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Conservative management of persistent postnatal urinary and faecal incontinence: randomised controlled trial [with consumer summary]
Glazener CM, Herbison GP, Wilson PD, MacArthur C, Lang GD, Gee H, Grant AM
BMJ 2001 Sep 15;323(7313):593-596
clinical trial
6/10 [Eligibility criteria: Yes; Random allocation: Yes; Concealed allocation: Yes; Baseline comparability: Yes; Blind subjects: No; Blind therapists: No; Blind assessors: No; Adequate follow-up: No; Intention-to-treat analysis: Yes; Between-group comparisons: Yes; Point estimates and variability: Yes. Note: Eligibility criteria item does not contribute to total score] *This score has been confirmed*

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%) versus 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%) versus 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%) versus 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%) versus 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.
Reproduced with permission from the BMJ Publishing Group.

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