Effect of Holistic Postural Rehabilitation Combined With Electrical Stimulation and Biofeedback on Postpartum Pelvic Floor Dysfunction: A Multicenter Randomized Controlled Trial

Background: To evaluate the effects of holistic postural rehabilitation exercise in combination with electrical stimulation and biofeedback on urinary incontinence (UI) symptoms and pelvic floor muscle strength in patients suffering postpartum pelvic floor dysfunction. Methods: A single-anonymized, randomized controlled trial was conducted from January 2021 to December 2022. A total of 120 patients, 42 days postpartum and diagnosed with pelvic floor dysfunction at three medical institutions in a certain city (Beijing, China), were enrolled and randomly assigned into the experimental group (n = 41) or control group (n = 46) using a random number table; thus, 87 medical records were included in the analysis. The experimental group received holistic postural rehabilitation exercises and electrical stimulation biofeedback therapy, while the control group received conventional Kegel exercises and electrical stimulation biofeedback therapy. Pelvic floor muscle strength and pelvic floor function were assessed at 42 days postpartum (baseline), 1 month, and 3 months post-intervention using the Pelvic Floor Distress Inventory-20 (PFDI-20) questionnaire, to evaluate bladder symptoms, bowel symptoms, and UI. The scores of the two groups were compared. Results: The experimental group exhibited significantly improved Class I pelvic floor muscle strength compared to the control group at a statistical level (p = 0.00). For UI symptoms, the frequency of urine leakage differed significantly at 3 months post-intervention (p = 0.03). The results of the comparison between the analysis groups: At all three time points (baseline, 1 month, and 3 months), comparisons of each index yielded p > 0.05. The analysis concludes that total PFDI-20 scores or any subscale scores did not differ significantly instatistical level between the groups at any time point. According to the analysis results of pelvic floor physiological indicators After the 3-month intervention, both groups exhibited improvements in postpartum pelvic floor muscle recovery. However, when comparing Type I muscle strength, the experimental group out performed the control group statistically (p < 0.05). At baseline, the severity of UI symptoms did not present an obvious difference in statistical level between the two groups, indicating good baseline consistency. After 3 months of intervention, the frequency of urinary leakage differed a lot. The intergroup comparison showed that t = 4.83 and p = 0.03 (< 0.05), suggesting that the experimental group achieved remarkably larger improvement in reducing urinary leakage frequency versus the control group. Conclusions: Holistic postural rehabilitation exercise combined with electrical stimulation biofeedback can reduce the frequency and volume of postpartum UI, improve Class I fibromuscular muscle strength, and enhance pelvic floor stability and function. However, the effects on pelvic organ prolapse (POP), colorectal and anal dysfunction, and lower urinary tract symptoms were not significant and warrant further clinical investigation. Clinical Trial registration: The study has been registered on https://clinicaltrials.gov/ (registration number: ChiCTR2000029618, registration link: https://www.chictr.org.cn/showprojEN.html?proj=48903).