The diagnostic strength of the 24-h pad test for self-reported symptoms of urinary incontinence in pregnancy and after childbirth

Is a 6-week supervised pelvic floor muscle exercise program effective in preventing stress urinary incontinence in late pregnancy in primigravid women?: a randomized controlled trial

OBJECTIVE

The study investigated the effect of a 6-week supervised pelvic floor muscle exercise (PFME) program to prevent stress urinary incontinence (SUI) at 38 weeks' gestation.

STUDY DESIGN

We conducted a randomized controlled trial into two arms design: one intervention group and one control group, using the randomly computer-generated numbers. A research assistant, who was not involved with care of the participants, randomly drawn up and opened the envelope for each participant to allocate into the intervention group and the control group. The investigators could not be blinded to allocation. Seventy primigravid women who had continent with gestational ages of 20-30 weeks were randomly assigned to participate in the intervention (n=35) and control groups (n=35). The intervention was a supervised 6-week PFME program with verbal instruction and a handbook, three training sessions of 45 min with the main researcher (at 1st, 3rd and 5th week of the program) and self-daily training at home for an overall period of 6 weeks. The control condition was the PFME and the stop test had been trained by the main researcher to all of the participants in the intervention group.

OUTCOMES

The primary outcome was self-reported of SUI, and the secondary outcome was the severity of SUI in pregnant women which comprises of frequency, volume of urine leakage and score of perceived severity of SUI in late pregnancy at 38th weeks of pregnancy. Statistical analysis was performed using Chi-square test, Independent-sample t-test, and Mann-Whitney U-test. Significance P-value was <0.05.

RESULTS

At the end of the intervention, 2 of 35 women in the intervention group and 5 of 35 women in the control group dropped out of the study. Therefore, the total of the study participants consisted of 63 pregnant women (33 in the intervention group and 30 in the control group). Fewer women in the intervention group reported SUI than the control group: 9 of 33 (27.3%) versus 16 of 30 (53.3%) at 38 weeks' gestational age (OR 3.05, 95% CI 1.07-8.70, P=0.018).

CONCLUSIONS

The 6-week supervised PFME program was effective in preventing SUI and decreasing the SUI severity in pregnant women who reported SUI at late pregnancy. The women who performed PFME program under the training sessions once every two weeks found that the program demands less time, incurs lower costs and possibly offers more motivation to exercise. This 6-week supervised PFME program may be suitable in real clinical situation.

Stress urinary incontinence in pregnant women: a review of prevalence, pathophysiology, and treatment

INTRODUCTION AND HYPOTHESIS

Stress urinary incontinence (SUI) is the most common type of urinary incontinence (UI) in pregnant women and is known to have detrimental effects on the quality of life in approximately 54.3 %. Pregnancy is the main risk factor for the development of SUI. This review provides details of the pathophysiology leading to SUI in pregnant women and SUI prevalence and treatment during pregnancy.

METHODS

We conducted a PubMed search for English-language and human-study articles registered from January 1990 to September 2012. This search was performed for articles dealing with prevalence and treatment of SUI during pregnancy. In the intervention studies, we included studies that used a randomized controlled trial (RCT) design or studies comparing a treatment intervention to no treatment.

RESULTS

A total of 534 articles were identified; 174 full-text articles were reviewed, and 28 of them met eligibility criteria and are reported on here. The mean prevalence of SUI during pregnancy was 41 % (18.6-60 %) and increased with gestational age. The increasing pressure of the growing uterus and fetal weight on pelvic-floor muscles (PFM) throughout pregnancy, together with pregnancy-related hormonal changes, may lead to reduced PFM strength as well as their supportive and sphincteric function. These cause mobility of the bladder neck and urethra, leading to urethral sphincter incompetence. Pelvic floor muscle exercise (PFME) is a safe and effective treatment for SUI during pregnancy, without significant adverse effects.

CONCLUSIONS

Understanding these issues can be useful for health-care professionals when informing and counseling pregnant women to help prevent SUI during pregnancy and the postpartum period.

The impact of pregnancy and vaginal delivery on urinary incontinence

OBJECTIVE

To identify women who had urinary incontinence (UI) before, during, and after pregnancy, and to determine whether women with symptoms of UI during pregnancy were the same women who had urinary incontinence postpartum.

METHODS

All primigravid women who delivered within 1 year (1999) at the Charité Hospital in Berlin received a questionnaire about UI at 5 different time points during pregnancy and the postpartum period.

RESULTS

Of 610 eligible women, 411 (67.4%) completed the questionnaire. The prevalence of urinary incontinence increased significantly in the second half of pregnancy (26.3%, P<0.001). Although the overall number of women who reported UI within 6 weeks after delivery (28.5%) was almost the same as the number reporting UI in the second half of pregnancy, approximately every second women changed from being continent to incontinent and vice versa.

CONCLUSION

The group of women who experienced UI postpartum was different from the group that experienced UI before delivery and vice versa. Pregnancy itself may influence pelvic floor function in a different way compared with vaginal delivery.