A tailored pelvic floor exercise program commenced immediately post-partum promotes continence.

Question: Does a physiotherapy-assisted individually tailored pelvic floor exercise program promote urinary continence in women who have undergone stressful deliveries? Design: Randomised controlled trial. Setting: Australian tertiary teaching hospitals. Patients: Six hundred and seventy-six women who had a forceps or ventouse delivery, or a high birth weight baby (> 4000g) (consent rate 78.9%). Subjects were recruited within 48 hours of delivery and randomised into intervention (n = 348) or control groups (n = 328). Interventions: All subjects received standard written information on pelvic floor function and exercises. Whilst in hospital, the intervention group also received a physiotherapy-assisted individually tailored pelvic floor exercise program which was reviewed by the same physiotherapist eight weeks later. Adherence strategies following the health belief model were used to encourage training. Outcomes: Outcomes were assessed by telephone interview 12 weeks post-partum. Primary outcome was urinary incontinence (determined as positive response to any of five standard questions). Secondary outcomes were incontinence severity and compliance with pelvic floor exercises measured with validated scales. The effects of age, body mass, previous incontinence, perineal status, collagen status and type of delivery was tested. Results: Loss to follow-up was 6% in both intervention and control groups. Eighteen-point-four per cent of the intervention group did not attend the 8-weeks revision session. The prevalence of incontinence in the intervention group was 31%, and in the control group, 38% (difference 7.4%, 95% CI 0.2% to 14.6%). The adjusted odds ratio of incontinence for intervention compared with control was 0.65 (95% CI 0.46 to 0.91). Prior experience of incontinence, and continence status immediately post partum significantly predicted continence status at 12-weeks follow-up. Ten-point-one per cent of the intervention group had severe incontinence, compared with 17% in the control group (difference 7.0%, 95% CI 1.6% to 11.8%). Compliance with pelvic floor exercises was 84% (95% CI 80% to 88%) in the intervention group and 58% (95% CI 52% to 63%) in the control group. Conclusion: A physiotherapy-assisted individually tailored pelvic floor exercise program commenced immediately post-partum for women who have had stressful deliveries significantly promotes urinary continence three months later. Commentary The researchers should be congratulated on conducting a high quality trial with large numbers, and also for using adherence strategies to support pelvic floor training. However, Brubaker (2002) has commented that the effect was small (7%) despite " conscientious rehabilitation efforts " (p. 1227). It is sad that the medical profession (including physiotherapists) believe that …