Conservative management of persistent postnatal urinary and faecal incontinence: randomised controlled

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.

Prevention of postpartum stress incontinence in primigravidae with increased bladder neck mobility: a randomised controlled trial of antenatal pelvic floor exercises

“…As with any behavioural intervention particularly in asymptomatic primigravidae, compliance and dropouts are problematic. Large dropout rates have been noted in similar studies in pregnancy 14,26,27 . However, the unwillingness of some patients to undergo investigations (perineal ultrasound, perineometry and pad test) was disappointing as regular contact was provided.…”

“…There is good evidence that postnatal pelvic floor exercises are effective in the treatment of postpartum stress incontinence 7,13,14 . Few studies exist using antenatal pelvic floor exercises 15,16 despite the possibility that these might be effective in preventing postnatal stress incontinence 5 .…”

Effect of Kegel Exercise to Prevent Urinary and Fecal Incontinence in Antenatal and Postnatal Women: Systematic Review

“…요실금 발생은 모든 문헌에서 측정되었고, 대변실금은 5개 문헌 (Bø & Haakstad, 2011;Glazener et al, 2005;Glazener et al, 2001;Sleep & Grant, 1987;Wilson & Herbison, 1998 케겔요법 후 질 회음근 수축력은 4개 문헌 (Møkved & Bø, 2000;Møkved et al, 2003;Reilly et al, 2002;Wilson & Herbison, 1998 …”

Long Term Effects of Pre- and post Partum Pelvic Floor Muscle Treatment in Primigravid with Stress Urinary Incontinence: A Short Systematic Review

“…Long-term follow up was undertaken only in three trials [7][8][9]. None of these studies found a significantdifference long-term in prevalence rates of incontinence between the PFMT and control groups.…”