Objectives To test the effectiveness of a physiotherapist delivered intervention designed to prevent urinary incontinence among women three months after giving birth. Design Prospective randomised controlled trial with women randomised to receive the intervention (which entailed training in pelvic floor exercises and incorporated strategies to improve adherence) or usual postpartum care. Setting Postpartum wards of three tertiary teaching hospitals in the Hunter region, New South Wales, Australia. Participants Women who had forceps or ventouse deliveries or whose babies had a high birth weight (>4000 g), or both-676 (348 in the intervention group and 328 in the usual care group) provided endpoint data at three months. Main outcome measures Urinary incontinence at three months measured as a dichotomous variable. The severity of incontinence was also measured. Self report of the frequency of performance of pelvic floor exercises was recorded. Results At three months after delivery, the prevalence of incontinence in the intervention group was 31.0% (108 women) and in the usual care group 38.4% (125 women); difference 7.4% (95% confidence interval 0.2% to 14.6%, P=0.044). At follow up significantly fewer women with incontinence were classified as severe in the intervention group (10.1%) v (17.0%), difference 7.0%, 1.6% to 11.8%). The proportions of women reporting doing pelvic floor exercises at adequate levels was 84% (80% to 88%) for the intervention group and 58% (52% to 63%) for the usual care group (P=0.001). Conclusions The intervention promoting urinary continence reduced the prevalence of urinary incontinence after giving birth, particularly its severity, and promoted the performance of pelvic floor exercises at adequate levels; both continence and adherence to the programme were measured at three months after delivery in women who had forceps or ventouse deliveries or babies weighing 4000 g or more.

Urge urinary incontinence, but not stress urinary incontinence, is associated with a modest increase in falls. Falls prevention programs need to include an assessment of incontinence and referral for interventions to ameliorate the symptoms of urge incontinence.

The Women's Health Australia project provided the opportunity to examine the prevalence of leaking urine and associated variables in three large cohorts of Australian women 18–23 years of age (“young” N = 14,761), 45–50 (“mid‐age” N = 14,070), and 70–75 (“older” N = 12,893). The proportion of women reporting leaking urine was 12.8% (95% CI: 12.2–13.3), 36.1% (35.2– 37.0), and 35% (34.1– 35.9) in each of the three cohorts, respectively. Logistic regression analysis showed significant associations between leaking urine and parity in the young and mid‐age women, and between leaking urine and constipation, other bowel symptoms, body mass index, and urine that burns or stings in all three groups. In the mid‐age and older cohorts, women who reported having both hysterectomy and prolapse repair, or prolapse repair alone, were also more likely to report leaking urine. Lower scores on the physical and mental component summary scores of the medical outcomes survey short form (36 items) questionnaire suggest lower quality of life among women who report leaking urine, compared with those who do not. Neurourol. Urodynam. 18:567–577, 1999. © 1999 Wiley‐Liss, Inc.

The Berg Balance Scale has acceptable reliability, although it might not detect modest, clinically important changes in balance in individual subjects. The review was only able to comment on the absolute reliability of the Berg Balance Scale among people with moderately poor to normal balance.

Given the lack of high-quality studies, the conclusions were informed by expert opinion. Adherence is central to short- and longer-term PFMT effect. More attention and explicit reporting is needed regarding: (1) applying health behavior theory in PFMT program planning; (2) identifying adherence determinants; (3) developing and implementing interventions targeting known adherence determinants; (4) using patient-centred approaches to evaluating adherence barriers and facilitators; (5) measuring adherence, including refining and testing instruments; and (6) testing the association between adherence and PFMT outcome.