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Cited by 190Pelvic floor disorders treatmentsUrinary Bladder and Prostate ResearchSexual function and dysfunction studies

Conservative management of persistent postnatal urinary and faecal incontinence: randomised controlled trial

Open access
Glazener, Cathryn M A, Herbison, G Peter, Wilson, P Don, MacArthur, Christine, Lang, Gordon D, Gee, Harry, Grant, Adrian M·2001·BMJ
DOI 10.1136/bmj.323.7313.593PMC PMC55571
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Abstract

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%) v 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%) v 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%) v 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%) v 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. What is already known on this topic: Vaginal delivery is a risk factor for urinary incontinence Three months after childbirth 20-30% of women still experience urinary incontinence Most women do not seek treatment What this study adds: Women will use conservative treatments such as pelvic floor exercises or bladder training Conservative management prevents persistent urinary incontinence in about one in 10 women who have postnatal incontinence Coexisting persistent faecal incontinence is also improved

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  • The training dosage and level of supervision might have been too low in the Glazener study (2001) but was quite high in the study by Bø et al. (2015).

    “The training dosage and level of supervision might have been too low in the Glazener study (2001) [58] but was quite high in the study by Bø et al. (2015) [54].”

    From International urogynecology consultation chapter 3 committee 2; conservative treatment of patient with pelvic organ prolapse: Pelvic floor muscle training (2022) · cites this paper as [58]

    The Intervention section (page unavailable) reports a prescribed 80–100 contractions daily and nurse visits at five, seven, and nine months after delivery. These details establish the Glazener study’s training dose and supervision, but the paper does not assess whether either was too low. The comparison with Bø et al. is attached to a different citation. (LLM, conf=0.78)

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  • The primary outcome of Bø et al. and Glazener et al.'s RCTs was UI, and both studies included women with and without POP; thus, the sample size may have been too small to detect significant differences for POP.

    “However, the primary outcome of Bø et al. [54] and Glazener et al.’s [58] RCTs was UI, and both studies included women with and without POP; thus, the sample size may have been too small to detect significant differences for POP.”

    From International urogynecology consultation chapter 3 committee 2; conservative treatment of patient with pelvic organ prolapse: Pelvic floor muscle training (2022) · cites this paper as [58]

    The Outcomes section (page unavailable) identifies persistence of urinary incontinence as Glazener et al.’s primary outcome. The Results and Power calculation sections describe recruitment and statistical power for urinary incontinence, but the paper does not establish whether participants had POP or assess whether its sample was too small to detect POP differences. This verdict concerns Glazener et al. only, not the separately cited Bø trial. (LLM, conf=0.88)

    Experimental — accuracy not yet measured

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Research works printed but not linked: 1

  1. Snooks SJ, Badenoch DF, Tiptaft RC, Swash M. Perineal damage in genu- ine stress incontinence. An electrophysiological study. Br J Urol 1985;57:422-6.

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Authors
Glazener, C. M. A., Herbison, G. P., Wilson, P. D., MacArthur, C., Lang, G. D., Gee, H., & Grant, A. M.
Affiliations
  • University of Aberdeen (GB)
  • University of Otago (NZ)
Corresponding author
Glazener, Cathryn M A
ORCID
Venue
BMJ
Publisher
BMJ
Published
2001-09-15
Volume
323
Issue
7313
Pages
593
ISSN
  • 0007-1447 (ISSN-L)
  • 0959-8138
  • 1468-5833
DOI
10.1136/bmj.323.7313.593
PMC
PMC55571
OpenAlex
W2111754109
Cited by
190
References
26
Citations by year
2026: 2 · 2025: 7 · 2024: 4 · 2023: 2 · 2022: 1 · 2021: 4 · 2020: 3 · 2019: 6 · 2018: 7 · 2017: 5 · 2016: 4 · 2015: 9 · 2014: 9 · 2013: 10 · 2012: 7
FWCI
6.80
Type
journal article
Language
en
Open access
Licence
www.bmj.com/company/legal-information/terms-conditions/legal-information/tdm-licencepolicy (tdm)
Locations
  • BMJ (publishedVersion)
  • Europe PMC (PubMed Central) (publishedVersion)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
  • University of Birmingham Research Portal (University of Birmingham) (submittedVersion)
Funders
  • Wellcome Trust
  • Health Research Council of New Zealand
Topics
  • Health Sciences › Medicine › Rheumatology › Pelvic floor disorders treatments
  • Health Sciences › Medicine › Urology › Urinary Bladder and Prostate Research
  • Health Sciences › Medicine › Psychiatry and Mental health › Sexual function and dysfunction studies
Keywords
postpartum urinary incontinence, fecal incontinence, pelvic floor muscle training, bladder training, conservative treatment, nurse-led intervention, postpartum care, women's health, anxiety and depression, well-being, vaginal delivery, pelvic floor dysfunction, community-based intervention
MeSH terms
Adult, Exercise Therapy, Fecal Incontinence, Female, Follow-Up Studies, Humans, Muscle Contraction, Puerperal Disorders, Severity of Illness Index, Urinary Incontinence, Treatment Outcome, Pelvic Floor

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