It is amazing how impeccable is a woman from the point of view of Procreation in the global scale, but an individual is not spared from many hazards related to childbearing. Although some complications or consequences are far from life-threatening events, but nevertheless they can gradually render her life nightmare despite innocuous beginning. Delivery is a great challenge for a pelvic floor and unfortunately significant number of women may fail to regain strength of pelvic floor in full measure. Several drops of urine on underwear may remain neglected amidst the rigors of the first postpartum year, but ageing is capable to worsen urine loss substantially when only surgery may bring resolution. Therefore it is reasonable to provide preventive approach against development female urinary incontinence (UI) for women after parturition, in first turn for high-risk groups (macrosomic fetus, dysfunctional labour, vaginal assisted delivery, extensive perineum rupture, substantial weight gain during pregnancy, short stature, etc). Faults of instructions, inability of visualization, low compliance, failure to generate strong contraction make exercises for pelvic floor muscle (PFM) almost imperceptible for a woman’s self-assessment, thereby discourage her from routine workout. A breakthrough treatment (EMSELLA) utilizes electromagnetic energy to trigger supramaximal PFM contraction in a single session. Our study aimed to evaluate course EMSELLA procedures within the first half a year after parturition as a preventive measure against stressful urine incontinence (UI).

A cross-sectional study involved 87 female patients aged 20-39 years who were accrued within 2-6 months passed after delivery. Their risk of UI development in the future had been stratified by elaborated questionnaire as high. The first arm (50 pts) was instructed to do kegel exercises (one month of 15-minute classes 5 times per week). The second arm (37 pts) underwent 6 sessions of EMSELLA procedure (28 minutes twice per week). Assessment was conducted at the time of accrual and in the end of the month since the first workout or session by means of Colpex feedback system (kegel ball with laser pointer and measuring tape on the wall): distance between a point with relaxed PFM and the point at the highest exertion of PFM. Another tool for assessment was surface electromyography (sEMG): signals of the right and left PFM recorded during contraction and relaxation and evaluated by root mean square (RMS) and median frequency (MF).
The prevalence between dichotomous categories was compared with the use of chi-square tests. The continuous variables were expressed as mean, percentage value and frequency. Probable risk factors of UI were evaluated by binary logistic regression models with positive/negative UI as dependent variable and others as independent variables using the Backward Stepwise elimination of non-significant variables. The odds ratios (OR) and 95% Confidence interval (CI) were estimated. All calculations were conducted via SPSS for Windows, version 18.0, considering p value <0.05 as statically significant.

Both arms matched by the mean age (27.08±2.36 and 29±4.17 years), total score of questionnaire regarding risk of UI, initial RMS (4.35±0.68 and 3.97±0.71 103mV, mean value of right and left) and predominance of low-frequency pattern: MF (143.23±7.61 and 149.02±5.33 Hz, mean value of right and left). Compliance in the group of EMSELLA was very high (97.3%): only one woman failed to complete the course, subjectively result met expectations in 91.2%. The PFM activity showed a trend to a rise of power (RMS 7.97±1.82 103mV, p<0.05), frequency pattern became more variable with wider bandwidth and high-frequency swings. The group of kegel showed low compliance: only 18% pts completed the course, furthermore 54% dropped out during the first week, even “good” responders reported satisfaction with their expectations just in 22%. Power of PFM activity grew insignificantly (RMS 5.56±1.02 103mV, p<0.05), frequency pattern scrambled to 158.72±7.01 Hz (p>0.05) but without remarkable changes of variability. In a year UI was reported by 14.0% (n=7) women of that group, mostly classified as stress UI (71.4%, n=5), others: urge UI – 28.6% (n=2).

Electromagnetic approach substantially exceeded routine kegel training in capability to regain preexistent state of PFM after parturition owing to imposed supramaximal PFM contraction pattern, long duration of session and high compliance. Therefore it is highly recommended within half a year after childbearing event as a preventive measure against UI.

UI affects mostly female population. Childbearing puts significant challenge on the pelvic floor and failure to regain the full functional capacity of PFM can pave the way for UI. Obesity, short stature, fetal macrosomia, persistent constipation, family history as risk factors might conduce to trigger UI even in the near future after first parturition. Implementation of electromagnetic approach to generate supramaximal PFM contraction of sophisticated pattern provides a highly effective measure to strengthen pelvic floor support and prevent from UI, especially in hig-risk group.