Conservative management of persistent postnatal urinary and faecal incontinence

randomised controlled trial

C. M. A. Glazener, G. P. Herbison, P. D. Wilson, C. MacArthur, G. D. Lang, H. Gee, A. Grant

Research output: Contribution to journalArticle

121 Citations (Scopus)

Abstract

Objectives To assess the effect of nurse assessment with reinforcement of pelvic floor muscle training exercises and bladder training compared with standard management among women with persistent incontinence three months postnatally.

Design Randomised controlled trial with nine months' follow up.

Setting Community intervention in three centres (Dunedin, New Zealand; Birmingham; Aberdeen).

Participants 747 women with urinary incontinence three months postnatally, allocated at random to intervention (371) or control (376) groups. Intervention Assessment by nurses of urinary incontinence with conservative advice on pelvic floor exercises at five, seven, and nine months after delivery supplemented with bladder training if appropriate at seven and nine months.

Main outcome measures Primary: persistence and severity of urinary incontinence 12 months after delivery. Secondary: performance of pelvic floor exercises, change in coexisting faecal incontinence, wellbeing, anxiety, and depression.

Results Women in the intervention group had significantly less urinary incontinence: 167/279 (59.9%) v 169/245 (69.0%), difference 9.1% (95% confidence interval 1.0% to 17.3%, P = 0.037) for any incontinence and 55/279 (19.7%) v 78/245 (31.8%), difference 12.1% (4.7% to 19.6%, P = 0.002) for severe incontinence. Faecal incontinence was also less common: 12/273 (4.4%) v 25/237 (10.5%), difference 6.1% (1.6% to 10.8%, P = 0.012). At 12 months women in the intervention group were more likely to be performing pelvic floor exercises (218/278 (79%) v 118/244 (48% P < 0.001).

Conclusions A third of women may have some urinary incontinence three months after childbirth. Conservative management provided by nurses seems to reduce the likelihood of urinary and coexisting faecal incontinence persisting 12 months postpartum. Further trials for faecal incontinence are needed.

Original languageEnglish
Pages (from-to)593-596
Number of pages4
JournalBMJ
Volume323
Issue number7313
DOIs
Publication statusPublished - 15 Sep 2001

Keywords

  • prevalence
  • delivery

Cite this

Glazener, C. M. A., Herbison, G. P., Wilson, P. D., MacArthur, C., Lang, G. D., Gee, H., & Grant, A. (2001). Conservative management of persistent postnatal urinary and faecal incontinence: randomised controlled trial. BMJ, 323(7313), 593-596. https://doi.org/10.1136/bmj.323.7313.593

Conservative management of persistent postnatal urinary and faecal incontinence : randomised controlled trial. / Glazener, C. M. A.; Herbison, G. P.; Wilson, P. D.; MacArthur, C.; Lang, G. D.; Gee, H.; Grant, A.

In: BMJ, Vol. 323, No. 7313, 15.09.2001, p. 593-596.

Research output: Contribution to journalArticle

Glazener, CMA, Herbison, GP, Wilson, PD, MacArthur, C, Lang, GD, Gee, H & Grant, A 2001, 'Conservative management of persistent postnatal urinary and faecal incontinence: randomised controlled trial', BMJ, vol. 323, no. 7313, pp. 593-596. https://doi.org/10.1136/bmj.323.7313.593
Glazener, C. M. A. ; Herbison, G. P. ; Wilson, P. D. ; MacArthur, C. ; Lang, G. D. ; Gee, H. ; Grant, A. / Conservative management of persistent postnatal urinary and faecal incontinence : randomised controlled trial. In: BMJ. 2001 ; Vol. 323, No. 7313. pp. 593-596.
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abstract = "Objectives To assess the effect of nurse assessment with reinforcement of pelvic floor muscle training exercises and bladder training compared with standard management among women with persistent incontinence three months postnatally.Design Randomised controlled trial with nine months' follow up.Setting Community intervention in three centres (Dunedin, New Zealand; Birmingham; Aberdeen).Participants 747 women with urinary incontinence three months postnatally, allocated at random to intervention (371) or control (376) groups. Intervention Assessment by nurses of urinary incontinence with conservative advice on pelvic floor exercises at five, seven, and nine months after delivery supplemented with bladder training if appropriate at seven and nine months.Main outcome measures Primary: persistence and severity of urinary incontinence 12 months after delivery. Secondary: performance of pelvic floor exercises, change in coexisting faecal incontinence, wellbeing, anxiety, and depression.Results Women in the intervention group had significantly less urinary incontinence: 167/279 (59.9{\%}) v 169/245 (69.0{\%}), difference 9.1{\%} (95{\%} confidence interval 1.0{\%} to 17.3{\%}, P = 0.037) for any incontinence and 55/279 (19.7{\%}) v 78/245 (31.8{\%}), difference 12.1{\%} (4.7{\%} to 19.6{\%}, P = 0.002) for severe incontinence. Faecal incontinence was also less common: 12/273 (4.4{\%}) v 25/237 (10.5{\%}), difference 6.1{\%} (1.6{\%} to 10.8{\%}, P = 0.012). At 12 months women in the intervention group were more likely to be performing pelvic floor exercises (218/278 (79{\%}) v 118/244 (48{\%} P < 0.001).Conclusions A third of women may have some urinary incontinence three months after childbirth. Conservative management provided by nurses seems to reduce the likelihood of urinary and coexisting faecal incontinence persisting 12 months postpartum. Further trials for faecal incontinence are needed.",
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T1 - Conservative management of persistent postnatal urinary and faecal incontinence

T2 - randomised controlled trial

AU - Glazener, C. M. A.

AU - Herbison, G. P.

AU - Wilson, P. D.

AU - MacArthur, C.

AU - Lang, G. D.

AU - Gee, H.

AU - Grant, A.

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N2 - Objectives To assess the effect of nurse assessment with reinforcement of pelvic floor muscle training exercises and bladder training compared with standard management among women with persistent incontinence three months postnatally.Design Randomised controlled trial with nine months' follow up.Setting Community intervention in three centres (Dunedin, New Zealand; Birmingham; Aberdeen).Participants 747 women with urinary incontinence three months postnatally, allocated at random to intervention (371) or control (376) groups. Intervention Assessment by nurses of urinary incontinence with conservative advice on pelvic floor exercises at five, seven, and nine months after delivery supplemented with bladder training if appropriate at seven and nine months.Main outcome measures Primary: persistence and severity of urinary incontinence 12 months after delivery. Secondary: performance of pelvic floor exercises, change in coexisting faecal incontinence, wellbeing, anxiety, and depression.Results Women in the intervention group had significantly less urinary incontinence: 167/279 (59.9%) v 169/245 (69.0%), difference 9.1% (95% confidence interval 1.0% to 17.3%, P = 0.037) for any incontinence and 55/279 (19.7%) v 78/245 (31.8%), difference 12.1% (4.7% to 19.6%, P = 0.002) for severe incontinence. Faecal incontinence was also less common: 12/273 (4.4%) v 25/237 (10.5%), difference 6.1% (1.6% to 10.8%, P = 0.012). At 12 months women in the intervention group were more likely to be performing pelvic floor exercises (218/278 (79%) v 118/244 (48% P < 0.001).Conclusions A third of women may have some urinary incontinence three months after childbirth. Conservative management provided by nurses seems to reduce the likelihood of urinary and coexisting faecal incontinence persisting 12 months postpartum. Further trials for faecal incontinence are needed.

AB - Objectives To assess the effect of nurse assessment with reinforcement of pelvic floor muscle training exercises and bladder training compared with standard management among women with persistent incontinence three months postnatally.Design Randomised controlled trial with nine months' follow up.Setting Community intervention in three centres (Dunedin, New Zealand; Birmingham; Aberdeen).Participants 747 women with urinary incontinence three months postnatally, allocated at random to intervention (371) or control (376) groups. Intervention Assessment by nurses of urinary incontinence with conservative advice on pelvic floor exercises at five, seven, and nine months after delivery supplemented with bladder training if appropriate at seven and nine months.Main outcome measures Primary: persistence and severity of urinary incontinence 12 months after delivery. Secondary: performance of pelvic floor exercises, change in coexisting faecal incontinence, wellbeing, anxiety, and depression.Results Women in the intervention group had significantly less urinary incontinence: 167/279 (59.9%) v 169/245 (69.0%), difference 9.1% (95% confidence interval 1.0% to 17.3%, P = 0.037) for any incontinence and 55/279 (19.7%) v 78/245 (31.8%), difference 12.1% (4.7% to 19.6%, P = 0.002) for severe incontinence. Faecal incontinence was also less common: 12/273 (4.4%) v 25/237 (10.5%), difference 6.1% (1.6% to 10.8%, P = 0.012). At 12 months women in the intervention group were more likely to be performing pelvic floor exercises (218/278 (79%) v 118/244 (48% P < 0.001).Conclusions A third of women may have some urinary incontinence three months after childbirth. Conservative management provided by nurses seems to reduce the likelihood of urinary and coexisting faecal incontinence persisting 12 months postpartum. Further trials for faecal incontinence are needed.

KW - prevalence

KW - delivery

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DO - 10.1136/bmj.323.7313.593

M3 - Article

VL - 323

SP - 593

EP - 596

JO - BMJ

JF - BMJ

SN - 0959-8146

IS - 7313

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