Dr Pauline Chiarelli: Female urinary incontinence in Australia: prevalence and prevention in postpartum women.

Underpinning this PhD is an examination of the basic science of continence and a review of the international and Australian literature pertaining to the prevalence of urinary incontinence. Although there have been few studies that have evaluated the prevalence of female urinary incontinence in the Australian population, the available studies suggest that incontinence is a morbid and costly condition. 

The The Australian Longitudinal Study on Women’s Health project provided an opportunity to obtain current data on the prevalence of leaking urine and associated factors in a large representative sample of Australian women. The prevalence of leaking urine in cohorts of women aged 18-23, 45-50 and 70-75 years was estimated to be 12.8% (CI: 12.2 - 13.3), 36.1% (CI: 35.2 - 37.0), and 35% (CI: 34.1 - 35.9) respectively. 

Despite the burden of illness imposed by urinary incontinence, to date there has been no evidence to support the concept of primary continence promotion as an effective method of preventing urinary incontinence. Therefore, a major aim of this thesis was to examine this.

Given that trauma to the pelvic floor following childbirth appears to be related to the development of incontinence, postpartum women were chosen as the target group. 

Evidence from the literature and expert opinion were combined with the conceptual framework of the Health Belief Model to develop the components of a continence promotion program. The effectiveness of an intervention delivered by physiotherapists to postpartum women was evaluated using a randomised controlled trial among 720 women. Multivariate analyses, that controlled for potential residual confounding effects of maternal, delivery, and continence variables, indicated that women in the intervention group were 40% less likely to report incontinence at three-months postpartum than women in the control group (Odds ratio=0.6, 95% CI: 0.5 - 0.9, p=0.01). Women in the intervention group were more likely than women in the control group to report that they were performing the recommended pelvic floor exercises (p=0.001). 

The intervention was also found to be acceptable to women and its components were well utilised. This suggests that the intervention could feasibly be provided for women who deliver in hospitals where physiotherapists are empl