Comparison of Rehabilitation Exercise Protocol (5R) and Swiss Ball Training for Postpartum Pelvic Floor Muscle Dysfunction

Postpartum pelvic floor muscle dysfunction (PFMD) is a significant health concern affecting women after childbirth. Pregnancy and vaginal delivery can lead to stretching, weakening, and potential injury to the pelvic floor muscles and connective tissues. As a result, many postpartum women experience symptoms such as urinary incontinence, pelvic organ prolapse, decreased pelvic stability, and reduced functional capacity. These symptoms can significantly affect daily activities, psychological well-being, and overall quality of life.

Physiotherapy-based rehabilitation is considered one of the most effective non-invasive management strategies for postpartum pelvic floor dysfunction. Various exercise-based approaches have been proposed to strengthen pelvic floor muscles, improve neuromuscular control, and restore functional stability of the pelvic region.

The Rehabilitation Exercise Protocol (5R) is a structured therapeutic program designed to promote systematic recovery of pelvic floor muscle function. The protocol typically incorporates progressive phases including muscle relaxation, activation and recruitment of pelvic floor muscles, resistance training, repeated contractions for endurance, and recovery strategies to enhance muscle performance and functional stability.

Swiss ball training has also gained popularity as a rehabilitation method for postpartum women. Exercises performed on a Swiss ball introduce an element of instability, which stimulates activation of the core musculature including the pelvic floor, abdominal muscles, and lower back stabilizers. This training approach may improve coordination, balance, and pelvic stability while enhancing overall muscle strength.

Despite the widespread use of both approaches, limited evidence exists comparing the effectiveness of the structured 5R rehabilitation protocol and Swiss ball training in postpartum pelvic floor rehabilitation. Therefore, this study aims to compare the therapeutic effects of these two interventions in postpartum women diagnosed with pelvic floor muscle dysfunction.

This randomized controlled study will recruit postpartum women who meet the eligibility criteria. Participants will be randomly allocated into two groups. Group A will receive the Rehabilitation Exercise Protocol (5R), while Group B will undergo Swiss ball training exercises. Both interventions will be conducted over a defined treatment period under physiotherapy supervision.

Outcome measures will be assessed at baseline and after completion of the intervention period to evaluate improvements in pelvic floor muscle strength, symptom severity, and functional outcomes. The results of this study will provide evidence regarding the most effective physiotherapy intervention for postpartum pelvic floor muscle rehabilitation and may guide clinical practice for improving postpartum recovery.

Inclusion criteria

Females aged 20-40 years who have given birth within the last 6 months (normal deliveries).

Delivery mood: both Normal and cesarean deliveries. Primiparous and Multiparous women. Women willing to participate in study. Confirmed pelvic floor dysfunction. Self-report of urinary incontinence (stress or urge) occurring at least once per week

Exclusion criteria

Women with high-risk pregnancies or postpartum complications (e.g., severe preeclampsia, postpartum hemorrhage).

Participants with diagnosed musculoskeletal or neurological disorders affecting movement.

History of pelvic surgery or severe musculoskeletal disorders. Women with diastasis recti exceeding a clinically significant threshold