Perineal care during pregnancy and postpartum period: prevention and morbidity related to pelvic floor muscle strength, sexual function and urinary continence

Abstract

Pregnancy and childbirth may influence the pelvic floor muscles (PFM) and the occurrence of genito-urinary tract morbidities, on a temporary or permanent mode. Objectives: To analyze the perineal muscle strength (PMS), sexual function and urinary continence in women during pregnancy and the first six months after delivery; to evaluate the effect of supervised and unsupervised kinesiotherapy (KT) of the PFM in the urinary continence, the sexual function and the PMS among incontinent women, during the same period; to check the adhesion of women to the KT of the PFM. Methods: A cohort study with nested randomized controlled trial. The population is women attended by a health facility provided by insurance model, in Guarulhos, São Paulo. All women who will begin prenatal care in the first trimester of pregnancy, between October 2012 and March 2013, will be included in the cohort, with an estimated following about 500 women up to six months after delivery. A hundred women with urinary incontinence (UI) during pregnancy will be randomly included in the trial, distributed in experimental and control group (biweekly sessions of supervised KT of PFM during 12 weeks and unsupervised KT, respectively). Outcomes and assessment tools are: PMS, assessed by perineometry; sexual function, assessed by the Female Sexual Function Index-IFSF; IU, assessed by the International Consultation on Incontinence Questionnaire-Short Form-ICIQ-SF. All women will be evaluated in the first, second and third trimester of pregnancy and around 45, 90 and 180 days after delivery. Data will be analyzed using descriptive and inferential statistics. (AU)