvic floor muscle function conform the new standardized terminology of the International Continence Society. Neurourol Urodyn. 2009;28:295–300. Scholar
  19. 19.
    Miller JM, Ashton-Miller JA, DeLancey JO. A pelvic muscle precontraction can reduce cough-related urine loss in selected women with mild SUI. J Am Geriatr Soc. 1998;46:870–4.CrossRefPubMedGoogle Scholar
  20. 20.
    Brown SJ, Donath S, MacArthur C, et al. Urinary incontinence in nulliparous women before and during pregnancy: prevalence, incidence, and associated risk factors. Int Urogynecol J. 2010;21:193–202. Scholar
  21. 21.
    Madhu C, Enki D, Drake MJ, Hashim H. The functional effects of cigarette smoking in women on the lower urinary tract. Urol Int. 2015;95:478–82. Scholar
  22. 22.
    de Groat WC, Griffiths D, Yoshimura N. Neural control of the lower urinary tract. Compr Physiol. 2015;5:327–96. Scholar
  23. 23.
    Kahyaoglu Sut H, Balkanli Kaplan P. Effect of pelvic floor muscle exercise on pelvic floor muscle activity and voiding functions during pregnancy and the postpartum period. Neurourol Urodyn. 2016;35:417–22. Scholar
  24. 24.
    Garber CE, Blissmer B, Deschenes MR, et al. Quantity and quality of exercise for developing and maintaining cardiorespiratory, musculoskeletal, and neuromotor fitness in apparently healthy adults: guidance for prescribing exercise. Med Sci Sports Exerc. 2011;43:1334–59. Scholar
  25. 25.
    Boyle R, Hay-Smith EJC, Cody JD, Morkved S. Pelvic floor muscle training for prevention and treatment of urinary and fecal incontinence in antenatal and postnatal women: a short version Cochrane review. Neurourol Urodyn. 2014;33:269–76. Scholar
  26. 26.
    Dash D, Sebastian TM, Aggarwal M, Tripathi M. Impact of health education on drug adherence and self-care in people with epilepsy with low education. Epilepsy Behav. 2015;44:213–7. Scholar
  27. 27.
    Yu M, Chair SY, Chan CWH, Choi KC. A health education booklet and telephone follow-ups can improve medication adherence, health-related quality of life, and psychological status of patients with heart failure. Heart Lung. 2015;44:400–7. Scholar
  28. 28.
    Moossdorff-Steinhauser HFA, Albers-Heitner P, Weemhoff M, et al. Factors influencing postpartum women’s willingness to participate in a preventive pelvic floor muscle training program: a web-based survey. Eur J Obstet Gynecol Reprod Biol. 2015;195:182–7. Scholar
  29. 29.
    Frawley HC, McClurg D, Mahfooza A, et al. Health professionals’ and patients’ perspectives on pelvic floor muscle training adherence-2011 ICS state-of-the-science seminar research paper IV of IV. Neurourol Urodyn. 2015;34:632–9. Scholar
  30. 30.
    Porta Roda O, Díaz López MA, Vara Paniagua J, et al. Adherence to pelvic floor muscle training with or without vaginal spheres in women with urinary incontinence: a secondary analysis from a randomized trial. Int Urogynecol J. 2016;27:1185–91. Scholar

Copyright information

© The International Urogynecological Association 2019

Authors and Affiliations

  • Cinara Sacomori
    • 1
  • Kamilla Zomkowski
    • 2
  • Isabela dos Passos Porto
    • 3
  • Fernando Luiz Cardoso
    • 3
  • Fabiana Flores Sperandio
    • 3
  1. 1.School of KinesiologyUniversidad Bernardo O’HigginsSantiagoChile
  2. 2.Physical Therapy DepartmentUniversidade do Sul de Santa Catarina-UNISULPalhoçaBrazil
  3. 3.Physical Therapy Department, College of Health and Sport Science-CEFIDSanta Catarina State University-UDESCFlorianópolisBrazil

Personalised recommendations