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Clinical Trial
. 2005 Feb 12;330(7487):337.
doi: 10.1136/bmj.38320.613461.82. Epub 2004 Dec 22.

Randomised controlled trial of conservative management of postnatal urinary and faecal incontinence: six year follow up

Cathryn M A Glazener  1 , G Peter Herbison, Christine MacArthur, Adrian Grant, P Don Wilson
Affiliations
Clinical Trial

Randomised controlled trial of conservative management of postnatal urinary and faecal incontinence: six year follow up

Cathryn M A Glazener et al. BMJ. .

Abstract

Objective: To determine the long term effects of a conservative nurse-led intervention for postnatal urinary incontinence.

Design: Randomised controlled trial.

Setting: Community based intervention in three centres in the United Kingdom and New Zealand.

Participants: 747 women with urinary incontinence at three months after childbirth, of whom 516 were followed up again at 6 years (69%).

Intervention: Active conservative treatment (pelvic floor muscle training and bladder training) at five, seven, and nine months after delivery or standard care.

Main outcome measures: Urinary and faecal incontinence, performance of pelvic floor muscle training.

Results: Of 2632 women with urinary incontinence, 747 participated in the original trial. The significant improvements relative to controls in urinary (60% v 69%) and faecal (4% v 11%) incontinence at one year were not found at six year follow up (76% v 79% (95% confidence interval for difference in means -10.2% to 4.1%) for urinary incontinence, 12% v 13% (-6.4% to 5.1%) for faecal incontinence) irrespective of subsequent obstetric events. In the short term the intervention had motivated more women to perform pelvic floor muscle training (83% v 55%) but this fell to 50% in both groups in the long term. Both urinary and faecal incontinence increased in prevalence in both groups during the study period.

Conclusions: The moderate short term benefits of a brief nurse-led conservative treatment of postnatal urinary incontinence may not persist, even among women with no further deliveries. About three quarters of women with urinary incontinence three months after childbirth still have this six years later.

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Figures

Figure 1
Figure 1
Progress of women through phases of trial
See this image and copyright information in PMC

References

    1. Wilson PD, Herbison RM, Herbison GP. Obstetric practice and the prevalence of urinary incontinence three months after delivery. Br J Obstet Gynaecol 1996;103: 154-61. - PubMed
    1. MacArthur C, Bick DE, Keighley MR. Faecal incontinence after childbirth. Br J Obstet Gynaecol 1997;104: 46-50. - PubMed
    1. Hay-Smith EJC, Bo K, Berghmans LCM, Hendriks HJM, de Bie RA, van Waalwijk van Doorn ESC. Pelvic floor muscle training for urinary incontinence in women. Cochrane Database Syst Rev 2001;(1): CD001407. - PubMed
    1. Wilson PD, Herbison GP. A randomized controlled trial of pelvic floor muscle exercises to treat postnatal urinary incontinence. Int Urogynecol J 1998;9: 257-64. - PubMed
    1. Glazener CMA, Herbison GP, Wilson PD, MacArthur C, Lang GD, Gee H, et al. Conservative management of persistent postnatal urinary and faecal incontinence: a randomised controlled trial. BMJ 2001;323: 593-6. - PMC - PubMed

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