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Effect of Pelvic-Floor Exercise Education on Pelvic-Floor Exercise Practices among Postpartum Women in Nigeria

Abstract

Pelvic-floor dysfunction is an important postpartum health concern that may affect women's continence, sexual health, physical comfort, mobility, and quality of life following pregnancy and childbirth. Pregnancy, vaginal delivery, prolonged labour, instrumental delivery, and other obstetric factors may contribute to weakening or injury of the pelvic-floor muscles. Despite the potential benefits of pelvic-floor muscle exercises in strengthening these muscles and supporting postpartum recovery, some women in Nigeria may have limited knowledge of appropriate pelvic-floor exercises, difficulty identifying the correct muscles, inadequate postpartum counselling, cultural discomfort discussing pelvic-floor health, and limited access to trained healthcare professionals. Pelvic-floor exercise education provides an opportunity to teach postpartum women about the importance, correct technique, frequency, duration, and benefits of pelvic-floor exercises. Improved education may increase women's knowledge, confidence, and adoption of appropriate exercise practices. Against this background, this study investigates the effect of pelvic-floor exercise education on pelvic-floor exercise practices among postpartum women in Nigeria. The study will be anchored on the Health Belief Model, Social Cognitive Theory, and Health Promotion Model. The Health Belief Model explains how women's perceptions of susceptibility to pelvic-floor problems, perceived severity, perceived benefits of pelvic-floor exercises, perceived barriers, and cues to action may influence their exercise practices. Social Cognitive Theory emphasizes knowledge, self-efficacy, behavioural capability, observational learning, and social support in developing and maintaining pelvic-floor exercise behaviours. The Health Promotion Model emphasizes individual experiences, perceived benefits and barriers, interpersonal influences, and behavioural factors that influence participation in health-promoting activities. Collectively, these theoretical perspectives provide a suitable framework for explaining how pelvic-floor exercise education may influence exercise practices among postpartum women in Nigeria. The study will adopt a quantitative analytical cross-sectional or quasi-experimental research design. The study population will comprise postpartum women who have recently given birth and are within the defined postpartum period in selected healthcare facilities and communities across Nigeria. A multistage sampling technique will be used to select states, local government areas, communities, healthcare facilities, postpartum clinics, and eligible women. Pelvic-floor exercise education will be assessed using indicators such as exposure to educational sessions, information on pelvic-floor muscle function, identification of pelvic-floor muscles, correct exercise technique, frequency and duration of exercises, benefits of regular exercise, appropriate timing for initiation, precautions, healthcare-provider demonstrations, educational materials, and follow-up support. Pelvic-floor exercise practices will be assessed using indicators such as whether women perform pelvic-floor exercises, frequency of exercise, duration of exercise sessions, consistency of practice, correct identification and contraction of pelvic-floor muscles, adherence to recommended exercise routines, and continuation of exercises over the postpartum period. Where appropriate, validated pelvic-floor exercise knowledge and practice assessment tools will be used. Data will be collected using structured questionnaires, pelvic-floor exercise assessment tools, postpartum clinic records, educational records, and relevant maternal health programme documents. Descriptive statistics will be used to summarize participants' characteristics, exposure to pelvic-floor exercise education, knowledge levels, and exercise practices. Inferential statistical techniques, including chi-square tests, t-tests, correlation analysis, and logistic or multiple regression analysis where appropriate, will be used to determine the effect of pelvic-floor exercise education on pelvic-floor exercise practices. Where a quasi-experimental design is adopted, pelvic-floor exercise practice scores before and after structured education may be compared, while relevant demographic, socioeconomic, obstetric, and healthcare-access factors are appropriately controlled. Diagnostic tests will also be conducted to assess the reliability, validity, and robustness of the findings. The study is expected to find that pelvic-floor exercise education has a significant positive effect on pelvic-floor exercise practices among postpartum women in Nigeria. Women exposed to structured and practical pelvic-floor exercise education are expected to demonstrate better knowledge of pelvic-floor exercises, greater confidence in performing them, and higher levels of regular exercise practice than women without such education. Practical demonstrations may help women correctly identify and contract the pelvic-floor muscles and understand the appropriate frequency and duration of exercise. Education delivered during antenatal care, postnatal care, community health programmes, and postpartum follow-up may reinforce exercise practices and encourage women to incorporate pelvic-floor exercises into their daily routines. However, fatigue, childcare responsibilities, lack of privacy, cultural discomfort, limited access to trained physiotherapists or other healthcare professionals, inadequate postpartum follow-up, and poor awareness may affect adherence. The study therefore expects accessible, practical, culturally appropriate, and professionally guided pelvic-floor exercise education to contribute significantly to improved pelvic-floor exercise practices among postpartum women in Nigeria. The study is expected to contribute to the literature on pelvic-floor exercise education, pelvic-floor muscle exercises, postpartum health, maternal rehabilitation, women's reproductive health, postpartum recovery, pelvic-floor dysfunction prevention, and public health in Nigeria. The findings will provide useful information to the Federal Ministry of Health and Social Welfare, National Primary Health Care Development Agency, state ministries of health, hospitals, primary healthcare centres, physiotherapists, midwives, obstetricians, nurses, maternal health programmes, women's health organizations, development partners, and policymakers regarding strategies for improving postpartum pelvic-floor health. The study will also provide evidence-based recommendations for integrating pelvic-floor exercise education into routine antenatal and postnatal care, training healthcare providers in pelvic-floor exercise counselling and demonstration, strengthening postpartum rehabilitation services, expanding community-based education, improving postpartum follow-up, and increasing awareness of pelvic-floor health among women and families across Nigeria.

Keywords: Pelvic-floor exercise education, pelvic-floor exercise practices, postpartum women, pelvic-floor muscle exercises, postpartum health, maternal rehabilitation, pelvic-floor health, women's health, postnatal care, Nigeria, public health.