To study the effects of pelvic floor exercises on pelvic floor muscle strength and posterior urethro vesical angle in the puerperal period.

Methodology: The study was started after ethical clearance from the Institutional Research Committee. The trial was registered in Clinical trial of India.  Study design: The study design was a single group pre test post test experimental design.  Inclusion criteria: Primiparous women irrespective of mode of delivery (Vaginal labor or C section), Women between the age group 20 to 35years, mothers with less than one week puerperal status and before getting the discharge from the hospital . Those who gave consent to attend postnatal physiotherapy clinic for follow up at their 6th and   12th postpartum week. Exclusion criteria: Mothers with any history of major abdomino – pelvic surgery except “C section” and /or episiotomy. Those who were medically unfit to travel long distances (if any) during follow up. 142 postnatal primiparous women after consenting to the study were enrolled and assessed in the 6th week of the postpartum period. A detailed history taking and clinical examination was done including pelvic floor muscle strength on the modified oxford scale by a trained physiotherapist. The retrovesical angle was then measured by a radiologist specialised in urogynaecological diagnostic imaging. The retrovesical angle (beta angle) was measured at rest, maximum pelvic contraction and on valsalva on ultrasound imaging. The participant was then taught pelvic floor exercises along with breathing exercises, lumbopelvic stabilising exercises and counselled about the do’s and dont’s. special emphasis was given about the ill effects of increased intra-abdominal pressure. The dosimetry of the pelvic floor exercises were given according to the strength and subjective assessment of each patient. The patient were called for re-assessment on the 12th week postpartum. The pelvic floor muscle strength and retrovesical angle were measured by the same therapist and radiologist.

Results:  On comparison of mean difference of pelvic floor muscle strength at 6 week (Pretest) & 12 week (Posttest) by using paired t test showed significant difference (P<0.0001). The comparison of mean difference of beta angle on rest and maximum pelvic contraction at pre test and post test showed significant difference (P<0.0001). However, the comparison of mean difference of beta angle on rest and valsalva at pre test and post test showed no significant difference (P>0.05).

The results showed significant improvement in post test on both modified oxford scale as well as on posterior urethra vesical angle during maximum contraction. However, negative impact of IIAP found on comparison of the mean difference of the beta angle at rest tested with valsalva, this suggested need of further extension (after 12 weeks) of  postnatal physiotherapy program. The effect of pelvic floor physical therapy proved benefical in terms of strength, endurance and repetitions. Significant difference was seen in post test on the modified oxford scale.

Conclusion: Pelvic floor exercises proved beneficial in improving strength of the pelvic floor muscles as measured by modified oxford scale and posterior urethrovesical angle.