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Promoting urinary continence in women after delivery: randomised controlled trial

BMJ 2002; 324 doi: https://doi.org/10.1136/bmj.324.7348.1241 (Published 25 May 2002) Cite this as: BMJ 2002;324:1241
  1. Pauline Chiarelli (Pauline.Chiarelli{at}newcastle.edu.au), senior lecturer physiotherapy,
  2. Jill Cockburn, professor of behavioural science in relation to medicine
  1. Faculty of Health, School of Population Health Sciences, University of Newcastle, Box 24, Callaghan, NSW 2308, Australia
  1. Correspondence to: P Chiarelli
  • Accepted 29 November 2001

Abstract

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 (Embedded Image4000 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.

What is already known on this topic

What is already known on this topic Intensive pelvic floor exercise programmes can reduce urinary incontinence in selected groups of female patients

The effectiveness of interventions promoting continence in reducing urinary incontinence in the female population overall has not been investigated

Pelvic floor exercises are widely held to be an important component of continence promotion programmes

What this study adds

What this study adds Continence promotion programmes delivered to a selected population are able to prevent urinary incontinence in that population

Few studies have examined the efficacy of compliance aiding strategies in helping women adhere to prescribed pelvic floor exercise programmes

Footnotes

  • Funding Medical Benefits Fund, Physiotherapy Foundation, and University of Newcastle Research Management Committee.

  • Competing interests None declared.

  • Accepted 29 November 2001
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