Twelve-year follow-up of conservative management of postnatal urinary and faecal incontinence and prolapse outcomes: randomised controlled trial

C M A Glazener; C Macarthur; S Hagen; A Elders; R Lancashire; G P Herbison; P D Wilson; The ProLong Study Group

doi:10.1111/1471-0528.12473

Twelve-year follow-up of conservative management of postnatal urinary and faecal incontinence and prolapse outcomes: randomised controlled trial

C M A Glazener, C Macarthur, S Hagen, A Elders, R Lancashire, G P Herbison, P D Wilson, The ProLong Study Group

Applied Health Sciences

Research output: Contribution to journal › Article › peer-review

35 Citations (Scopus)

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Abstract

Objective
To determine the long-term (12-year) effects of a conservative nurse-led intervention for postnatal urinary incontinence.

Design
Follow-up of a randomised controlled trial.

Setting
Community-based intervention in three centres (in the UK and New Zealand).

Population
A cohort of 747 women with urinary incontinence at 3 months after childbirth, of whom 471 (63%) were followed up after 12 years.

Methods
Women were randomly allocated to active conservative treatment after delivery (pelvic floor muscle training and bladder training), or to a control group receiving standard care.

Main outcome measures
Prevalence of urinary incontinence (primary outcome) and faecal incontinence, symptoms and signs of prolapse, and performance of pelvic floor muscle training at 12 years.

Results
The significant improvements relative to controls that had been found in urinary incontinence (60 versus 69%; risk difference, RD, −9.1%; 95% confidence interval, 95% CI, −17.3 to −1.0%) and faecal incontinence (4 versus 11%; RD −6.1%; 95% CI −10.8 to −1.6%) at 1 year did not persist for urinary incontinence (83 versus 80%; RD 2.1%; 95% CI −4.9 to 9.1%) or faecal incontinence (19 versus 15%; RD 4.3%; 95% CI −2.5 to 11.0%) at the 12–year follow up, irrespective of incontinence severity at trial entry. The prevalence of prolapse symptoms or objectively measured pelvic organ prolapse also did not differ between the groups. In the short term the intervention motivated more women to perform pelvic floor muscle training (83 versus 55%), but this fell in both groups by 12 years (52 versus 49%).

Conclusions
The moderate short-term benefits of a brief nurse-led conservative treatment for postnatal urinary incontinence did not persist. About four-fifths of women with urinary incontinence 3 months after childbirth still had this problem 12 years later.

Original language	English
Pages (from-to)	112-120
Number of pages	9
Journal	BJOG-An International Journal of Obstetrics and Gynaecology
Volume	121
Issue number	1
Early online date	22 Oct 2013
DOIs	https://doi.org/10.1111/1471-0528.12473
Publication status	Published - Jan 2014

Bibliographical note

© 2013 Royal College of Obstetricians and Gynaecologists.

Funded by
Royal College of Obstetricians and Gynaecologists, London, UK; Health Research Council of New Zealand. Grant Number: RG 819/06
New Zealand Lottery Grant Board
Health Services Research Unit, University of Aberdeen
Chief Scientist Office of the Scottish Government Health Directorates

Keywords

bladder training
faecal incontinence
pelvic floor dysfunction
pelvic floor muscle training
pelvic organ prolapse
randomised controlled trial
urinary incontinence

Access to Document

10.1111/1471-0528.12473

Twelve-year follow-up of conservative management of postnatal urinary and faecal incontinence and prolapse outcomes
This is the accepted version of the following article: zener, CMA, Macarthur, C, Hagen, S, Elders, A, Lancashire, R, Herbison, GP, Wilson, PD & The ProLong Study Group 2014, 'Twelve-year follow-up of conservative management of postnatal urinary and faecal incontinence and prolapse outcomes: randomised controlled trial' BJOG: An International Journal of Obstetrics and Gynaecology, vol 121, no. 1, pp. 112-120., which has been published in final form at 10.1111/1471-0528.12473
Accepted author manuscript, 147 KB

Cite this

Glazener, C. M. A., Macarthur, C., Hagen, S., Elders, A., Lancashire, R., Herbison, G. P., Wilson, P. D., & The ProLong Study Group (2014). Twelve-year follow-up of conservative management of postnatal urinary and faecal incontinence and prolapse outcomes: randomised controlled trial. BJOG-An International Journal of Obstetrics and Gynaecology, 121(1), 112-120. https://doi.org/10.1111/1471-0528.12473

Glazener, CMA, Macarthur, C, Hagen, S, Elders, A, Lancashire, R, Herbison, GP, Wilson, PD & The ProLong Study Group 2014, 'Twelve-year follow-up of conservative management of postnatal urinary and faecal incontinence and prolapse outcomes: randomised controlled trial', BJOG-An International Journal of Obstetrics and Gynaecology, vol. 121, no. 1, pp. 112-120. https://doi.org/10.1111/1471-0528.12473

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abstract = "ObjectiveTo determine the long-term (12-year) effects of a conservative nurse-led intervention for postnatal urinary incontinence.DesignFollow-up of a randomised controlled trial.SettingCommunity-based intervention in three centres (in the UK and New Zealand).PopulationA cohort of 747 women with urinary incontinence at 3 months after childbirth, of whom 471 (63%) were followed up after 12 years.MethodsWomen were randomly allocated to active conservative treatment after delivery (pelvic floor muscle training and bladder training), or to a control group receiving standard care.Main outcome measuresPrevalence of urinary incontinence (primary outcome) and faecal incontinence, symptoms and signs of prolapse, and performance of pelvic floor muscle training at 12 years.ResultsThe significant improvements relative to controls that had been found in urinary incontinence (60 versus 69%; risk difference, RD, −9.1%; 95% confidence interval, 95% CI, −17.3 to −1.0%) and faecal incontinence (4 versus 11%; RD −6.1%; 95% CI −10.8 to −1.6%) at 1 year did not persist for urinary incontinence (83 versus 80%; RD 2.1%; 95% CI −4.9 to 9.1%) or faecal incontinence (19 versus 15%; RD 4.3%; 95% CI −2.5 to 11.0%) at the 12–year follow up, irrespective of incontinence severity at trial entry. The prevalence of prolapse symptoms or objectively measured pelvic organ prolapse also did not differ between the groups. In the short term the intervention motivated more women to perform pelvic floor muscle training (83 versus 55%), but this fell in both groups by 12 years (52 versus 49%).ConclusionsThe moderate short-term benefits of a brief nurse-led conservative treatment for postnatal urinary incontinence did not persist. About four-fifths of women with urinary incontinence 3 months after childbirth still had this problem 12 years later.",

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T1 - Twelve-year follow-up of conservative management of postnatal urinary and faecal incontinence and prolapse outcomes

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AU - Lancashire, R

AU - Herbison, G P

AU - Wilson, P D

AU - The ProLong Study Group

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AB - ObjectiveTo determine the long-term (12-year) effects of a conservative nurse-led intervention for postnatal urinary incontinence.DesignFollow-up of a randomised controlled trial.SettingCommunity-based intervention in three centres (in the UK and New Zealand).PopulationA cohort of 747 women with urinary incontinence at 3 months after childbirth, of whom 471 (63%) were followed up after 12 years.MethodsWomen were randomly allocated to active conservative treatment after delivery (pelvic floor muscle training and bladder training), or to a control group receiving standard care.Main outcome measuresPrevalence of urinary incontinence (primary outcome) and faecal incontinence, symptoms and signs of prolapse, and performance of pelvic floor muscle training at 12 years.ResultsThe significant improvements relative to controls that had been found in urinary incontinence (60 versus 69%; risk difference, RD, −9.1%; 95% confidence interval, 95% CI, −17.3 to −1.0%) and faecal incontinence (4 versus 11%; RD −6.1%; 95% CI −10.8 to −1.6%) at 1 year did not persist for urinary incontinence (83 versus 80%; RD 2.1%; 95% CI −4.9 to 9.1%) or faecal incontinence (19 versus 15%; RD 4.3%; 95% CI −2.5 to 11.0%) at the 12–year follow up, irrespective of incontinence severity at trial entry. The prevalence of prolapse symptoms or objectively measured pelvic organ prolapse also did not differ between the groups. In the short term the intervention motivated more women to perform pelvic floor muscle training (83 versus 55%), but this fell in both groups by 12 years (52 versus 49%).ConclusionsThe moderate short-term benefits of a brief nurse-led conservative treatment for postnatal urinary incontinence did not persist. About four-fifths of women with urinary incontinence 3 months after childbirth still had this problem 12 years later.

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Twelve-year follow-up of conservative management of postnatal urinary and faecal incontinence and prolapse outcomes: randomised controlled trial

Abstract

Bibliographical note

Keywords

Access to Document

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Cite this