1. Managing stress incontinence in postnatal women (Review) Authors: Vjollca Ndreu, PhD Student Faculty of Technical Medical Sciences, University of Medicine,Tirana, Albania Fatjona Kamberi, PhD Student Faculty of Technical Medical Sciences, University of Medicine,Tirana, Albania Enkeleda Sinaj, PhD Student Faculty of Technical Medical Sciences, University of Medicine,Tirana, Albania Anila Sula, General Nurse

2. Introduction Urinary Incontinence, as defined by The International Continence Society is the complaint of any involuntary leakage of urine. Urinary Incontinence is a common problem among adults and conservative management is recommended as the first-line treatment. [ 1 ] Physical therapies, particularly pelvic floor muscle exercise,are the mainstay of such conservative management. [ 9 ] 1

3. Purpose The purpose is to summarise current literature and describe trends in the use of pelvic floor muscle exercise in the management of Stress Urinary Incontinence in women. Methodology In conducting this systematic review,we searched the MEDLINE (via PubMed) CINAHL and Cochrane databases for relevant articles and undertook manual searches of reference lists from systematic reviews and proceedings of the ICS. The results and analyses are clearly presented and well discussed. The data were properly interpreted in the context of the characteristics and quality of the trials. 2

4. Results Thirteen trials were included in the review, involving 5170 women (2485 in the PFMT group and 2585 controls). Intensive antenatal PFMT effectively prevented the occurrence of incontinence in late pregnancy by 56% [3 trials, 307 women relative risk (RR) 0.44; 95% CI 0.30–0.65], in the early postpartum period by 50% (2 trials, 118 women RR 0.50; 95% CI 0.31–0.80), and up until six months post partum by 30% (4 trials, 553 women RR 0.71; 95% CI 0.52–0.97) compared with usual antenatal and/or postnatal care. Postnatal women with incontinence who received intensive PFMT were less likely to report urinary incontinence at 12 months after delivery (20% reduction in risk; RR 0.79; 95% CI 0.70–0.9) compared with those who did not receive the treatment. Women who received intensive antenatal PFMT had 10% lower risk of urinary incontinence in late pregnancy (RR 0.88; 95% CI 0.81–0.96). Our review confirms that pelvic floor muscle exercise is particularly beneficial in the treatment of urinary stress incontinence in females. Studies have shown up to 70% improvement in symptoms of stress incontinence following appropriately performed pelvic floor exercise. This improvement is evident across all age groups. There is evidence that women perform better with exercise regimes supervised by specialist physiotherapists or continence nurses. 3

5. Conclusions  Overall, there is evidence for the widespread recommendation for use of PFM training as a first-line conservative management programme for women with stress, urge or mixed Urinary Incontinence.  Pelvic floor muscle exercise helps women with all types of urinary incontinence.  The treatment is most beneficial in women with stress urinary incontinence alone,  and who participate in a supervised pelvic floor muscle training programs for at least three months. 4

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