Four RCTs were included (n=675). Studies scored 3 out of 5 on the Jadad criteria. All used adequate allocation concealment. None were double blinded. In all studies the investigator was blinded to the treatment group.
Incontinence :Perineal exercises were associated with a statistically significant reduction in the risk of urinary incontinence from six weeks to three months post partum compared with control (odds ratio 0.45, 95% CI: 0.31 to 0.66, p<0.0001; three studies, n=603). No significant heterogeneity was found. There was no statistically significant difference between treatment groups in the development of urinary incontinence in the 34th or 35th week of gestation (odds ratio 0.13, 95% CI: 0.00 to 3.77, p=0.23; two studies, n=373). Significant heterogeneity was found (p=0.02, I2=82%).
One study not included in meta-analyses reported that perineal exercises were associated with a statistically significant reduction in the risk of incontinence in the 35th week of gestation (p=0.043), six weeks (p=0.032) and six months post-partum (p=0.044), but there was no treatment difference at 12 months.
There was no difference in the risk of incontinence according to type of birth.
Muscle strength: Two of four studies that assessed perineal muscle strength reported a significant improvement in perineal exercise groups; the two other studies reported no significant difference between treatment groups.
Quality of life: One study reported a significant improvement at three months postpartum in the general health domain of the short-form-36 (SF-36) in the exercise training group.