Physical Therapist Interventions to Prevent Postpartum Urinary Incontinence: A Systematic Review.

Abstract

Objective: This systematic review aimed to describe and synthesize the scientific evidence on the effects of physical therapy in preventing postpartum urinary incontinence. Data sources: The following databases were searched up to April 2023: PubMed/MEDLINE, Web of Science, ScienceDirect, PEDro, CINAHL, and Scopus. Study selection: Studies were included if they were randomized controlled trials; included women during pregnancy or at postpartum period; conducted a physical therapist intervention; and studied the prevention of postpartum urinary incontinence. Data extraction and synthesis: Two researchers extracted information of the descriptive characteristics of the studies and the interventions, variables, main outcomes, and results. Main outcome and measures: Main outcomes were variables related to postpartum urinary incontinence. Quality appraisal was conducted using the PEDRO and Cochrane Risk of Bias 2.0 tools.

Results: Among the 2067 studies initially identified, 9 met the inclusion criteria. The main interventions include pelvic floor muscle exercises, electrical stimulation, and perineal massage. The studies demonstrated a positive impact on postpartum urinary incontinence incidence and related symptoms in most of the studies included. However, the heterogeneity presented in the characteristics of the sample, protocol, and outcome measures limited the conclusions reached. Quality assessment revealed moderate to high methodological quality in 90% of trials using the PEDro scale, while 70% presented a high risk of bias according to the Cochrane tool. Conclusions and relevance: Physical therapist interventions, particularly pelvic floor muscle exercises, may have a positive effect in preventing postpartum urinary incontinence compared to usual care or no intervention. However, the heterogeneity and limited number of studies emphasize the need for more high-quality randomized controlled trials.