Research priorities
(Not in order of priority)
- Prospective
studies of risk factors in continent women (including further work
on caffeine, medications and obesity).
- Further
study the effect of childbirth practices such as episiotomy and
assisted delivery on long-term continence.
- Further
study on the effect of pre- or post-natal pelvic floor education and
exercise.
- Study
the effect of exercise and lifting on the pelvic floor.
- Excessive
physical stress during exercise or repeated lifting may be a risk
factor in the development of incontinence in women.
- Young
men are a low risk group for incontinence (with the exception of
nocturnal enuresis).
Clinical evidence (Indicates
what is known about preventing incontinence.)
- Constipation,
obesity, smoking and some medications (e.g. alpha blockers, caffeine
and diuretics) may be risk factors.
- Asymptomatic
bacteriuria is not linked to incontinence.
- Adults
with neurological disease often have inevitable bladder or sphincter
impairment, but active management may prevent this manifesting as
incontinence.
- For
women, the major risk factor is undoubtedly vaginal delivery during
childbirth.
- Cesarean
section appears to prevent incontinence, certainly for the first
baby, possibly less so for multiple births.
- Vacuum
extraction rather than forceps is preferred for assisted delivery to
prevent incontinence.
- The
relation of episiotomy to incontinence is unclear.
- There
is weak evidence that antenatal pelvic floor exercise may be
protective in the postnatal period. Longer term benefit is unproven.
- Prospective
studies of the effect of constipation in continent females.
- Methods
to improve bladder emptying and prevent complications in patients
with neurological disease (e.g. does the Crede maneuver create
long-term problems?).
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