The Journal of Maternal-Fetal & Neonatal Medicine

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Device-assisted pelvic floor muscle postpartum

exercise programme for the management of pelvic
floor dysfunction after delivery

Natalia Vladimirovna Artymuk & Svetlana Yurevna Khapacheva

To cite this article: Natalia Vladimirovna Artymuk & Svetlana Yurevna Khapacheva (2020):
Device-assisted pelvic floor muscle postpartum exercise programme for the management of
pelvic floor dysfunction after delivery, The Journal of Maternal-Fetal & Neonatal Medicine, DOI:
10.1080/14767058.2020.1723541

To link to this article: https://doi.org/10.1080/14767058.2020.1723541

Published online: 04 Feb 2020.

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THE JOURNAL OF MATERNAL-FETAL & NEONATAL MEDICINE
https://doi.org/10.1080/14767058.2020.1723541

ORIGINAL ARTICLE

Device-assisted pelvic floor muscle postpartum exercise programme for the

management of pelvic floor dysfunction after delivery
Natalia Vladimirovna Artymuk and Svetlana Yurevna Khapacheva
G.A. Ushakova Obstetrics and Gynecology Department, Kemerovo State Medical University, Kemerovo, Russia

ABSTRACT ARTICLE HISTORY

Background: Pelvic floor dysfunction (PFD) is a multifactorial condition that clinically manifests Received 16 November 2019
as the pelvic prolapse, urinary and/or rectal incontinence, and sexual dysfunction. Revised 21 January 2020
Aim: We aimed to evaluate the efficacy of two pelvic floor trainers for the prevention of PFD in Accepted 27 January 2020
women during the postpartum period.
KEYWORDS
Materials and methods: This was a prospective, randomized, open-label study in 70 women in Pelvic floor dysfunction;
the postpartum period. Participants were randomized to complete a daily, 20-min set of pelvic pelvic floor muscle exercise;
floor muscle exercises using the EmbaGYN (UK; Group 1, n ¼ 40) or the Magic Kegel Master prolapse; rectal
device (China; Group 2, n ¼ 40) for 4 weeks. All participants anonymously completed the PFDI-20 incontinence; sexual
questionnaire and FSFI form at baseline and last visit. Pelvic floor muscle strength was measured dysfunction; urinary
using the XFT-0010 device. incontinence
Results: After the completion of the 4-week pelvic floor muscle exercise program, there was a
significant decrease in the rates of all PFD symptoms including pelvic organ prolapse and urin-
ary and/or fecal incontinence in both groups. The rates of sexual dysfunction after the exercise
program decreased significantly only in Group II (69.4 versus 25.0%; h ¼.001). After the program,
Group I showed a significant reduction in the number of women with symptoms of urgent urin-
ary incontinence versus baseline (35.3 versus 8.8% p ¼ .009). Similarly, the rates of urine loss
associated with coughing, sneezing or laughing in Group I decreased from 41.2% at baseline to
11.8% after the program (h ¼.006) and the rates of urine leakage independent of physical activ-
ity from 23.5 to 5.9% (p ¼ .040), respectively.
Conclusion: The 4-week postpartum pelvic floor muscle exercise program utilizing the
EmbaGYN or Magic Kegel Master device has significantly increased the pelvic floor muscle
strength and decreased the symptoms of pelvic organ prolapse, urinary and fecal incontinence.
The use of the Magic Kegel Master device significantly reduced the symptoms of sexual dysfunc-
tion. The use of the EmbaGYN device was effective in addressing the individual symptoms of
urinary incontinence.

Introduction 50–60-year-olds, reaching almost 80% [4]. Pregnancy

Pelvic floor dysfunction (PFD) is a multifactorial condi-
tion that clinically manifests as the pelvic prolapse,
urinary and/or rectal incontinence, and sexual dysfunc-
tion [1]. Symptoms of PFD have been reported in
19.7–50.3% of women aged 20–39 years and in
41–77.2% of women aged 50–79 years [1]. However,
the true prevalence of this condition may be underes-
timated due to the diversity of symptoms leading to
the referral of women with PFD to a broad range of
specialists and, potentially, underdiagnosis [2].
Pelvic floor dysfunction usually starts to develop
during the postpartum period and often remains
asymptomatic for a long time [3,4]. The highest
incidence of PFD has been reported among the
and delivery are significant risk factors for PFD [4–6].
For instance, women with first- or second-degree peri-
neal tears or after episiotomy showed signs of abnor-
mal pelvic morphometry on 3 D rotational ultrasound
at 3 months after delivery [4]. Furthermore, elective
cesarean delivery may not fully protect against the
postpartum stress urinary incontinence [5].
There is currently no consensus on the best
approach to PFD management [7]. Pelvic floor muscle
exercises have been effective in reducing the symp-
toms of PFD, but this intervention needs to com-
mence before the clinical manifestations of the
condition [8–10]. The efficacy of nonsurgical manage-
ment may also be higher in women who adopt an

CONTACT Natalia Vladimirovna Artymuk artymuk@gmail.com G.A. Ushakova Obstetrics and Gynecology Department, Kemerovo State Medical
University, 22a Voroshilov street, Kemerovo 650056, Russia
ß 2020 Informa UK Limited, trading as Taylor & Francis Group
2 N. V. ARTYMUK AND S. Y. KHAPACHEVA
overall healthy lifestyle: quit smoking, maintain
healthy body weight, control blood sugar, and
undergo treatment of respiratory and gastrointestinal
comorbidities [11–13]. A study by Celiker et al. (2014)
showed that pelvic floor muscle exercises effectively
reduced the symptoms of stress and mixed urinary
incontinence and increased the strength of pelvic floor
muscles [14]. In a multicentre randomized controlled
study by Hagen et al. (2014), women who received an
individualized pelvic floor muscle exercise programs
reported a decrease of prolapse symptoms after
12 months; this improvement significantly increased
the quality of life [15].
Dedicated devices for pelvic floor exercises, also
referred to as pelvic floor trainers, are being increas-
ingly used to assist with the reduction of PFD symp-
toms; however, studies in the postpartum period are
lacking [16]. Our study aimed to evaluate the efficacy
of pelvic floor trainer use for the prevention of PFD in
postpartum women.
Materials and methods
This was a prospective, randomized, open-label study
in 70 women in the postpartum period. We included
women who had undergone delivery in the preceding
12 weeks, aged 18–45 years, and with a negative
pregnancy test. Women after assisted delivery (forceps
or ventouse), cesarean delivery, third- and fourth-
degree perineal tears, urinary and/or gastrointestinal
infections or inflammatory diseases, severe comorbid-
ities, and cognitive and mental disorders were
excluded from the study.
Eligible women were randomized in a 1:1 ratio
using the sealed envelope method to complete a
daily, 20-min set of pelvic floor muscle exercises using
the EmbaGYNTM (UK; Group 1, n ¼ 40) or the Magic
Kegel Master device (China; Group 2, n ¼ 40)
for 4 weeks.
The EmbaGYN device emits weak electrical impulses
which stimulate the branches of the genitofemoral
nerve, resulting in the contraction of the pelvic floor
muscles depending in the program settings. The
Magic Kegel Master device is a silicone, peanut-shaped
vibrating device controlled via a smartphone
Bluetooth app. The app records the muscle pressure
data from the highly-sensitive sensors in the vaginal
piece and provides instructions and feedback to the
user. All patients used the “postpartum” exer-
cise program.
At baseline, all patients underwent the pelvic floor
muscle assessment and device training. Over the
4 weeks of the study, we contacted the patients by
phone weekly to assess progress and provide motiv-
ation and encouragement. The pelvic floor muscle
assessment was repeated at the second visit.
Participants also completed the 20-item Pelvic Floor
Distress Inventory (PFDI-20) questionnaire and the
five-item Female Sexual Function Index (FSFI) ques-
tionnaire. The 20-item PFDI included three categories
of questions covering the symptoms of pelvic organ
prolapse (Pelvic Organ Prolapse Distress Inventory –
POPDI-6), colorectal anal symptoms (Colorectal Anal
Distress Inventory – CRAD-8) and urinary incontinence
symptoms (Urinary Distress Inventory – UDI-6). All
symptoms could be scored from 0 (never experienced)
to 4 (constantly experiencing). The total score for the
PFDI-20 questionnaire was calculated as a sum of the
scores for all questions multiplied by 25 and can range
from 0 to 300 points [17]. The five-item (short) FSFI
included questions on the level of sexual desire/inter-
est (libido), sexual arousal, discomfort or pain during
and/or after intercourse, natural vaginal lubrication,
and the frequency of orgasms; each parameter could
be scored from 0 to 5. The total score below 22.15
points was interpreted as a marker of female sexual
dysfunction [18].
Pelvic floor muscle strength (mmHg) was measured
using the Pneumatic Pelvic Muscle Trainer XFT-0010
device (China). The assessment was carried out using
the “Testing the level of strength of the pelvic
muscles” program.
The study was conducted at the Kemerovo Region
Clinical Perinatal Center (Kemerovo, Russia). All women
had given informed consent to participate in the
study. The study protocol was approved by the Ethics
Committee of the Kemerovo State Medical University.
Statistical data analysis was performed using the
analysis Tools Pack and Statistica v10.0 software.
Continuous variables are presented as a mean, vari-
ance, and 95% confidence interval (CI) and were com-
pared using a paired t-test (Student’s test). Categorical
variables are presented as absolute numbers and pro-
portions and were compared using a v2-test. When
testing statistical hypotheses, the level of critical sig-
nificance <0.05 was utilized.
Results
We initially enrolled 80 eligible women, of whom 36
in Group I and 36 women in Group II completed the
study. Six women in Group I and four women in
Group II were excluded from the analysis due to non-
adherence to the exercise program. There were no
 THE JOURNAL OF MATERNAL-FETAL & NEONATAL MEDICINE 3

Table 1. Baseline demographics.

Parameter Group I (n ¼ 34) Group II (n ¼ 36) p
Age (years), M ± m 30.3 ± 3.8 29.4 ± 4.2 .874
Primigravida, n (%) 19 (57.7) 16 (45.5) .339
Primiparous, n (%) 19 (57.7) 16 (45.5) .339
Secundiparous, n (%) 15 (42.3) 20 (54.5) .339
Current or history of somatic diseases, n (%) 23 (67.5) 20 (55.6) .299
Age of menarche, M ± m 12.7 ± 1.1 12.8 ± 1.4 .955
History of gynaecological diseases, n (%) 10 (29.4) 10 (27.8) .880

Table 2. Pelvic floor muscle strength and PFD symptoms.

Baseline After the 4-week pelvic floor muscle exercise program p (versus baseline)
Group I Group II Group I Group II
Parameter (n ¼ 34) (n ¼ 36) p (n ¼ 34) (n ¼ 36) p Group I Group II
Strength of the pelvic floor muscles, 59.5 ± 0.7 58.6 ± 0.5 .860 65.8 ± 0.7 66.3 ± 1.0 .944 <.001 <.001
mmHg, mean ± SD
Frequency of PFD symptoms, n (%) 26 (76.4) 30 (83.3) .474 14/41.2 12 (33.3) .498 .001 .005
Pelvic organ prolapse, n (%) 23 (67.6) 23 (63.9) .741 10/29.4 8 (22.2) .492 .002 <.001
Urinary incontinence, n (%) 26 (76.5) 30 (86.1) .300 14/41.2 12 (33.3) .498 .004 <.001
Fecal incontinence, n (%) 26 (76.5) 25 (72.2) .685 8/23.5 11 (30.6) .509 <.001 <.001
Sexual dysfunction, % 55.9 69.4 .241 44.1 25.0 .093 .332 <.001
Decreased libido, % 38.2 50/0 .322 14.7 13.9 .923 .028 .002
Decreased sexual arousal, % 20.5 38.9 .095 20.5 11.1 .277 1.000 .007
Discomfort or pain, % 11.8 13.9 .791 11.8 5.6 .354 1.000 .233
Decreased natural lubrication, % 29.4 25.0 .679 20.6 11.1 .277 .401 .126
Lack of orgasm, % 41.1 58.3 .152 29.4 11.2 .056 .311 <.001

significant differences in the demographic characteris-
tics between the study groups (Table 1).
At baseline, pelvic floor muscle strength and the
rates of PFD symptoms and sexual dysfunction did not
differ significantly between the groups. After the com-
pletion of the 4-week exercise program, a significant
increase in the pelvic floor muscle strength versus the
baseline was observed in both groups (Group I:
59.5 ± 3.9 versus 65.8 ± 4.2 mmHg, p ¼ .0001; Group II:
58.6 ± 3.3 versus 66.3 ± 5.8 mmHg, p ¼ .0001). After the
exercise program, we recorded a significant decrease
in the frequency of all PFD symptoms including pelvic
organ prolapse and urinary and/or fecal incontinence
in both groups. The pelvic muscle strength and fre-
quency of PFD symptoms after the completion of the
exercise program did not differ significantly between
the study groups (p > .05).
Specifically, at 12 weeks postpartum, symptoms of
pelvic prolapse were reported in 67.6 and 63.9% of
women in Group I and II, respectively, colorectal-anal
symptoms in 76.5 and 86.1%, urinary incontinence in
76.5 and 72.2%, and symptoms of sexual dysfunction
in 55.9 and 69.4% (p > .05 for all). After the comple-
tion of the pelvic floor exercise program, the number
of patients complaining of the lower abdomen pres-
sure decreased significantly versus the baseline from
41.2 to 14.7% in Group I (p ¼ .016) and from 44.4 to
11.1% in Group II (p ¼ .005). The rate of pelvic
“heaviness” reduced from 32.4% at baseline to 5.9% in
Group I (p ¼ .006) and from 22.2% at baseline to 2.8%
in Group II (p ¼ .013). The rate of foreign body sensa-
tion in the vagina decreased from 23.5% at baseline
to 5.9% in Group I (p ¼ .040) and from 19.4% at base-
line to 5.6% in Group II (p ¼ .075). The rate of frequent
urination decreased from 44.1% at baseline to 11.8%
in Group I (p ¼ .003) and from 58.3 to 22.2% in Group
II (p ¼ .002).
After completing the pelvic floor exercise program,
significantly fewer women in Group I reported symp-
toms of urgent urinary incontinence versus baseline
(8.8 versus 35.3%, p ¼ .009). Similar trends were
observed for the urine loss associated with coughing,
sneezing or laughing (11.8 versus 42.1%, h ¼.006) and
the loss of small amounts of urine independent of
physical activity (5.9 versus 23.5%, p ¼ .040). The num-
ber of patients experiencing incomplete bladder emp-
tying decreased significantly after the exercise
program versus the baseline only in Group I (2.9 ver-
sus 32.1%, p ¼ .002).
Table 2 shows the pelvic floor muscle strength, fre-
quency of PFD and sexual dysfunction symptoms in
the study before and after the pelvic floor exer-
cise program.
After the pelvic floor muscle exercise program, the
overall frequency of symptoms of sexual dysfunction
decreased significantly only in Group II (69.4 versus
25.0%, p ¼ .001). In Group I, symptoms of sexual dys-
function at baseline were recorded in 55.9% patients
4 N. V. ARTYMUK AND S. Y. KHAPACHEVA
compared with 44.1% after the program (p ¼ .332).
The number of patients with decreased libido after
the exercise program decreased significantly in Group
I (p ¼ .028).
Discussion
Prevalence of pelvic prolapse symptoms and other
signs of PFD has been reported to vary between 19.7
and 77.2%, and to a large extent depends on the age
of the study population and the methodology used
[2]. We have previously reported >50% prevalence of
PFD symptoms and 80% prevalence of sexual dys-
function symptoms in a cohort of 1167 women of
reproductive age in the Kemerovo region [19]. The
association between the pelvic organ prolapse, colo-
rectal-anal and urinary incontinence symptoms with
parity has been well-established [19].
Our current study showed a high prevalence of
PFD symptoms in young women postpartum.
Specifically, the symptoms of pelvic prolapse within
12 weeks after delivery were found in 63.9–67.6% of
women, symptoms of urinary incontinence in
72.2–76.5% and symptoms of sexual dysfunction in
55.9–69.4%. These findings indicate the need for post-
partum pelvic rehabilitation and early detection of
PFD for timely, nonsurgical interventions to prevent
the disease progression, reduce the need for surgery,
and improve women’s quality of life.
Pelvic floor muscle exercises are the first-line strat-
egy for nonsurgical management of pelvic prolapse,
including the cases associated with urinary and fecal
incontinence. The exercises are usually based on
Kegel’s exercises but may also utilize devices providing
user feedback or vaginal trainers. Four randomized
clinical trials showed that this approach was effective
in reducing the degree of pelvic prolapse in 17% of
patients [20]. A decrease in the severity of urinary and
fecal incontinence was observed in 40–60% of
patients, and the lack of pelvic prolapse progression
was seen in more than 94% of women [21].
Our study showed that a 4-week pelvic floor
muscles exercise program using dedicated electrosti-
mulating or vibrating devices in the first 12 weeks of
the postpartum period reduced all symptoms of PFD
including pelvic prolapse, urinary and fecal incontin-
ence. Specifically, the use of the vibrating Magic Kegel
Master device significantly improved all parameters of
sexual function and decreased the number of women
with reduced sexual desire and arousal, discomfort or
pain during sexual intercourse, vaginal dryness and
lack of orgasm.
In a study by Serov et al. (2011), electric stimulation
of the pelvic floor muscles in patients with decreased
pelvic floor muscle tone with/without mild to moder-
ate stress urinary incontinence resulted in an 50%
improvement of clinical markers of PFD in 87.5% of
patients with symptoms of stress urinary incontinence
and in 100% of asymptomatic women. The improve-
ment occurred after 4–5 weeks of treatment [22]. Eder
et al. (2014) found that electric stimulation of the pel-
vic floor muscles using the EmbaGYN device in
patients with stress urinary incontinence was highly
efficacious. At week 12, the average number of urinary
incontinence episodes per day decreased by 56.2%
(p ¼ .152) [23]. The EmbaGYN’s mechanism of action
includes indirect stimulation of the pelvic floor
muscles through the branches of the genitofemoral
nerve. Repeated contraction caused by the electrical
impulses increases the muscle mass and strength.
Muscle contractions may also improve blood circula-
tion in the adjacent deep tissues [24]. Finally, Yang
et al. (2017) showed that Kegel’s exercises combined
with electrical stimulation significantly reduced the
degree of urinary incontinence [25].
In our study, we obtained data on the higher effi-
ciency of the EmbaGYN device compared with Magic
Kegel Master for some symptoms of urinary incontin-
ence. These included urgent and stress urinary incon-
tinence, urine leakage independent of physical
activity, and the incomplete bladder emptying sensa-
tion. However, the frequency of symptoms of sexual
dysfunction after the exercise program decreased sig-
nificantly only in patients using the vibrating Magic
Kegel Master device.
Conclusion
The postpartum 4-week pelvic floor muscle exercise
program using the EmbaGYN or Magic Kegel Master
device has significantly increased the pelvic floor
muscle strength and decreased the symptoms of pel-
vic organ prolapse, urinary and fecal incontinence ver-
sus the baseline. The use of the Magic Kegel Master
device significantly reduced the symptoms of sexual
dysfunction. The use of the EmbaGYN device was
effective for addressing the individual symptoms of
urinary incontinence. Further larger-scale studies are
needed to confirm the potential benefits of various
methods and pelvic floor stimulation modes.
Acknowledgements
The EmbaGYN (United Kingdom), Magic Kegel Master
(China) and Pneumatic Pelvic Muscle Trainer XFT-0010

(China) were provided by Pentcroft Pharma
(Moscow, Russia).
Disclosure statement
No potential conflict of interest was reported
the author(s).
ORCID
Natalia Vladimirovna Artymuk http://orcid.org/0000-0001-
7014-6492
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