Am Fam Physician. 2002 Apr 1;65(7):1457-1458.
Despite advances in obstetrics, 20 to 30 percent of new mothers report urinary incontinence three months after delivery. In studies of elderly women, retraining the pelvic floor muscles with exercise has been shown to reduce urinary incontinence, but large studies have not been conducted in young women with postpartum incontinence. Glazener and colleagues studied more than 700 mothers reporting incontinence three months after delivery to assess the impact of pelvic floor exercises.
All mothers delivering a live infant in the three participating hospital units were surveyed about symptoms of incontinence. Those reporting involuntary loss of urine occurring in the previous month were invited to participate in the study. A total of 747 women were randomly allocated to intervention or control groups. Women in the intervention group were instructed in pelvic floor exercises by physical therapists and asked to achieve 80 to 100 contractions daily. Patients were visited at home to monitor and reinforce the exercise program seven and nine months after delivery. If infection or other pathology was suspected, women were referred to their primary care physicians. Mothers in the control group were not visited by the research team but received standard advice and postpartum care. Outcome measures included urinary symptoms, use of pads, and levels of anxiety or depression.
Initially, 33 percent of 7,879 mothers reported incontinence three months after delivery. Of 747 who consented to participate, the 371 mothers assigned to intervention were demographically comparable to the 376 mothers in the control group.
Mothers in the intervention group reported high rates of compliance with the exercise program. A total of 79 percent of the intervention group reported performing pelvic floor exercises at the 12-month follow-up visit, compared with 48 percent of the control group. Mothers in the intervention group also reported achieving significantly more exercise contractions per day. Women in the intervention group had a significantly lower rate of urinary symptoms, particularly of severe incontinence. They also reported less use of pads, less fecal incontinence, and less anxiety than women in the control group.
The authors conclude that a conservative program of exercises performed at home significantly reduces postpartum urinary incontinence. With support and encouragement, mothers can continue an exercise program for pelvic floor musculature over at least one year with good results.
ANNE D. WALLING, M.D.
Glazener CM, et al. Conservative management of persistent postnatal Urinary and faecal incontinence: randomised controlled trial. BMJ. September 15, 2001;323:593–6.
editor's note: Verification that one third of mothers have postpartum urinary incontinence is shocking. Physicians should ask directly about these symptoms and be prepared to offer simple but effective therapy. Although the authors are repeating patient reports, it is difficult to accept that busy mothers of young children could consistently achieve the number of contractions requested in this study. Patients find Kegel exercises difficult or awkward to do consistently—there must be a better way to address this common problem.—a.d.w.
Copyright © 2002 by the American Academy of Family Physicians.
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