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PAPERS: Cathryn M A Glazener, G Peter Herbison, Christine MacArthur, Adrian Grant, and P Don Wilson Randomised controlled trial of conservative management of postnatal urinary and faecal incontinence: six year follow up BMJ 2005; 330: 337 [Abstract] [Full text]

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Conservative management of postnatal incontinenece

Ramesh Appiahanna   (12 February 2005)

Is urinary incontinence of less than once a week clinically important?

Shashikant L. Sholapurkar   (7 March 2005)

Conservative management of postnatal incontinenece 12 February 2005
Ramesh Appiahanna, SHO in O&G Goerge Eliot hospital, Nuneaton,CV10 7DJ Send response to journal: Re: Conservative management of postnatal incontinenece	Dear sir This study highlighted the existing cochrane data information about using conservative treatment for postnatal incontinenece.As we are aware that there are not only longterm physical but also social & psychological problems associated with incontinence. The risk of sphincter injury is increased at first delivery , forceps delivery, fetal birth-weight greater than 4,000 g and prolonged second stage of labour, occipito-posterior position, and midline episiotomy. Injury can be prevented or minimized by appropriate training for the instrumental deliveries, optimizing perineal repair technique, and by appropriate postnatal assessment of symptomatic women. The dictum that`Prevention is better than cure` still stands. Competing interests: None declared
Is urinary incontinence of less than once a week clinically important? 7 March 2005
Shashikant L. Sholapurkar, Associate Specialist in Obst and Gynaecology Royal United Hospital, Bath BA1 3NG Send response to journal: Re: Is urinary incontinence of less than once a week clinically important?	This randomised controlled trial by Glazener et al draws a convincing conclusion that short term benefits of nurse led conservative treatment of postnatal urinary incontinence do not persist. However, inclusion of patients with very mild urinary incontinence (less than once a week) may be of questionable value in clinical practice. Moreover only 747 women out of 2632 women with urinary incontinence were recruited raising a possibility of selection bias. There are also some minor concerns about the statistics mentioned, making it difficult to interpret. In the abstract it is mentioned that there was 60% improvement in urinary incontinence in treatment group comapred to 69% improvement in control group. However, this seems to be meant to imply that 60% patients in treatment group were still incontinent at one year compared to 69% in control group. The same confusion applies to 4% and 11% improvement in fecal incontinence in treatment and control group at one year. This sentence is again meant to imply that 4% (out of women with urinary and/or faecal incotinence) of treatment group had faecal incontinence at one year. It would be more appropriate to use the total number of women with faecal incontinence in each group as a denominator here to avoid confusion in interpreting the abstract on its own. In the discussion it is mentioned that two fifths of women with fecal incontinence at baseline still reported it 6 years later. This does not match with the statistics mentioned in table 1, where percentage of patients with faecal incontinence dropped from 15.7% to 13.9% at six years, which does not appear to be a three fifth drop. Similarly in the box "What this study adds", figures of three quarters and over 10% of faecal incontince can be misinterpreted in the absence of mention of appropriate denominator. Apart from these minor drawbacks, the study seems to be well designed and does provide valuable conclusions. Competing interests: None declared