Clinical Abstracts: Pelvic Floor Muscle Exercises and Incontinence
With Comments by Adrianne Fugh-Berman, MD
Source: Glazener CM, et al. Conservative management of persistent postnatal urinary and faecal incontinence: Randomised controlled trial. BMJ 2001;323:593-596.
Design and Setting: Randomized controlled trial in three New Zealand communities.
Participants: 747 women with urinary incontinence three months postnatally.
Intervention: Treatment consisted of home assessment by trained nurses, and instruction on pelvic floor muscle (PFM) exercises at five, seven, and nine months after delivery. Bladder training (exercises designed to increase intervals between voiding) was added at seven and nine months, if necessary. Controls were untreated.
Outcomes: Persistence and severity of urinary incontinence 12 months after delivery. Secondary outcome measures included performance of PFM exercises, change in coexisting fecal incontinence, and changes in mood.
Results: Compared to controls, the intervention group had significantly less incontinence (167/279 [59.9%] vs. 169/245 [69%], difference 9.1%) (95% confidence interval [CI] 1-17.3%, P = 0.037); less severe incontinence (19.7% vs. 31.8%, difference 12.1%) (95% CI 4.7-10.6%, P = 0.002), and less fecal incontinence (15.1-4.4% among treated, 16.3-10.5% among controls, difference 6.1%) (95% CI 1.6-10.8%, P = 0.012). There were no significant differences between groups in general feeling of well-being or depression scores (assessed by HAD, presumably Hamilton anxiety and depression scale, although this is not stated). There was a significant difference favoring the treated group in HAD anxiety scores.
Funding: Well-being (grant sponsored by GlaxoWellcome) and Health Research Council of New Zealand.
Comments: This interesting trial shows a benefit for simple, non-invasive interventions in the treatment of postnatal urinary incontinence. The authors note that three months after delivery, up to 30% of women have urinary incontinence and 4% have fecal incontinence. Although there have been numerous successful trials showing a benefit for PFM exercises among older women with stress incontinence, one of the few controlled trials that included postpartum women found no benefit of PFM exercises three months postpartum.1 The findings of that trial convinced Glazener et al to focus on persistent incontinence.
Three visits by a trained nurse seem like a potentially cost-effective solution for a common and socially disadvantageous problem. Many women have trouble learning PFM exercises, in which case biofeedback can be very effective (see Alternative Therapies in Women’s Health, July 1999). It would be interesting to repeat this study with an additional intervention of biofeedback for women who need it.
Reference
1. Wilson PD, Herbison GP. A randomized controlled trial of pelvic floor exercises to treat postnatal urinary incontinence. Int Urogynecol Pelvic Floor Dysfunct 1998; 9:257-264.
Fugh-Berman A. Plevic floor muscle exercises and incontinence. Altern Ther Women's Health 2002;4:24.You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
- Award-winning Medical Content
- Latest Advances & Development in Medicine
- Unbiased Content