Skip to main content
SpringerLink
Log in

Effects of perineal preparation techniques on tissue extensibility and muscle strength: a pilot study

  • Original Article
  • Published:
International Urogynecology Journal Aims and scope Submit manuscript

Abstract

Introduction and hypothesis

Perineal preparation techniques for childbirth have been used with the aim of reducing perineal tears during the expulsive phase of labor. However, no studies were found to investigate the effects of instrument-assisted stretching versus perineal massage on pelvic floor muscle (PFM) variables. Therefore, the aim of this study was to evaluate the effect of instrument-assisted stretching versus perineal massage on the extensibility and strength of the PFMs.

Methods

Primiparous women were randomized to the instrument-assisted stretching (IStr) group (n = 13) and perineal massage (PnM) group (n = 14). The groups participated in eight sessions, twice weekly, beginning at the 34th gestational week. The IStr group underwent the intervention for 15 min using EPI-NO®. The PnM group underwent a perineal massage protocol for 10 min. Each woman was evaluated by a blinded physiotherapist before, after four and after eight sessions for primary (PFM extensibility using the EPI-NO® circumference) and secondary (PFM strength using a manometer) outcomes. Covariate analysis (ANCOVA) was used to compare the groups using the baseline values as a covariate.

Results

Both groups showed an increase in PFM extensibility compared with the evaluations before and after four and eight sessions (PnM group from 17.6 ± 1.8 to 20.2 ± 1.9 cm; IStr group from 19.9 ± 1.6 to 22.9 ± 1.6 cm;p < 0.001). There was no difference between groups. Regarding muscle strength, no statistical differences were observed between evaluations or between groups.

Conclusions

Instrument-assisted stretching and perineal massage increase extensibility and do not alter the strength of PFMs in pregnant women.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. WHO recommendations: intrapartum care for a positive childbirth experience. Geneva: World Health Organization; 2018. Licence: CC BY-NC-SA 3.0 IGO. http://www.who.int/reproductivehealth/publications/intrapartum-care-guidelines/en. Accessed 20 Feb 2018.

  2. Bo K, Frawley HC, Haylen BT, et al. An International Urogynecological Association (IUGA)/International Continence Society (ICS) joint report on the terminology for the conservative and nonpharmacological management of female pelvic floor dysfunction. Int Urogynecol J. 2017;28:191–213. https://doi.org/10.1002/nau.23107.

    Article  PubMed  Google Scholar 

  3. Beckmann MM, Stock OM. Antenatal perineal massage for reducing perineal trauma. Cochrane Database Syst Rev. 2013;30(4):CD005123. https://doi.org/10.1002/14651858.CD005123.pub3.

    Article  Google Scholar 

  4. Kamisan Atan SKL, Langer S, et al. Does the EPI-NO® birth trainer prevent vaginal birth-related pelvic floor trauma? A multicentre prospective randomised controlled trial. BJOG. 2016;123(6):995–1003. https://doi.org/10.1111/1471-0528.13924.

    Article  CAS  PubMed  Google Scholar 

  5. Hillebrenner J, et al. First clinical experiences with the new birth trainer EPI-NO® in primiparous women (Erste klinische Erfahrungen beiErstgebärenden mit einem neuartigen Geburtstrainer Epi-no®). Z Geburtshilfe Neonatol. 2001:205, 12–19.

  6. Kok J, Tan KH, Koh S, et al. Antenatal use of a novel vaginal birth training device by term primiparous women in Singapore. Singap Med J. 2004;45(7):318–23.

    CAS  Google Scholar 

  7. Kovacs GT, Heath P, Heather C. First Australian trial of the birth-training device EPI-NO: a highly significantly increased chance of an intact perineum. Aust N Z J Obstet Gynaecol. 2004;44(4):347–8. https://doi.org/10.1111/j.1479-828X.2004.00265.x.

    Article  PubMed  Google Scholar 

  8. Ruckhabäberle E, Jundt K, Bäuerle M, et al. Prospective randomized multicenter trial with the birth trainer EPI-NO® for the prevention of perineal trauma. Aust N Z J Obstet Gynaecol. 2009;49(5):478–83. https://doi.org/10.1111/j.1479-828X.2009.01044.x.

    Article  Google Scholar 

  9. Brito LG, Ferreira CH, Duarte G, Nogueira AA, Marcolin AC. Antepartum use of EPI-NO birth trainer for preventing perineal trauma: systematic review. Int Urogynecol J. 2015;26(10):1429–36. https://doi.org/10.1007/s00192-015-2687-8.

    Article  PubMed  Google Scholar 

  10. Zanetti MR, Petricelli CD, Alexandre SM, Paschoal A, Araujo Júnior E, Nakamura MU. Determination of a cutoff value for pelvic floor distensibility using the EPI-NO balloon to predict perineal integrity in vaginal delivery: ROC curve analysis. Prospective observational single cohort study. Sao Paulo Med J. 2016;134(2):97–102. https://doi.org/10.1590/1516-3180.2014.8581009.

    Article  PubMed  Google Scholar 

  11. Sut HK, Kaplan PB. Effect of pelvic floor muscle exercise on pelvic floor muscle activity and voiding functions during pregnancy and the postpartum period. Neurourol Urodyn. 2016;35:417–22. https://doi.org/10.1002/nau.22728.

    Article  Google Scholar 

  12. Santos MD, Palmezoni VP, Torelli L, Baldon VSP, Sartori MGF, Resende APM. Evaluation of pelvic floor muscle strength and its correlation with sexual function in primigravid and non-pregnant women: a cross-sectional study. Neurourol Urodyn. 2018 Feb;37(2):807–14. https://doi.org/10.1002/nau.23353.

    Article  PubMed  Google Scholar 

  13. Palmezoni VP, Santos MD, Pereira JM, Bernardes BT, Pereira-Baldon VS, Resende AP. Pelvic floor muscle strength in primigravidae and non-pregnant nulliparous women: a comparative study. Int Urogynecol J. 2017;28(1):131–7. https://doi.org/10.1007/s00192-016-3088-3.

    Article  PubMed  Google Scholar 

  14. Laycock J. Pelvic muscle exercise: physiotherapy for the pelvic floor. Urol Nurs. 1994;14:136–40.

    CAS  PubMed  Google Scholar 

  15. Steel RGD, Torrie JH. Principles and procedures of statistics: a biometrical approach. 2nd ed. New York: McGraw-Hill; 1980. p. 20–90.

    Google Scholar 

  16. McHugh MP, Cosgrave CH. To stretch or not to stretch: the role of stretching in injury prevention and performance. Scand J Med Sci Sports. 2010;20:169–81. https://doi.org/10.1111/j.1600-0838.2009.01058.x.

    Article  CAS  PubMed  Google Scholar 

  17. Nakamura MU, Sass N, Júnior JE, Petricelli CD, Alexandre SM, Júnior EA, et al. Tolerância da parturiente à extensibilidade perineal avaliada pelo EPI-NO: estudo observacional. Einstein. 2014;12(1):22–6. https://doi.org/10.1590/S1679-45082014AO2944.

    Article  PubMed  PubMed Central  Google Scholar 

  18. Petricelli CD, Resende APM, Júnior JE, Júnior EA, Alexandre SM, Zanetti MRD, et al. Distensibility and strength of the pelvic floor muscles of women in the third trimester of pregnancy. Biomed Res Int. 2014; 2014:Article ID 437867, 6 pages. https://doi.org/10.1155/2014/437867.

  19. Duarte G, Coutinho CM. Mecanismo de parto. In: CHJ F, editor. Fisioterapia na saúde da mulher: teoria e prática. 2nd ed. Rio de Janeiro: Guanabara Koogan; 2011.

    Google Scholar 

  20. Rahn DD, Ruff MD, Brown AS. Biomechanical properties of the vaginal wall: effect of pregancy, elastic fiber deficiency, and pelvic organ prolapse. Am J Obstet Gynecol. 2008;198(5):590.e1–6. https://doi.org/10.1016/j.ajog.2008.02.022.

    Article  Google Scholar 

  21. Rosário JLP, Souza A, Cabral CMN, João SMA, Marques AP. Reeducação Postural Global e alongamento estático segmentar na melhora da flexibilidade, força muscular e amplitude de movimento: um estudo comparativo. Fisioter Pesq. 2008;15(1):12–8. https://doi.org/10.1590/S1809-29502008000100003.

    Article  Google Scholar 

  22. Endilich PW, Farina GR, Dambroz C, Gonçalves WLS, Moysés MR, Mill JG, et al. Efeitos agudos do alongamento estático no desempenho da força dinâmica em homens jovens. Rev Bras Med Esporte. 2009;15(3):200–3. https://doi.org/10.1590/S1517-86922009000300007.

    Article  Google Scholar 

  23. Brasil. Portal Brasil. Número de cesarianas cai pela primeira vez desde 2010. Disponível em: <http://www.brasil.gov.br/saude/2017/03/numero-de-cesarianas-cai-pela-primeira-vez-desde-2010>. Accessed 21 Mar 2018.

  24. Memon H, Handa VL. Pelvic floor disorders following vaginal or cesarean delivery. Curr Opin Obstet Gynecol. 2012;24(5):349–54.

    Article  PubMed  PubMed Central  Google Scholar 

  25. Oliveira LS, Brito LG, Quintana SM, Duarte G, Marcolin AC. Perineal trauma after vaginal delivery in healthy pregnant women. Sao Paulo Med J. 2014;132(4):231–8. https://doi.org/10.1097/GCO.0b013e328357628b.

    Article  PubMed  Google Scholar 

  26. Priddis H, Dahlen HG, Schmied V, Sneddon A, Kettle C, Brown C, et al. Risk of recurrence, subsequente mode of birth and morbidity for women who experienced severe perineal trauma in first birth in New South Wales between 2000–2008: a population based data linkage study. BMC Pregnancy Childbirth. 2013;13(89):1–7. https://doi.org/10.1186/1471-2393-13-89.

    Article  Google Scholar 

  27. Pergialiotis V, Vlachos D, Protopapas A, Papa K, Vlachos G. Risk factors for severe perineal lacerations during childbirth. Int J Gynecol Obstet. 2014;125:6–14. https://doi.org/10.1016/j.ijgo.2013.09.034.

    Article  Google Scholar 

  28. Riesco MLG, Costa ASC, Almeida SFS, Basile ALO, Oliveira SMJV. Episiotomia, laceração e integridade perineal em partos normais: análise de fatores associados. Rev Enferm UERJ. 2011;19(1):77–83.

    Google Scholar 

  29. Svabık K, Shek K, Dietz H. How much does the levator hiatus have to stretch during childbirth? BJOG. 2009;116:1657–62. https://doi.org/10.1111/j.1471-0528.2009.02321.x.

    Article  PubMed  Google Scholar 

  30. Toozs-Hobson P, Balmforth J, Cardozo L, Khullar V, Athanasiou S. The effect of mode of delivery on pelvic floor functional anatomy. Int Urogynecol J. 2008;19:407–16. https://doi.org/10.1007/s00192-007-0455-0.

    Article  Google Scholar 

  31. Krofta L, Otcenasek M, Kasikova E, Feyereisl J. Pubococcygeus-puborectalis trauma after forecps delivery: evaluation of the levator ani muscle with 3D/4D ultrasound. Int Urogynecol J. 2009;20:1175–81. https://doi.org/10.1007/s00192-009-0837-6.

    Article  Google Scholar 

  32. Shek KL, Dietz HP. The effect of childbirth on hiatal dimensions. Obstet Gynecol. 2009;113(6):1272–8. https://doi.org/10.1097/AOG.0b013e3181a5ef23.

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

We thank the Higher Education Personnel Improvement Coordination for the scholarship provided to the author Síssi Sisconeto de Freitas.

Author information

Authors and Affiliations

  1. Physical Therapy Postgraduate Program, Federal University of Triângulo Mineiro associated to Federal University of Uberlândia, Uberlândia, MG, Brazil

    Síssi Sisconeto de Freitas

  2. Postgraduate Program in Health Sciences, Federal University of Uberlândia, Uberlândia, MG, Brazil

    Alana Leandro Cabral

  3. Mathematics Department, Federal University of Uberlândia, Uberlândia, MG, Brazil

    Rogério de Melo Costa Pinto

  4. Physical Therapy Department, Federal University of Uberlândia, Uberlândia, MG, Brazil

    Ana Paula Magalhães Resende & Vanessa Santos Pereira Baldon

  5. Federal University of Uberlândia, Campus Physical Education, Benjamin Constant Street, number 1286, Uberlândia, MG, 38400-678, Brazil

    Vanessa Santos Pereira Baldon

Authors
  1. Síssi Sisconeto de Freitas
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Alana Leandro Cabral
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Rogério de Melo Costa Pinto
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Ana Paula Magalhães Resende
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Vanessa Santos Pereira Baldon
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Vanessa Santos Pereira Baldon.

Ethics declarations

Conflicts of interest

None.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

de Freitas, S.S., Cabral, A.L., de Melo Costa Pinto, R. et al. Effects of perineal preparation techniques on tissue extensibility and muscle strength: a pilot study. Int Urogynecol J 30, 951–957 (2019). https://doi.org/10.1007/s00192-018-3793-1

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00192-018-3793-1

Keywords

Search

Navigation