COMMENTARY

Incontinence During Pregnancy: A Safe, Easy Treatment

Bret Stetka, MD; Ariana L. Smith, MD

Disclosures

December 21, 2012

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Hello. I'm Bret Stetka, Editorial Director at Medscape. Welcome to the F1000 Practice-Changing Minute, where we report commentaries from the Faculty of 1000 on highly rated studies that may change clinical practice. Our commentary today covers the study "Does Regular Exercise Including Pelvic Floor Muscle Training Prevent Urinary and Anal Incontinence During Pregnancy? A Randomised Controlled Trial" that Drs. Stafne and colleagues published in BJOG.[1] The F1000 commentator has given this a ranking of Must Read.

The following F1000 commentary on this study was written by Ariana L. Smith, MD, Assistant Professor of Urology in Surgery, Pennsylvania Hospital, Philadelphia, Pennsylvania.

In her commentary on this study, Dr. Smith wrote:

"This is a large (n=855) randomized, non-blinded, controlled trial looking at the prevention of urinary and anal incontinence during pregnancy with implementation of an exercise program that incorporated pelvic floor muscle exercises. Pregnant women should be made aware of these data as well as of their limitations. Certainly, there appears to be no harm (none reported) with this program and, therefore, making it available to pregnant women as a prevention or treatment strategy seems reasonable.

The control group received 'standard care,' which included written information on and recommendations for pelvic floor muscle exercises. The intervention consisted of 12 weekly group sessions led by physiotherapists as well as twice weekly home exercises. Adherence to the thrice-weekly exercise program was recorded and found to be 55%, with 72% of women in the intervention group reporting once weekly exercise (compared to 10% of women exercising three times per week and 30% of women exercising once per week in the control group). Urinary incontinence late in pregnancy was reported in 11% of the intervention group vs. 19% of the control group (p<0.004). Fecal incontinence affected a small percentage of women in each group and a statistical difference was not noted; adequate power to detect a difference if present was not attained in this study. The authors conclude that pregnant women should exercise, and in particular do pelvic floor exercises, to prevent and treat urinary incontinence in late pregnancy. Their data did not assess differences in treatment and prevention (although those data are likely available); and we are not able to determine which components of the program (aerobic exercise, general strength training, pelvic floor exercises or balance exercises) were effective; therefore, that statement should be revised. Nonetheless, the effect on urinary incontinence does appear significant enough to warrant intervention. There was no difference in weight or body mass index (BMI) between the two groups at follow-up, suggesting weight loss (or less weight gain) was not the cause of improved continence. At this point, recommendations to pregnant women based on this study would need to include the whole exercise program since the effect of just the pelvic floor exercises cannot be parceled out. Additional statistics looking at the treatment effects versus the prevention effects would also be helpful for counseling patients."

This concludes today's commentary from Ariana L. Smith, MD, for the F1000 Practice-Changing Minute. I am Bret Stetka. Thank you for listening.

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