British Medical Journal (BMJ)


05/27/2002
By Harvey McConnell

Physiotherapy training can reduce the prevalence of urinary incontinence in women after giving birth, reducing the severity of incontinence and helping women learn to perform pelvic floor exercises at adequate levels.

Researchers tracked incontinence in 676 women three months after they had forceps or ventouse deliveries or gave birth to babies weighing 4,000 grams or more. Births took place at one of three tertiary teaching hospitals in New South Wales, Australia.

Investigators from the University of Newcastle in Callaghan assigned 348 of the women to an intervention group and 328 to usual care. Women in the intervention group received a 20-minute visit from a physiotherapist while in hospital followed by another session eight weeks after delivery. The follow-up session was 30 minutes long and given at home by the same physiotherapist.

Women in the usual care group received routine postpartum care which did not include a visit from a physiotherapist.

While in hospital, participants in both groups received a brochure outlining general postpartum and pelvic floor exercises. They were also invited to join routine physiotherapy postnatal classes held in the wards.

At three months post-delivery, prevalence of incontinence in women in the intervention group was 31.0 percent. In the usual care group, it was 38.4 percent. Significantly fewer incontinent women in the intervention group were classified as severe (10.1 percent) compared with those in the usual care group (17.0 percent).

Approximately 84 percent of women in the intervention group reported doing pelvic floor exercises at adequate levels. Only 58 percent of women in the usual care group did.

"This is the first study to show that an intervention delivered to women in the immediate and early postpartum reduces the likelihood of urinary incontinence three months later," the investigators state.

They say the results have several important implications. One, many women experience incontinence after delivery. Two, the intervention helped women with severe mixed incontinence the most. Three, the intervention succeeded because it was based on established theories of behavioural change and incorporated input from patients themselves.

Researchers suggest other health professionals such as midwives and primary-care doctors could be trained to deliver the intervention: midwives immediately after delivery and doctors at a postpartum visit.
BMJ, 2002; 324: 1241-1243. "Promoting urinary continence in women after delivery: randomised controlled trial"