The incidence of SUI at 6 weeks post partum was 8.7% for the PEFLOW group compared to 13.9% for those receiving usual care (P = .03).
A multicenter randomized clinical trial published in JAMA Network Open found that a specialized exercise program combining pelvic floor muscle training (PFMT) with global postural exercises significantly reduced the incidence of stress urinary incontinence (SUI) in the early postpartum period. The training program, referred to as the pelvic floor workout (PEFLOW), was effective at strengthening the pelvic hammock during pregnancy to mitigate the involuntary leakage of urine typically caused by increased abdominal pressure.1
The incidence of SUI at 8 weeks post partum is reported to be 25.7%, as pregnancy and delivery often weaken the pelvic floor.2 While PFMT is traditionally recommended as a first-line treatment, its effectiveness as a preventative measure during pregnancy has remained inconclusive in medical literature because of variations in patient adherence and procedural appropriateness. To address these inconsistencies, researchers developed PEFLOW, which integrates muscle contractions with postural alignment and utilizes a mobile application for instructions and reminders.1
The trial was conducted across 9 hospitals in China and enrolled 764 primiparous women aged 20 to 40 years with singleton pregnancies of less than 16 weeks’ gestation. Participants were randomized into 2 groups of 382 women each. Women with severe complications, a history of recurrent miscarriage, or pre-existing pelvic organ prolapse were excluded from the study.
The exercise group practiced the PEFLOW program from 28 weeks’ gestation until delivery. To ensure compliance and proper technique, participants received checkups and guidance every 2 weeks. The control group received usual medical care. Researchers followed the participants through January 17, 2024, assessing outcomes at 37 weeks’ gestation and at 6 weeks, 3 months, 6 months, and 12 months post partum.
The primary outcome was the incidence of SUI at 6 weeks post partum. Intention-to-treat analysis revealed that the incidence was significantly lower in the exercise group than in the control group. Specifically, 8.7% (32 of 367) of women in the exercise group experienced SUI compared with 13.9% (50 of 360) in the control group. This represented a risk difference of 5.17 percentage points (P = .03).
Beyond the reduction in leakage, the study measured pelvic floor muscle strength using the Modified Oxford Scale (MOS). A score of 4 or higher on this scale indicated good or strong contraction. At 6 weeks post partum, the proportion of women achieving an MOS score of 4 or higher was 17.8% (68 of 382) in the exercise group, significantly higher than the 7.9% (30 of 382) observed in the control group. This resulted in a risk difference of 9.95% (P < .001).
Findings suggested “that PEFLOW may be an effective option for preventing SUI in pregnancy,” the authors concluded, though they noted that “additional studies are warranted.”
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