Pelvic Floor Muscle Strength and Bothersome Urinary Incontinence after Pregnancy: A Cohort Study

Urinary incontinence (UI) is a common concern during and after pregnancy, but its persistence into the postpartum period—and the factors influencing it—remain complex and not fully understood. Our recently published study in the International Urogynecology Journal aimed to examine the relationship between pelvic floor muscle (PFM) strength and the experience of bothersome UI in the first year postpartum. We followed over 500 women and tracked their pelvic floor function at four time points postpartum (3,6,9,12 months).

PFM strength was assessed using the Modified Oxford Scale (MOS) by trained physiotherapists, and UI was evaluated using the International Consultation on Incontinence Questionnaire–Short Form (ICIQ-UI SF). We found that a PFM strength of ≥3 MOS was associated with significantly lower bother from UI across the first year postpartum. Importantly, women with UI during pregnancy were consistently more likely to experience UI postpartum, suggesting early screening and support during pregnancy may be key. Our results also contribute to the growing body of evidence that pelvic floor training should be a core component of maternal health, however, PFM training is only one piece of the puzzle.

Postpartum UI is multifactorial, influenced by perineal trauma, physical activity levels, hormonal changes, psychological factors, and overall functional recovery. A comprehensive, individualized approach to postpartum care is essential to effectively address these interrelated contributors. One unique aspect of this study was the hands-on clinical assessments. As one of the physiotherapists involved in the study shared: "It’s incredibly valuable to identify issues early on. Many women don’t actively seek help for their problems during the early postpartum period—many are unsure of what is 'normal' and hope things will resolve on their own.

They may end up putting unnecessary strain on their bodies or training the pelvic floor incorrectly, or not at all. An objective assessment provides an opportunity to identify patients who have issues or are at risk of developing them, and to offer them increased knowledge. A common comment from the participants was ‘Every woman should have access to this!’…" (Ute Jesberg, physiotherapist) We hope this study encourages further dialogue around integrative and preventive models of care in postpartum pelvic health and underscores the importance of timely identification and support for those at risk.

Written by: Sónia Coelho Cristóvão, Doctoral Student, MSc, Department of Neuroscience and Physiology, Section for Health and Rehabilitation, University of Gothenburg, Gothenburg, Sweden

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