Shijagurumayum Acharya R1,2, Therese Tveter A3, Grotle M3,4, Khadgi B1, Eberhard Gran M2,5,6, Braekken IH7, Stuge B8
1Kathmandu University School of Medical Sciences, Kathmandu University Dhulikhel Hospital, Department of Physiotherapy, Dhulikhel, Nepal, 2Institute of Clinical Medicine, University of Oslo, Oslo, Norway, 3Oslo Metropolitan University, Department of Physiotherapy, Faculty of Health Sciences, Oslo, Norway, 4Oslo University Hospital, Formi, Oslo, Norway, 5Akershus University Hospital, Health Services Research Unit, Lorenskog, Norway, 6Norwegian Institute of Public Health, Department of Child Health, Oslo, Norway, 7University of Bergen, Department of Global Public Health and Primary Care, Bergen, Norway, 8Oslo University Hospital, Division of Orthopaedic Surgery, Oslo, Norway
Background: Pelvic floor dysfunctions like pelvic organ prolapse and urinary incontinence are a major reproductive health issue in Nepal. Pelvic floor muscle training (PFMT) is recommended as first line treatment for prevention and treatment of pelvic floor dysfunctions. There is lack of knowledge on the feasibility of performing a PFMT program in pregnant Nepalese women.
Purpose: The aim was to develop a PFMT program and to assess the feasibility in pregnant Nepalese women, secondly to investigate characteristics of women who complied with the PFMT program.
Methods: The PFMT program included; information and education material (video, leaflet, poster), information about health benefits performing PFMT, individual instruction and group exercises led by a specialized women's health physiotherapist. The pelvic floor muscle exercises were taught in six positions (adapted according to daily lifestyle of Nepalese women) and they were advised to perform 3x10 repetitions once a day, and to record their home exercises using an exercise diary. Motivational telephonic calls were performed once a month. The PFMT program and the educational material were finalized after counselling user representatives and pre-testing in 30 pregnant Nepalese women .Compliers were defined as women attending four or more training days or individual visits. Pregnant women (before 16 weeks of gestation) visiting Dhulikhel Hospital were recruited consecutively. Sociodemographic factors, pregnancy history, The International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form (ICIQ-UI SF), Pelvic Organ Prolapse Symptom Score (POP-SS) and Edinburgh Postnatal Depression Scale (EPDS-5) questionnaires were collected at first and last visit. Data on number of antenatal visits, records of exercise diary and questions on motivation for performing and the reasons for not performing PFMT, and the most preferred exercise position were also collected. The PFMT program was provided on the first day of the visit and the women were encouraged to perform exercises at home on a daily basis.
Results: A sample of 253 pregnant women with mean age 25 (Standard deviation, (SD) 4) years and mean gestation weeks of 10 (SD 3) were included. In total, 164 (65%) participants were considered as compliers to the PFMT program and 89 (35%) did not comply. Preliminary results showed that factors complying with the PFMT were to prevent pelvic organ prolapse (82, 50%), considered important for health (76, 46%) and to prevent urinary incontinence (21, 13%). Lack of time (78, 48%), forgot to do exercise (59, 36%) and not able to perform exercise due to health problems (54, 33%) were the reasons for not being able to perform the pelvic floor exercise.
Conclusion(s): The results showed that more than half of the women completed the PFMT program indicating that PFMT is feasible in pregnant Nepalese women. Future studies need to investigate the effectiveness of the PFMT in Nepal.
Implications: PFMT during pregnancy was feasible to perform for women living both in rural and urban areas of Nepal under counselling from physiotherapists. PFMT is cost effective and expected to prevent pelvic floor dysfunctions.
Keywords: Pelvic floor muscle training, physical therapy, pregnancy
Funding acknowledgements: The Norwegian State Educational Loan Fund through the Norwegian Quota Scheme, Norway; Association for Support of Physiotherapy in Nepal, Switzerland
Purpose: The aim was to develop a PFMT program and to assess the feasibility in pregnant Nepalese women, secondly to investigate characteristics of women who complied with the PFMT program.
Methods: The PFMT program included; information and education material (video, leaflet, poster), information about health benefits performing PFMT, individual instruction and group exercises led by a specialized women's health physiotherapist. The pelvic floor muscle exercises were taught in six positions (adapted according to daily lifestyle of Nepalese women) and they were advised to perform 3x10 repetitions once a day, and to record their home exercises using an exercise diary. Motivational telephonic calls were performed once a month. The PFMT program and the educational material were finalized after counselling user representatives and pre-testing in 30 pregnant Nepalese women .Compliers were defined as women attending four or more training days or individual visits. Pregnant women (before 16 weeks of gestation) visiting Dhulikhel Hospital were recruited consecutively. Sociodemographic factors, pregnancy history, The International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form (ICIQ-UI SF), Pelvic Organ Prolapse Symptom Score (POP-SS) and Edinburgh Postnatal Depression Scale (EPDS-5) questionnaires were collected at first and last visit. Data on number of antenatal visits, records of exercise diary and questions on motivation for performing and the reasons for not performing PFMT, and the most preferred exercise position were also collected. The PFMT program was provided on the first day of the visit and the women were encouraged to perform exercises at home on a daily basis.
Results: A sample of 253 pregnant women with mean age 25 (Standard deviation, (SD) 4) years and mean gestation weeks of 10 (SD 3) were included. In total, 164 (65%) participants were considered as compliers to the PFMT program and 89 (35%) did not comply. Preliminary results showed that factors complying with the PFMT were to prevent pelvic organ prolapse (82, 50%), considered important for health (76, 46%) and to prevent urinary incontinence (21, 13%). Lack of time (78, 48%), forgot to do exercise (59, 36%) and not able to perform exercise due to health problems (54, 33%) were the reasons for not being able to perform the pelvic floor exercise.
Conclusion(s): The results showed that more than half of the women completed the PFMT program indicating that PFMT is feasible in pregnant Nepalese women. Future studies need to investigate the effectiveness of the PFMT in Nepal.
Implications: PFMT during pregnancy was feasible to perform for women living both in rural and urban areas of Nepal under counselling from physiotherapists. PFMT is cost effective and expected to prevent pelvic floor dysfunctions.
Keywords: Pelvic floor muscle training, physical therapy, pregnancy
Funding acknowledgements: The Norwegian State Educational Loan Fund through the Norwegian Quota Scheme, Norway; Association for Support of Physiotherapy in Nepal, Switzerland
Topic: Women's & men's pelvic health
Ethics approval required: Yes
Institution: University of Oslo; Kathmandu University Dhulikhel Hospital
Ethics committee: Norwegian Regional Ethics Committee; The Nepal Health Research Council
Ethics number: (REK Nord, 2015/2209); (112/2016);
All authors, affiliations and abstracts have been published as submitted.
