Individualized pelvic floor rehabilitation training on psychological and functional recovery in postpartum women with generalized anxiety disorder

Abstract

Background: Postpartum women are at an increased risk of generalized anxiety disorder (GAD), which can negatively affect both mental health and physical recovery. Pelvic floor dysfunction, common in this population, can exacerbate psychological distress. Although pelvic floor rehabilitation is effective in physical recovery, its potential to improve psychological outcomes, especially in women with GAD, remains underexplored.

Aim: To evaluate the effectiveness of an individualized pelvic floor rehabilitation program in improving anxiety, pelvic floor function, and quality of life in postpartum women with GAD.

Methods: A retrospective study was performed to analyze 80 postpartum women with GAD who completed a 12-week individualized pelvic floor rehabilitation program (January 2020-December 2024), combining supervised pelvic floor muscle training and psychological support. Primary outcomes were changes in GAD-7 and Hamilton anxiety rating scale (HAM-A) scores and pelvic floor function measured by surface electromyography (sEMG). Secondary outcomes included World Health Organization quality of life-BREF, pelvic floor symptom severity, and impact on daily activities (pelvic floor impact questionnaire). Assessments were conducted at baseline and 6 and 12 weeks during the intervention period.

Results: Significant improvements were observed in anxiety measures, with mean GAD-7 scores decreasing from 14.8 ± 3.2 at baseline to 8.2 ± 2.9 at week 12 (P < 0.001) and HAM-A scores decreasing from 22.6 ± 4.5 to 12.4 ± 3.8 (P < 0.001). Pelvic floor function showed substantial enhancement, with sEMG amplitude increasing from 22.4 ± 5.6 µV to 35.9 ± 6.8 µV (P < 0.001). Quality of life improved across all domains, with the most significant improvements in psychological (28.5% increase) and physical health (25.8% increase). Program adherence was 91.5% for the supervised sessions, and no serious adverse events were reported.

Conclusion: Individualized pelvic floor rehabilitation training effectively improves both psychological and functional outcomes in postpartum women with GAD. The high adherence and significant outcomes make this integrated approach feasible and effective.

Keywords: Generalized anxiety disorder; Mental health; Pelvic floor rehabilitation; Physical therapy; Postpartum care.

Figure 1

Changes in generalized anxiety disorder-7 scale and Hamilton anxiety rating scale scores over the 12-week intervention period. GAD-7: Generalized anxiety disorder-7 scale; HAM-A: Hamilton anxiety rating scale.