Six weeks of supervised pelvic-floor training (12 one-hour BeBo® sessions), started 6-8 weeks after a first birth, made the pelvic floor more enduring than education alone after either kind of birth, and stronger in some comparisons, and 10 min of EMG biofeedback added after each session gave more endurance, but the leaking-symptom score (UDI-6) did not improve more than in controls: a randomised trial of 120 completers, 20 per arm, after vaginal or caesarean birth, analysed per protocol
Main caveat: The authors' own: single centre; only primiparous women aged 25-35 early after birth; 6 weeks with no longer follow-up; spontaneous recovery over time.
Handzlik-Waszkiewicz and colleagues, at the University of Physical Culture in Cracow, randomised first-time mothers 6-8 weeks after birth, separately for vaginal and caesarean deliveries, to a 6-week supervised programme of the BeBo® pelvic-floor method (two individual 60-min sessions a week: awareness, mobilisation, strengthening, relaxation and carrying the pelvic floor into daily movements), the same programme followed each time by 10 min of vaginal-probe EMG biofeedback, or standardised education only.
The primary outcomes were pelvic-floor strength and endurance by perineometer and by a physiotherapist's digital examination (PERFECT scheme); the secondary outcomes were leaking symptoms (UDI-6), the KHQ (quality of life with urinary symptoms) and the SQoL-F (sexual quality of life). Of 156 women randomised, 120 completed and were analysed (20 per arm).
Both programmes raised pelvic-floor endurance more than education after either kind of birth; biofeedback added further endurance (both strata) and, after vaginal birth, further strength, repetitions and fast contractions.
The leaking score fell over the 6 weeks in all groups, but no programme reduced it more than education did after Holm adjustment, and incontinence-related quality of life did not differ between groups either. Sexual quality of life rose more with biofeedback than with education after vaginal birth only.
The abstract describes the programmes as reducing leaking symptoms and improving quality of life; the between-group results in the full text do not show that.
Participants
213 screened, 156 eligible and randomised, 36 discontinued (mostly too many missed sessions), 120 analysed: 20 per arm in six arms (vaginal: BeBo®, BeBo® + EMG, control; caesarean: the same three).
Primiparous, singleton, physiological pregnancy, aged 25-35 (mean 29.0 ± 1.9 years), body mass 67.9 ± 8.8 kg, BMI 24.7 ± 2.6; no group differences at baseline (Table 1).
Excluded: postpartum complications (including pubic symphysis diastasis and third- or fourth-degree perineal tears), stage III-IV prolapse, infections, endometriosis, obesity, diabetes, and other medical and mental-health conditions.
Vaginal-delivery arms: episiotomy in 55-65% and perineal tears (first or second degree) in 40-45%, no difference between arms.
Physical activity or sport before or after birth: not reported.
Protocol
BeBo® arms: 12 individual supervised sessions over 6 weeks (2 a week, 60 min: 10 min education, 50 min practice) with one urogynaecological physiotherapist; at most two absences, made up with home assignments, else withdrawn.
EMG arms: the same, plus 10 min of biofeedback after each session (Noraxon Ultium, vaginal probe, surface electrodes on abdominal and adductor muscles to watch for compensation): sets of five 3-, 5- and 10-s holds at 20%, 50% and 80% of that day's maximal contraction, with 1-min rests.
Control arms: standardised education on the postpartum pelvic floor and a safe return to daily activities; asked not to join any supervised pelvic-floor programme; offered training afterwards.
Measures (baseline and after 6 weeks): Peritron perineometer (maximal voluntary contraction and resting pressure, cmH2O; endurance, s, until pressure fell by 35%); PERFECT digital examination (power on the 0-5 Oxford scale, endurance up to 10 s, repetitions and fast contractions up to 10); UDI-6 (0-100, higher = more distress), KHQ, SQoL-F (higher = better). Assessors and statistician blinded.
Analysis: sample size of 16 per group for the group × time interaction (f = 0.15, power 80%), raised to 20; recruitment continued until 120 completers; per protocol; Holm adjustment over three contrasts per stratum and outcome; Hedges' g on the pooled baseline SD.
Key Results
Difference in change from baseline to 6 weeks between arms (95% CI; Holm-adjusted p), Tables 4, 6, 8, 10 and 12:
| Outcome | Vaginal: BeBo® vs control | Vaginal: BeBo®+EMG vs control | Vaginal: EMG added | Caesarean: BeBo® vs control | Caesarean: BeBo®+EMG vs control | Caesarean: EMG added |
|---|---|---|---|---|---|---|
| Maximal contraction, cmH2O | +4.20 (1.68 to 6.73); 0.003 | +6.80 (4.27 to 9.32); <0.001 | +2.59 (0.10 to 5.08); 0.042 | +1.91 (−0.92 to 4.74); 0.276 | +4.03 (1.24 to 6.82); 0.016 | +2.13 (−0.70 to 4.96); 0.276 |
| Perineometer endurance, s | +1.90 (1.23 to 2.58); <0.001 | +2.96 (2.29 to 3.63); <0.001 | +1.06 (0.39 to 1.72); 0.002 | +1.79 (0.80 to 2.78); 0.001 | +2.11 (1.14 to 3.08); <0.001 | +0.32 (−0.66 to 1.31); 0.51 |
| PERFECT power, points | +0.29 (−0.10 to 0.67); 0.139 | +0.69 (0.30 to 1.07); 0.002 | +0.40 (0.02 to 0.78); 0.078 | +0.13 (−0.27 to 0.52); 0.529 | +0.42 (0.03 to 0.81); 0.103 | +0.30 (−0.10 to 0.69); 0.283 |
| PERFECT endurance, s | +1.57 (0.66 to 2.48); 0.001 | +3.18 (2.27 to 4.10); <0.001 | +1.61 (0.71 to 2.52); 0.001 | +1.16 (0.22 to 2.09); 0.033 | +2.14 (1.22 to 3.07); <0.001 | +0.99 (0.05 to 1.93); 0.039 |
| UDI-6 leaking score, points (negative = better) | −0.19 (−2.90 to 2.51); 1 | −0.64 (−3.36 to 2.07); 1 | −0.45 (−2.98 to 2.08); 1 | −1.35 (−3.41 to 0.71); 0.386 | −2.32 (−4.54 to −0.09); 0.124 | −0.97 (−3.79 to 1.85); 0.491 |
| KHQ, points (negative = better) | −5.33 (−17.27 to 6.61); 0.757 | −7.69 (−19.63 to 4.25); 0.614 | −2.36 (−14.15 to 9.43); 0.757 | −5.07 (−17.33 to 7.20); 1 | −3.33 (−15.42 to 8.76); 1 | +1.74 (−10.53 to 14.00); 1 |
| SQoL-F, points (positive = better) | +9.97 (−1.30 to 21.23); 0.165 | +15.12 (3.85 to 26.38); 0.027 | +5.15 (−5.97 to 16.27); 0.361 | +11.16 (−0.40 to 22.73); 0.175 | +7.95 (−3.46 to 19.36); 0.340 | −3.22 (−14.78 to 8.35); 0.583 |
Raw values: perineometer endurance rose from 3.02 to 5.23 s (BeBo®) and 3.58 to 6.85 s (BeBo® + EMG) against 3.51 to 3.82 s in controls after vaginal birth; 4.38 to 6.95 s and 4.83 to 7.72 s against 4.50 to 5.29 s after caesarean (Table 3). Maximal contraction rose from 16.99 to 22.11 and 17.15 to 24.86 cmH2O against 16.90 to 17.82 cmH2O in vaginal-birth controls.
Resting pressure: no effect of anything (all adjusted p = 1.000; g −0.14 to 0.03).
Repetitions and fast contractions (PERFECT): more with both programmes than control after vaginal birth (e.g. repetitions +1.33 and +2.03); after caesarean only the biofeedback arm beat control (repetitions +0.95, 0.33 to 1.57; fast contractions +1.11, 0.25 to 1.96).
Leaking score at baseline was low: UDI-6 means 1.85-9.50 on a 0-100 scale (vaginal-birth controls 9.50 ± 7.78 against 3.45 and 5.05 in the training arms); after 6 weeks 1.15-7.40. The main effect of time was significant (p < 0.001), the time × training interaction was not (p = 0.248).
Leaking and sexual quality of life: more leaking-symptom distress went with lower sexual quality of life (r = −0.514 at baseline, −0.506 at follow-up, whole sample).
Sexual activity and pain with intercourse: both changed over time within each delivery mode (pooled across arms, so not a treatment effect).
Adverse events: not reported as a measured outcome; the authors say withdrawals were mostly practical rather than adverse effects.
Practical Application
Supervised pelvic-floor training after birth built pelvic-floor endurance and, in some comparisons, strength, but it did not reduce leaking symptoms more than education did in this trial. After vaginal or caesarean birth, 12 supervised sessions over 6 weeks added about 1.8-1.9 s of perineometer hold time over education (biofeedback arms 2.1-3.0 s); the UDI-6 leaking score fell in every group, trained or not, with no between-group difference after adjustment — in women whose leaking scores were low to begin with.
Biofeedback added endurance, not a clear change in symptoms. Ten minutes of EMG biofeedback after each session added about 1 s of hold time after vaginal birth and, by the digital examination, after caesarean too; it also meant 10 more minutes of supervised training per session, which the authors say cannot be separated from the biofeedback itself.
This matches [SYNTH-95]'s line on leaking: the guide tells the assistant not to promise that pelvic-floor training will stop leaking after birth — it strengthens the pelvic floor (REF-1709) and the lower odds of leaking in one meta-analysis (REF-1398) were not confirmed by a second.This trial adds one more case of the same split: muscle function up, leaking symptoms no different from controls over 6 weeks. The abstract's statement that both programmes reduced leaking symptoms describes the fall over time, not a difference from control.
Caesarean births were included and responded: endurance rose more than with education after caesarean as well, so the pelvic-floor question is asked after either kind of birth (as SYNTH-95 already does at any age).
Not treatment advice. Whether and how to train the pelvic floor after birth, and with or without biofeedback, is decided with the obstetric provider and a pelvic-health physiotherapist; leaking, heaviness or pain on a return to running go to them (SYNTH-95).
Limitations
The authors' own: single centre; only primiparous women aged 25-35 early after birth; 6 weeks with no longer follow-up; spontaneous recovery over time; per-protocol analysis with no intention-to-treat; the biofeedback effect cannot be separated from 10 min more therapist contact and training; secondary questionnaire outcomes not powered and open to breastfeeding, hormonal, mood and relationship influences not analysed.
Attrition and adherence: 36 of 156 randomised women (23%) were withdrawn or lost, mostly for exceeding the permitted absences; recruitment continued until 20 completers per arm, and the dropouts per arm are not given in the text (they are in a flow figure not seen), so the analysed women are the adherent ones.
Leaking was barely measurable: women were not selected for incontinence and baseline UDI-6 means were 1.85-9.50 of 100, with the vaginal-birth controls starting higher (9.50) than the training arms (3.45 and 5.05); a short questionnaire score on a small symptom load has little room to separate groups.
Reporting errors in the paper: Table 11, titled SQoL-F, repeats the KHQ values of Table 9, and Table 12 carries the KHQ label, so the raw SQoL-F scores are not available; the Conclusions say BeBo® alone beat control only for strength after caesarean, while Table 4 shows the opposite (significant after vaginal birth, 4.20 cmH2O; not after caesarean, 1.91, p = 0.276) and endurance contrasts beat control in both strata; the abstract's reduction in leaking symptoms and improvement in quality of life are within-group changes, not between-group effects.
Funding and interests: funded by an internal grant of the University of Physical Culture in Cracow; the authors declare no conflicts of interest. BeBo® is a named commercial method and the biofeedback device a commercial product; no tie to either is declared.
Transfer: no athletes, no sport outcomes and no running or lifting tasks; pelvic-floor pressure in a supine test does not show what happens during impact.
How this entry was checked and changed
Why this level
a registered randomised trial read in full with 20 per arm (the rubric's A- band), not higher because the arms are under 50, the analysis is per protocol after 36 of 156 randomised women (23%) dropped out mostly for missed sessions, participants and therapists were not blinded, and follow-up ends at the end of the 6 weeks; pelvic-floor strength and endurance are measured muscle function, not a marker