***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Objective To assess the effect of pelvic floor education after vaginal delivery on pelvic floor characteristics in nulliparous women . Methods We examined 107 nulliparas during pregnancy and at 9 weeks and 10 months after vaginal delivery . Methods used included a question naire , clinical examination , perineosonography , urethral pressure profiles , and intravaginal and intra-anal pressure recordings during pelvic floor contraction . After the second examination , the women were assigned in alternating manner to either 12 sessions of pelvic floor exercises with biofeedback and electrostimulation ( n = 51 ) or no training ( n = 56 ) . The two groups were compared at the third examination . Results Stress urinary incontinence incidence decreased in 2 % of control subjects compared with 19 % of women who underwent pelvic floor education ( P = .002 ) , whereas the incidence of fecal incontinence ( 5 % versus 4 % , P = 1 ) and the percentage of women who recovered predelivery pelvic floor contraction strength ( 33 % versus 41 % , P = .4 ) were no different . We observed no significant differences in bladder neck position and mobility , urethral functional length , maximal urethral closure pressure , pressure transmission ratio , residual area of continence at stress st and ing , or intravaginal or intra-anal pressures during pelvic floor contraction between groups at the third examination . Conclusion Pelvic floor education , begun 2 months postpartum , significantly reduced the incidence of stress urinary incontinence , but not fecal incontinence or weak pelvic floor . Similarly , bladder neck behavior , urodynamic characteristics , intravaginal or intra-anal pressures during pelvic floor squeezing also were not modified A physiotherapist-delivered continence promotion program was recently implemented with postpartum women in Australia . A previous r and omised controlled trial demonstrated that the program was effective in promoting pelvic floor exercises and continence at 3 months postpartum . The present study compares pelvic floor exercise frequency and continence status for women in the intervention and ‘ usual care ’ control groups at 12 months postpartum . While there was no significant difference in continence status , women in the intervention group were more likely than those in the control group to be practising  pelvic floor exercises  at adequate frequencies . In turn , continued adherence to pelvic floor exercises at 12 months was predictive of continence at that time . Potential strategies for enhancing women ’s adherence to pelvic floor exercise regimes during and beyond the postpartum year are discussed Objective : To investigate the effect of supervised and unsupervised pelvic floor muscle exercises utilizing trunk stabilization for treating postpartum urinary incontinence and to compare the outcomes . Design : R and omized , single-blind controlled study . Setting : Outpatient rehabilitation hospital . Subjects : Eighteen subjects with postpartum urinary incontinence . Interventions : Subjects were r and omized  to either a supervised training group with verbal instruction from a physiotherapist , or an unsupervised training group after undergoing a supervised demonstration session . Main measures : Bristol Female Lower Urinary Tract Symptom question naire ( urinary symptoms and quality of life ) and vaginal function test ( maximal vaginal squeeze pressure and holding time ) using a perineometer . Results : The change values for urinary symptoms ( −27.22 ± 6.20 versus −18.22 ± 5.49 ) , quality of life ( −5.33 ± 2.96 versus −1.78 ± 3.93 ) , total score ( −32.56 ± 8.17 versus −20.00 ± 6.67 ) , maximal vaginal squeeze pressure ( 18.96 ± 9.08 versus 2.67 ± 3.64 mmHg ) , and holding time ( 11.32 ± 3.17 versus 5.72 ± 2.29 seconds ) were more improved in the supervised group than in the unsupervised group ( P < 0.05 ) . In the supervised group , significant differences were found for all variables between pre- and post-test values ( P < 0.01 ) , whereas the unsupervised group showed significant differences for urinary symptom score , total score and holding time between the pre- and post-test results ( P < 0.05 ) . Conclusions : These findings suggest that exercising the pelvic floor muscles by utilizing trunk stabilization under physiotherapist supervision may be beneficial for the management of postpartum urinary incontinence A r and omized controlled trial was carried out to evaluate the extent to which a program of reinforced pelvic floor muscle exercises ( PFME ) reduces urinary incontinence 1 year after delivery . Two hundred and thirty women who were incontinent 3 months postpartum were r and omized to either a control group doing st and ard postnatal pelvic floor muscle exercises ( n=117 ) or to an intervention group ( n=113 ) who saw a physiotherapist for instruction at approximately 3 , 4 , 6 and 9 months postpartum . Results collected 12 months after delivery included prevalence and frequency of incontinence and PFME , sexual satisfaction , perineometry measurements and pad tests . Twenty-six ( 22 % ) of the control group and 59 ( 52 % ) of the intervention group withdrew before the final assessment . The prevalence of incontinence was significantly less in the intervention group than in the control group ( 50 % versus 76%,P=0.0003 ) , and this group also did significantly more PFME . There were no significant differences between the groups as regards sexual satisfaction , perineometry measurements or pad test results OBJECTIVE : To date , the evidence on pelvic floor injury in labor remains sketchy due to a lack of prospect i ve studies comparing pelvic floor imaging before and after childbirth . We intended to define the incidence of major trauma to the pubovisceral muscle . METHODS : A total of 61 nulliparous women were seen at 36–40 weeks of gestation in a prospect i ve observational study . The assessment included an  interview and 3-dimensional translabial ultrasound  and was repeated 2–6 months postpartum . RESULTS : Fifty women ( 82 % ) were seen postpartum . Of the 39 women delivered vaginally , levator avulsion was diagnosed in 14 ( 36 % , 95 % confidence interval 21–51 % ) . Among those delivered vaginally , there were associations with higher maternal age ( P = .10 ) , vaginal operative delivery ( P = .07 ) , and worsened stress incontinence postpartum ( P = .02 ) . CONCLUSIONS : Avulsion of the inferomedial aspects of the levator ani from the pelvic sidewall occurred in approximately one third of all women delivered vaginally and was associated with stress incontinence 3 months after childbirth . LEVEL OF EVIDENCE : OBJECTIVES This study was undertaken to estimate the association between pelvic floor muscle training and demographic and health related factors that may influence pelvic floor muscle training postpartum . STUDY DESIGN This analysis includes the first 17,978 women enrolled in the Norwegian Mother and Child Cohort Study who answered questions about pelvic floor muscle training ( n = 17,744 ) . We used logistic regression analyses , and the results are presented as crude and adjusted odds ratios with 95 % CI . RESULTS Women doing regular pelvic floor muscle training were more educated , likely to participate in general fitness activities , and had more children .  Women experiencing urinary leakage  and pelvic girdle  pain  postpartum were also more likely to do pelvic floor muscle training ( adjusted odds ratio = 1.26 , 95 % CI 1.18 - 1.35 ; adjusted odds ratio = 1.31 , 95 % CI 1.23 - 1.39 ) . Those who smoked daily or were delivered by cesarean were less likely to do pelvic floor muscle training ( adjusted odds ratio = 0.81 , 95 % CI 0.72 - 0.91 ; adjusted odds ratio = 0.56 , 95 % CI 0.51 - 0.61 ) . CONCLUSION There is a need for more research concerning effective strategies to enhance postpartum pelvic floor muscle training The process by which new therapies enter clinical practice is frequently suboptimal . Often , ideas for new therapies are generated by clinical observations or laboratory studies ; therapies based on those ideas may enter clinical practice without any further scrutiny . As a consequence , some ineffective practice s become widespread . This article proposes a six-stage protocol for the implementation of new therapies . Hypotheses about therapy based on pre clinical research should be subject to clinical exploration and pilot studies prior to rigorous assessment with r and omised clinical trials . If r and omised clinical trials suggest that the intervention produces clinical ly important effects , further r and omised studies can be conducted to refine the intervention . New interventions should not be recommended , or included in teaching curricula , or taught in continuing education courses until their effectiveness has been demonstrated in high- quality r and omised clinical trials OBJECTIVE Urinary incontinence is a chronic health complaint that severely reduces quality of life . Pregnancy and vaginal delivery are main risk factors in the development of urinary incontinence . The aim of this study was to assess whether intensive pelvic floor muscle training during pregnancy could prevent urinary incontinence . METHODS We conducted a single-blind r and omized controlled trial at Trondheim University Hospital and three outpatient physiotherapy clinics in a primary care setting . Three hundred one healthy nulliparous women were r and omly allocated to a training ( n = 148 ) or a control group ( n = 153 ) . The training group attended a 12-week intensive pelvic floor muscle training program during pregnancy , supervised by physiotherapists . The control group received the customary information . The primary outcome measure was self-reported symptoms of urinary incontinence . The secondary outcome measure was pelvic floor muscle strength . RESULTS At follow-up , significantly fewer women in the training group reported urinary incontinence : 48 of 148 ( 32 % ) versus 74 of 153 ( 48 % ) at 36 weeks ' pregnancy ( P = .007 ) and 29 of 148 ( 20 % ) versus 49 of 153 ( 32 % ) 3 months after delivery ( P = .018 ) . According to numbers needed to treat , intensive pelvic floor muscle training during pregnancy prevented urinary incontinence in about one in six women during pregnancy and one in eight women after delivery . Pelvic floor muscle strength was significantly higher in the training group at 36 weeks ' pregnancy ( P = .008 ) and 3 months after delivery ( P = .048 ) . CONCLUSION Intensive pelvic floor muscle training during pregnancy prevents urinary incontinence during pregnancy and after delivery . Pelvic floor muscle strength improved significantly after intensive pelvic floor muscle training Abstract Objectives : To assess the effect of nurse assessment with reinforcement of pelvic floor muscle training exercises and bladder training compared with st and ard management among women with persistent incontinence three months postnatally . Design : R and omised controlled trial with nine months ' follow up . Setting : Community intervention in three centres ( Dunedin , New Zeal and ; Birmingham ; Aberdeen ) . Participants : 747 women with urinary incontinence three months postnatally , allocated at r and om to intervention ( 371 ) or control ( 376 ) groups . Intervention : Assessment by nurses of urinary incontinence with conservative advice on pelvic floor exercises at five , seven , and nine months after delivery supplemented with bladder training if appropriate at seven and nine months . Main outcome measures : Primary : persistence and severity of urinary incontinence 12 months after delivery . Secondary : performance of pelvic floor exercises , change in coexisting faecal incontinence , wellbeing , anxiety , and depression . Results : Women in the intervention group had significantly less urinary incontinence : 167/279 ( 59.9 % ) v 169/245 ( 69.0 % ) , difference 9.1 % ( 95 % confidence interval 1.0 % to 17.3 % , P=0.037 ) for any incontinence and 55/279 ( 19.7 % ) v 78/245 ( 31.8 % ) , difference 12.1 % ( 4.7 % to 19.6 % , P=0.002 ) for severe incontinence . Faecal incontinence was also less common : 12/273 ( 4.4 % ) v 25/237 ( 10.5 % ) , difference 6.1 % ( 1.6 % to 10.8 % , P=0.012 ) . At 12 months women in the intervention group were more likely to be performing pelvic floor exercises  ( 218/278 ( 79 % ) v 118/244 ( 48 % ) , P<0.001 ) . Conclusions : A third of women may have some urinary incontinence three months after childbirth . Conservative management provided by nurses seems to reduce the likelihood of urinary and coexisting faecal incontinence persisting 12 months postpartum . Further trials for faecal incontinence are needed . What is already known on this topic Vaginal delivery is a risk factor for urinary incontinence Three months after childbirth 20 - 30 % of women still experience urinary incontinence Most women do not seek treatment What this study adds Women will use conservative treatments such as pelvic floor 
    Output:
    
Based on the studies with relevant sample size , high adherence to a strength-training protocol and close follow-up , we found that PFMT during pregnancy and after delivery can prevent and treat UI .
A supervised training protocol following strength-training principles , emphasising close to maximum contractions and lasting at least 8 weeks is recommended .
PFMT is effective when supervised training is conducted .