Improving women’s health and wellbeing by better understanding postpartum urinary incontinence
Urinary incontinence occurs in 25-30% of mothers at six months postpartum. However, less than a quarter of these women seek care because they may not think anything can be done about it. While not a casual topic to discuss, postpartum urinary incontinence, or loss of bladder control or leaking, can persist beyond six months postpartum, forcing women to seek care.
The problem is, only a relatively low percentage of people who may need it actually seek care for postpartum urinary incontinence. This is in part due to:
- Potential shame and embarrassment
- Lack of general information about the condition and applicable treatment options
- Fear of more significant interventions such as surgery
- The unfortunate misconceptions that urinary incontinence is the inevitable product of giving birth and/or stems from the aging process
Postpartum urinary incontinence is a condition that affects a woman’s quality of life, can impede daily functioning, and lead to stigma, which may result in women trying questionably effective non-invasive therapies or pharmacologic and/or surgical approaches with potential lifelong side effects.
A non-invasive approach to preventing postpartum urinary incontinence is pelvic floor muscle therapy, which includes contracting the levator ani muscle (LAM). The LAM is a thin, broad muscle group located on either side of the pelvis. This therapy has shown some success in reducing the risk of urinary incontinence in women who implement this shortly after birth. However, an important question to consider is whether pelvic floor muscle therapy implemented during pregnancy can help to prevent LAM injury during vaginal delivery, which is often the cause of postpartum urinary incontinence.
How do we expand our knowledge of postpartum urinary incontinence and help women that need it?
In collaboration with colleagues in the Department of Urology and Gynecology at Boston Medical Center and here at Boston University School of Public Health (BUSPH), we are exploring the knowledge that women have about postpartum urinary incontinence. Our team will be talking with patients to learn about their general understanding of pelvic floor muscle therapy, if any, and see if they would consider participating in a study to receive this intervention. Our hope is to drive a better understanding of postpartum urinary incontinence and work to mitigate it.
This pilot study is called The Boston Study to Tackle Risks OF iNcontinence post-Gestation (Boston STRONG). Women who are 12-24 months postpartum, and whose children are receiving pediatric care at Boston Medical Center, are now being recruited to complete a survey about their experiences with postpartum urinary incontinence. In addition, a sample of these women will participate in a focus group to tell us about the barriers that might have impacted their participation in a randomized trial of pelvic floor muscle therapy if they had been asked when they were pregnant. We’re also asking currently pregnant women the same questions and inviting them to participate in a focus group as well.
We are hopeful that the results of this pilot study will confirm that women are willing to participate in a similar study where they’re randomly selected to receive the standard of current prenatal care with or without pelvic floor muscle therapy. This information will allow us to put forward a proposal to the NIH to implement our Boston STRONG randomized trial to see if prenatal pelvic floor muscle therapy can reduce the risk of burdensome postpartum urinary incontinence. If this proves true, there is an opportunity to improve employee productivity by reducing and improving the mental wellbeing of the numerous people experiencing this condition.
This pilot study is being conducted with co-Principal Investigator, Dr. Toby Chai, Chief of Urology at Boston Medical Center, with assistance from BUSPH’s Drs. Yvette Cozier and Lois McCloskey, as well as the Biostatistics and Epidemiology Data Analytics Center.
Bernard L Harlow, PhD, professor of epidemiology at Boston University School of Public Health, has a broad background in epidemiologic studies of female reproductive and gynecologic disorders. His research has focused on studies of malignant and borderline ovarian tumors, adverse obstetrical outcomes, premature menopause, and benign gynecological complications, particularly those arising in women suffering from childhood victimization and a variety of psychiatric disorders. He has made substantial methodological advancements in data collection, particularly with respect to studies of severe mood disorder and reproductive function, and studies of the prevalence and etiological predictors of chronic unexplained vulvar pain disorders.
