Exploring physiotherapy management for urinary incontinence in postpartum women: a scoping review

Purpose: The aim of this scoping review is to consolidate existing evidence regarding physiotherapy management of urinary incontinence (UI) in postpartum women. The primary objective is to identify key themes within the existing evidence base pertaining to management of postpartum UI. The secondary objective is to identify knowledge gaps and provide future recommendations for physiotherapists in clinical practice. Methods: A scoping review was conducted following the guidelines by Arksey and O’Malley (2005), further supported by Levac, Colquhoun and O’Brien (2010) to examine emerging evidence in the field. 4 databases (Science Direct, Web of Science BIOSIS, PubMed, Medline, ProQuest Science Journals) were searched between March 25th and 26th, 2023. Articles were screened and selected based on criteria determined by Sample, Phenomenon of Interest, Design, Evaluation, Research Type (SPIDER) tool. Studies were included if they explored clinical interventions targeting UI in postpartum women, including qualitative, quantitative and mixed-methods data. Results: Seven studies were retrieved, four which were randomised controlled trials (RCTs), one non-RCT, and two cohort studies. The interventions took place during the antenatal and postpartum period, mainly focusing on pelvic floor muscle training (PFMT). Results suggest that PFMT during the antenatal and postpartum periods is an effective intervention for the prevention and management of UI in postpartum women, however, a longer follow-up period would be beneficial to determine the longevity of PFMT. Conclusion(s): This review has demonstrated the necessity of implementing PFMT as feasible management of UI in postpartum women in physiotherapy practice. It was found that PFMT on postpartum UI improvement were statistically significant, although effectiveness depends on clinician approach and patient adherence. With focus on education of the pelvic floor and instructional cueing, this can increase women’s self-efficacy leading to higher adherence and better outcomes. A further call for more research is warranted to ascertain whether PFMT continues to be effective after the first 6 months postpartum, as well as to develop guidelines while considering the biopsychosocial complexities of UI, which can help physiotherapists’ shift away from assessing only biomedical factors. Impact: The findings of this review can help in designing the necessary interventions for management of postpartum UI: specifically, when assessing, treating, and improving patient education to better support women through the complex postpartum period. Physiotherapists have a duty to provide correct training to their patient and individual needs must be addressed to understand all aspects. With a combination of physiotherapists’ awareness of their role, patient education, and individualised management plan for postpartum UI, these recommendations can optimise patient adherence leading to more effective improvements.