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Impact of Pelvic Floor Exercise Education on Pelvic Floor Exercise Practices among Postnatal Women in Nigeria

Abstract

Pelvic floor health is an important component of postnatal women's health because pregnancy and childbirth may place considerable stress on the pelvic floor muscles and contribute to urinary incontinence, pelvic organ prolapse, reduced pelvic muscle strength, sexual health difficulties, and other postpartum concerns. Pelvic floor exercises, commonly known as pelvic floor muscle exercises, may help women strengthen and maintain pelvic floor muscle function following pregnancy and childbirth. However, postnatal women in Nigeria may have limited knowledge of pelvic floor exercises, uncertainty about correct exercise techniques, inadequate access to postpartum health education, cultural discomfort discussing pelvic health, and limited follow-up support after delivery. Pelvic floor exercise education provides an opportunity to improve women's knowledge, confidence, and practical ability to perform appropriate pelvic floor exercises. Against this background, this study investigates the impact of pelvic floor exercise education on pelvic floor exercise practices among postnatal women in Nigeria. The study will be anchored on the Health Belief Model, Social Cognitive Theory, and Self-Care Deficit Theory. 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, self-efficacy, and cues to action may influence their exercise practices. Social Cognitive Theory emphasizes observational learning, behavioural modelling, self-efficacy, reinforcement, and environmental influences in shaping health behaviours. Self-Care Deficit Theory emphasizes women's ability to acquire knowledge and independently perform appropriate self-care activities to maintain and improve their health. Collectively, these theoretical perspectives provide a suitable framework for explaining how pelvic floor exercise education may influence pelvic floor exercise practices among postnatal women in Nigeria. The study will adopt a quantitative quasi-experimental or analytical cross-sectional research design. The study population will comprise postnatal women aged 18 years and above who have delivered within a defined postpartum period and attend selected public and private healthcare facilities across Nigeria. A multistage sampling technique will be used to select geopolitical zones, states, local government areas, healthcare facilities, postnatal clinics, communities, and eligible postnatal women. Pelvic floor exercise education will be assessed using indicators such as exposure to structured pelvic floor education sessions, frequency and duration of education, knowledge of pelvic floor muscles, awareness of changes associated with pregnancy and childbirth, knowledge of pelvic floor exercise benefits, identification of pelvic floor muscles, correct exercise technique, exercise frequency, duration and progression, appropriate breathing and muscle relaxation, awareness of common postpartum pelvic floor problems, and knowledge of when to seek professional assessment. Pelvic floor exercise practices will be assessed using indicators such as whether women perform pelvic floor exercises, frequency and consistency of exercise, correct identification and contraction of pelvic floor muscles, appropriate exercise technique, adherence to recommended exercise routines, ability to incorporate exercises into daily activities, continuation of exercises during the postpartum period, use of exercise reminders or tracking where applicable, and consultation with healthcare professionals when symptoms persist. Data will be collected using structured questionnaires, pelvic floor knowledge assessment tools, practical demonstration checklists, self-reported exercise-practice scales, postpartum health records where available, and pre-test and post-test assessments where a quasi-experimental intervention is adopted. Descriptive statistics will be used to summarize participants' demographic and socioeconomic characteristics, obstetric history, mode of delivery, postpartum experiences, previous exposure to pelvic floor education, and exercise practices. Inferential statistical techniques, including chi-square tests, paired and independent t-tests, correlation analysis, and logistic or multiple regression analysis where appropriate, will be used to determine the impact of pelvic floor exercise education on pelvic floor exercise practices. Where a quasi-experimental design is adopted, exercise-practice scores before and after the educational intervention may be compared with those of a comparison group to determine changes associated with the intervention. 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 impact on pelvic floor exercise practices among postnatal women in Nigeria. Women exposed to structured and practical pelvic floor exercise education are expected to demonstrate greater knowledge, confidence, correct technique, and consistency in performing pelvic floor exercises than women without comparable exposure. Practical demonstrations and supervised exercises may improve women's ability to correctly identify and contract the pelvic floor muscles and incorporate exercises into their daily routines. Education may also increase awareness of postpartum urinary leakage, pelvic pressure, pelvic organ prolapse symptoms, and other concerns that may require professional evaluation. However, postpartum fatigue, childcare responsibilities, inadequate follow-up, limited access to physiotherapy or pelvic health professionals, cultural discomfort discussing pelvic health, lack of privacy, misinformation, and uncertainty about correct exercise techniques may reduce the effectiveness of education alone. The study therefore expects accessible, practical, culturally appropriate, and sustained pelvic floor exercise education, supported by appropriate postpartum care and follow-up, to contribute significantly to improved pelvic floor exercise practices among postnatal women in Nigeria. The study is expected to contribute to the literature on pelvic floor health, postnatal care, maternal health, pelvic floor exercises, postpartum recovery, women's health, physiotherapy, reproductive health, health education, 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, maternity and postnatal clinics, physiotherapists, midwives, nurses, obstetricians and gynaecologists, community health workers, maternal-health organizations, development partners, and policymakers regarding strategies for strengthening postpartum pelvic health. The study will also provide evidence-based recommendations for integrating pelvic floor exercise education into antenatal and postnatal care, strengthening practical exercise demonstrations, improving postpartum follow-up, increasing access to pelvic health professionals, improving women's awareness of pelvic floor problems, and developing sustainable maternal-health programmes that promote healthy pelvic floor practices among postnatal women across Nigeria.

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