In most maternity settings, women are taught pelvic-floor exercises to reduce urinary incontinence associated with childbirth. The authors of a recent study had previously reported modestly positive results at one year in a randomized trial of the use of an exercise intervention among women with urinary incontinence three months after giving birth. The 316 women in the intervention group had received advice on pelvic-floor exercises at five, seven, and nine months after delivery (with added bladder training at seven and nine months for those who had symptoms of urge incontinence), and the 376 women in the control group received usual care (which usually included "a brief description of pelvic-floor exercises").

Five years later (six years after the women had given birth), a follow-up questionnaire was mailed to the women to determine the rates of urinary incontinence in the two groups, as well as rates of fecal incontinence and the performance of pelvic-floor exercises.

Among respondents, the percentages of women in both groups performing the exercises were identical, at 50%, whereas at one year, more women in the intervention group had been performing them (83% versus 55%). And about 75% of the women who'd had urinary incontinence at baseline were still incontinent, whether they had received the intervention or not. Approximately 40% of those who'd had fecal incontinence three months postpartum continued to be incontinent of feces six years later. The authors speculate that "continual reinforcement" of the exercises over time might improve long-term results for this safe intervention.

Commenting on the study, researcher and AJN contributing editor Mary Palmer, PhD, RN,C, FAAN, writes that, "It's hard to postulate why effects seen at one year did not persist in later years. Had pelvic-muscle exercises stopped working? How long did the women perform the prescribed number of pelvic-muscle exercises before they stopped? Had they been performing them correctly? How many sessions and repetitions during each session are needed to maintain the effect on incontinence? We need answers to these questions to better help incontinent women improve or cure their incontinence."

Palmer also notes that this study "made it clear that strategies used to help people change behavior initially may not be effective in helping them maintain the change."-Fran Mennick, BSN, RN

Glazener CMA, et al. BMJ 2005;330(7487):337-40.