Prenatal and Postpartum Experience, Knowledge and Engagement with Kegels: A Longitudinal, Prospective, Multisite Study.

Introduction: Urinary incontinence (UI) increases during pregnancy and continues into the postpartum period. Continued UI impacts women's comfort and affects aspects of their everyday lives. Kegel exercises have been found to decrease the incidence and severity of UI. The purpose of this study was to describe severity of UI, how women gained knowledge about Kegels, influences impacting Kegel exercises during pregnancy and postpartum, and characterize women's performance of Kegels. Methods: A longitudinal, prospective, multistate study was undertaken at four sites across the United States. Postpartum women completed the Pelvic Floor Control Questionnaire that incorporated the Sandvik Severity Index. At 3 and 6 months postpartum the women's UI, performance of Kegels, and affect on life was reviewed through seven questions. Institutional Review Board (IRB) approval was obtained. Results: Participants were 368 predominately multiparous, white women. Approximately 20% of women reported prepregnancy UI. Multiparous women reported similar incidence rate of UI regardless of birth history. Among one-fifth of the participants, persistent UI was reported as 45.2% at 3 months and 44.1% at 6 months postpartum. Only 25% of these women sought care. Women learned about Kegel exercises from written information or their provider. Women performed an average 16 Kegels twice daily. Kegel performance increased at 3 months postbirth but dropped by 6 months. UI was associated with age >35 and parity. Discussion: Prevalence of UI before and during pregnancy and postpartum is high, yet consistent Kegel performance postpartum is low. Screening for UI is necessary and high-quality referrals for treatment are needed. Consistent education is needed for all women. Education and support should be individualized. Future research is needed to identify techniques that motivate women to routinely perform Kegel exercises.