Randomised controlled trial of conservative management of postnatal urinary and faecal incontinence: six year follow up.

OBJECTIVE To determine the long term effects of a conservative nurse-led intervention for postnatal urinary incontinence. DESIGN Randomised controlled trial. SETTING Community based intervention in three centres in the United Kingdom and New Zealand. PARTICIPANTS 747 women with urinary incontinence at three months after childbirth, of whom 516 were followed up again at 6 years (69%). INTERVENTION Active conservative treatment (pelvic floor muscle training and bladder training) at five, seven, and nine months after delivery or standard care. MAIN OUTCOME MEASURES Urinary and faecal incontinence, performance of pelvic floor muscle training. RESULTS Of 2632 women with urinary incontinence, 747 participated in the original trial. The significant improvements relative to controls in urinary (60% v 69%) and faecal (4% v 11%) incontinence at one year were not found at six year follow up (76% v 79% (95% confidence interval for difference in means -10.2% to 4.1%) for urinary incontinence, 12% v 13% (-6.4% to 5.1%) for faecal incontinence) irrespective of subsequent obstetric events. In the short term the intervention had motivated more women to perform pelvic floor muscle training (83% v 55%) but this fell to 50% in both groups in the long term. Both urinary and faecal incontinence increased in prevalence in both groups during the study period. CONCLUSIONS The moderate short term benefits of a brief nurse-led conservative treatment of postnatal urinary incontinence may not persist, even among women with no further deliveries. About three quarters of women with urinary incontinence three months after childbirth still have this six years later.