How to manage incontinence after childbirth?

We will discuss  “Twelve-year follow-up of conservative management of postnatal urinary and faecal incontinence and prolapse outcomes: randomised controlled trial” by Glazener and co-workers (The ProLong Study Group) from 26 March 2014. The paper will be made free-to-view for four weeks in mid-March. 

Hosted discussion sessions:

  • 26 March 2014 (Wednesday)- UK Time (GMT+1) 1900
  • 28 March 2014 (Friday) at the RCOG World Congress 2014- India Time (IST) 1310; Australia (AEDT) 1940; UK Time (GMT+1) 0740

Platforms: Twitter and on our Facebook page

Host: @elaineleung (UK) and @bluejchost (during RCOG Congress 2014)

The Blue Journal Club is an international journal club on women’s health research based on Twitter (as @BlueJCHost). We use the hashtag #BlueJC for our tweets. Simply add this hashtag (“#BlueJC”) to each tweet and we will capture it. Each #BlueJC opens for 7 days with an advertised start time.

All BJOG #BlueJC papers also have complementary slide sets suitable for face-to-face journal clubs with your local colleagues. You can access the slide set of this paper here (data S1).

The discussion points are attached below (quoted from the published manuscript):

Scenario

At your urogynaecology clinic, a patient presented with postpartum urinary incontinence 3 months after the delivery of her first baby. She asked, ‘am I going to have incontinence for the rest of my life? Is there anything that would help?’

 Description of research

Participants
Women who had urinary incontinence 3 months after the delivery of their children.
Intervention
Three one-to-one pelvic floor muscle training (PFMT) sessions, with bladder training if indicated, at 5, 7, and 9 months after birth
Comparison
Standard care
Outcomes

Primary outcome: The prevalence of urinary incontinence at 12 years after randomisation.

Secondary outcomes: Practice of PFMT, faecal incontinence, the Pelvic Organ Prolapse Symptom Score (POP-SS), Prolapse Organ Prolapse Quantification (POP–Q).

Study design
Randomised controlled trial

Discussion points

  • Was the intervention (e.g. intensity and duration) in this clinical trial the same as in other similar studies?
  • What is the purpose of stratification at randomisation in this clinical trial?
  • Was it necessary to stratify for mode of delivery and centre of care?
  • Was the primary outcome in this study appropriate? Would you select different outcome measures?
  • Was compliance satisfactory? How could this have affected the results?
  • Can you suggest any strategy to improve the response rate of a similar study in the future?
  • Take-home message: can you briefly summarise the results of this study? Has this study changed your practice?

For those who want to understand hashtags, this may be a useful guide. For an introduction to #BlueJC, please refer to BJOG 2013;120:657–60. Follow @BlueJCHostthis blog and our Facebook page to receive news about #BlueJC.