Twelve-year follow-up of conservative management of postnatal urinary and faecal incontinence and prolapse outcomes: randomised controlled trial

Cathryn Glazener, Christine Macarthur, Suzanne Hagen, Andrew Elders, Robert Lancashire, Peter Herbison, Don Wilson

Research output: Contribution to journalArticle

Abstract

Objective: To determine the long-term (12-year) effects of a conservative nurse-led intervention for postnatal urinary incontinence.
Design: Follow-up of a randomised controlled trial.
Setting: Community-based intervention in three centres (in the UK and New Zealand).
Population: A cohort of 747 women with urinary incontinence at 3 months after childbirth, of whom 471 (63%) were followed up after 12 years.
Methods: Women were randomly allocated to active conservative treatment after delivery (pelvic floor muscle training and bladder training), or to a control group receiving standard care. Main outcome measures Prevalence of urinary incontinence (primary outcome) and faecal incontinence, symptoms and signs of prolapse, and performance of pelvic floor muscle training at 12 years.
Results: The significant improvements relative to controls difference, RD, 9.1%; 95% confidence interval, 95% CI, 17.3 to 1.0%) and faecal incontinence (4 versus 11%; RD 6.1%; 95% CI 10.8 to 1.6%) at 1 year did not persist for urinary incontinence (83 versus 80%; RD 2.1%; 95% CI 4.9 to 9.1%) or faecal incontinence (19 versus 15%; RD 4.3%; 95% CI 2.5 to 11.0%) at the 12–year follow up, irrespective of incontinence severity at trial entry. The prevalence of prolapse symptoms or objectively measured pelvic organ prolapse also did not differ between the groups. In the short term the intervention motivated more women to perform pelvic floor muscle training (83 versus 55%), but this fell in both groups by 12 years (52 versus 49%).
Conclusions: The moderate short-term benefits of a brief nurse-led conservative treatment for postnatal urinary incontinence did not persist. About four-fifths of women with urinary incontinence 3 months after childbirth still had this problem 12 years later.
Original languageEnglish
Pages (from-to)112-120
Number of pages9
JournalBJOG: An International Journal of Obstetrics and Gynaecology
Volume121
Issue number1
Early online dateOct 2013
DOIs
Publication statusPublished - Jan 2014

Fingerprint

Fecal Incontinence
Prolapse
Urinary Incontinence
Randomized Controlled Trials
Pelvic Floor
Muscles
Nurses
Parturition
Pelvic Organ Prolapse
New Zealand
Signs and Symptoms
Conservative Treatment
Urinary Bladder
Outcome Assessment (Health Care)
Confidence Intervals
Control Groups
Population

Keywords

  • bladder training
  • urinary incontinence
  • pelvic floor muscle training
  • faecal incontinence
  • women's health

Cite this

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title = "Twelve-year follow-up of conservative management of postnatal urinary and faecal incontinence and prolapse outcomes: randomised controlled trial",
abstract = "Objective: To determine the long-term (12-year) effects of a conservative nurse-led intervention for postnatal urinary incontinence.Design: Follow-up of a randomised controlled trial. Setting: Community-based intervention in three centres (in the UK and New Zealand).Population: A cohort of 747 women with urinary incontinence at 3 months after childbirth, of whom 471 (63{\%}) were followed up after 12 years.Methods: Women were randomly allocated to active conservative treatment after delivery (pelvic floor muscle training and bladder training), or to a control group receiving standard care. Main outcome measures Prevalence of urinary incontinence (primary outcome) and faecal incontinence, symptoms and signs of prolapse, and performance of pelvic floor muscle training at 12 years.Results: The significant improvements relative to controls difference, RD, 9.1{\%}; 95{\%} confidence interval, 95{\%} CI, 17.3 to 1.0{\%}) and faecal incontinence (4 versus 11{\%}; RD 6.1{\%}; 95{\%} CI 10.8 to 1.6{\%}) at 1 year did not persist for urinary incontinence (83 versus 80{\%}; RD 2.1{\%}; 95{\%} CI 4.9 to 9.1{\%}) or faecal incontinence (19 versus 15{\%}; RD 4.3{\%}; 95{\%} CI 2.5 to 11.0{\%}) at the 12–year follow up, irrespective of incontinence severity at trial entry. The prevalence of prolapse symptoms or objectively measured pelvic organ prolapse also did not differ between the groups. In the short term the intervention motivated more women to perform pelvic floor muscle training (83 versus 55{\%}), but this fell in both groups by 12 years (52 versus 49{\%}).Conclusions: The moderate short-term benefits of a brief nurse-led conservative treatment for postnatal urinary incontinence did not persist. About four-fifths of women with urinary incontinence 3 months after childbirth still had this problem 12 years later.",
keywords = "bladder training, urinary incontinence, pelvic floor muscle training, faecal incontinence, women's health",
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Twelve-year follow-up of conservative management of postnatal urinary and faecal incontinence and prolapse outcomes: randomised controlled trial. / Glazener, Cathryn; Macarthur, Christine; Hagen, Suzanne; Elders, Andrew; Lancashire, Robert; Herbison, Peter; Wilson, Don.

In: BJOG: An International Journal of Obstetrics and Gynaecology, Vol. 121, No. 1, 01.2014, p. 112-120.

Research output: Contribution to journalArticle

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T1 - Twelve-year follow-up of conservative management of postnatal urinary and faecal incontinence and prolapse outcomes: randomised controlled trial

AU - Glazener, Cathryn

AU - Macarthur, Christine

AU - Hagen, Suzanne

AU - Elders, Andrew

AU - Lancashire, Robert

AU - Herbison, Peter

AU - Wilson, Don

PY - 2014/1

Y1 - 2014/1

N2 - Objective: To determine the long-term (12-year) effects of a conservative nurse-led intervention for postnatal urinary incontinence.Design: Follow-up of a randomised controlled trial. Setting: Community-based intervention in three centres (in the UK and New Zealand).Population: A cohort of 747 women with urinary incontinence at 3 months after childbirth, of whom 471 (63%) were followed up after 12 years.Methods: Women were randomly allocated to active conservative treatment after delivery (pelvic floor muscle training and bladder training), or to a control group receiving standard care. Main outcome measures Prevalence of urinary incontinence (primary outcome) and faecal incontinence, symptoms and signs of prolapse, and performance of pelvic floor muscle training at 12 years.Results: The significant improvements relative to controls difference, RD, 9.1%; 95% confidence interval, 95% CI, 17.3 to 1.0%) and faecal incontinence (4 versus 11%; RD 6.1%; 95% CI 10.8 to 1.6%) at 1 year did not persist for urinary incontinence (83 versus 80%; RD 2.1%; 95% CI 4.9 to 9.1%) or faecal incontinence (19 versus 15%; RD 4.3%; 95% CI 2.5 to 11.0%) at the 12–year follow up, irrespective of incontinence severity at trial entry. The prevalence of prolapse symptoms or objectively measured pelvic organ prolapse also did not differ between the groups. In the short term the intervention motivated more women to perform pelvic floor muscle training (83 versus 55%), but this fell in both groups by 12 years (52 versus 49%).Conclusions: The moderate short-term benefits of a brief nurse-led conservative treatment for postnatal urinary incontinence did not persist. About four-fifths of women with urinary incontinence 3 months after childbirth still had this problem 12 years later.

AB - Objective: To determine the long-term (12-year) effects of a conservative nurse-led intervention for postnatal urinary incontinence.Design: Follow-up of a randomised controlled trial. Setting: Community-based intervention in three centres (in the UK and New Zealand).Population: A cohort of 747 women with urinary incontinence at 3 months after childbirth, of whom 471 (63%) were followed up after 12 years.Methods: Women were randomly allocated to active conservative treatment after delivery (pelvic floor muscle training and bladder training), or to a control group receiving standard care. Main outcome measures Prevalence of urinary incontinence (primary outcome) and faecal incontinence, symptoms and signs of prolapse, and performance of pelvic floor muscle training at 12 years.Results: The significant improvements relative to controls difference, RD, 9.1%; 95% confidence interval, 95% CI, 17.3 to 1.0%) and faecal incontinence (4 versus 11%; RD 6.1%; 95% CI 10.8 to 1.6%) at 1 year did not persist for urinary incontinence (83 versus 80%; RD 2.1%; 95% CI 4.9 to 9.1%) or faecal incontinence (19 versus 15%; RD 4.3%; 95% CI 2.5 to 11.0%) at the 12–year follow up, irrespective of incontinence severity at trial entry. The prevalence of prolapse symptoms or objectively measured pelvic organ prolapse also did not differ between the groups. In the short term the intervention motivated more women to perform pelvic floor muscle training (83 versus 55%), but this fell in both groups by 12 years (52 versus 49%).Conclusions: The moderate short-term benefits of a brief nurse-led conservative treatment for postnatal urinary incontinence did not persist. About four-fifths of women with urinary incontinence 3 months after childbirth still had this problem 12 years later.

KW - bladder training

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KW - pelvic floor muscle training

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KW - women's health

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