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

Objectives To assess the effect of nurse assessment with reinforcement of p elvic floor muscle training exercises and bladder training compared with st andard management among women with persistent incontinence three months pos tnatally. Design Randomised controlled trial with nine months' follow up. Setting Community intervention in three centres (Dunedin, New Zealand; Birm ingham; Aberdeen). Participants 747 women with urinary incontinence three months postnatally, allocated at random to intervention (371) or control (376) groups. Interven tion Assessment by nurses of urinary incontinence with conservative advice on pelvic floor exercises at five, seven, and nine months after delivery su pplemented with bladder training if appropriate at seven and nine months. Main outcome measures Primary: persistence and severity of urinary incontin ence 12 months after delivery. Secondary: performance of pelvic floor exerc ises, change in coexisting faecal incontinence, wellbeing, anxiety, and dep ression. Results Women in the intervention group had significantly less urinary inco ntinence: 167/279 (59.9%) v 169/245 (69.0%), difference 9.1% (95% confidenc e 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 e xercises (218/278 (79%) v 118/244 (48% P < 0.001). Conclusions A third of women may have some urinary incontinence three month s after childbirth. Conservative management provided by nurses seems to red uce the likelihood of urinary and coexisting faecal incontinence persisting 12 months postpartum. Further trials for faecal incontinence are needed.