The clinical effectiveness and cost-effectiveness of interventions for preventing continence issues resulting from birth trauma: a rapid review

Background and Context

This rapid review looked at how effective different interventions are for preventing *continence issues caused by perineal birth trauma, a.k.a. injury to the perineum (the tissue between the vagina and the anus) which occurs in around 85% of vaginal births in the UK.

This is important because this type of childbirth related injury can contribute significantly to urinary and faecal *incontinence in women in the short, medium and long term. 

Incontinence also places a huge burden on the NHS, specifically ‘Stress Urinary Incontinence’ (caused by pressure on the bladder from coughing or sneezing), at an estimated £177 million per year.

Aims

The aim of this rapid review was to find evidence about which interventions work best to prevent incontinence following childbirth, and the related cost of those interventions.

Strategy

The researchers conducted a literature search of the evidence and found twenty-three relevant studies. The studies were published over a twenty-one-year period from 2003 onwards. 

Outcomes

The findings of this rapid review suggest that exercise-based interventions, particularly pre- and post-natal Pelvic Floor Muscle Training can prevent urinary incontinence. There was little evidence regarding the cost effectiveness of these interventions, but it is clear that investment in clinically effective, preventative approaches to reducing the burden of incontinence on the NHS is key. Evidence supporting the use of vaginal devices and pre-natal (pre-pregnancy) perineal massage was less clear from the evidence, particularly in relation to faecal incontinence.

Conclusion

The findings from this rapid review support the use of pre- and or post- natal (before and after childbirth) Pelvic Floor Training Exercises as an appropriate intervention to prevent incontinence whilst being cost effective. It is important that any future recommendations for practice and policy seek the views and experiences of women who have experienced faecal and urinary incontinence caused by childbirth. This intervention has the potential to improve women’s health in a cost-effective way, therefore reducing financial burden on the NHS.

Future research should also seek to further understand women's experiences of, and preferences for, available interventions, and to further understand the feasibility and implementation of interventions for preventing incontinence in routine practice.

* Continence is the ability to control your bladder and bowel function, while incontinence is the opposite – bladder or bowel leakage.

Lay summary written by Alexandra Strong, Public Partnership Group Member.

To read the full report, click here.