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

Abstract

Urinary and faecal incontinence, which are often linked to the stresses and strains of childbirth, particularly perineal trauma, are debilitating conditions that can significantly impact womens quality of life. Approximately 85% of vaginal births in the United Kingdom (UK) are affected by childbirth related perineal trauma, either spontaneously or due to episiotomy. Incontinence also places a significant financial burden on the healthcare system. Previous estimates have shown that stress urinary incontinence alone costs the National Health Service (NHS) 177 million UK pounds per year. The aim of this rapid review was to identify evidence on the clinical effectiveness and cost-effectiveness of interventions for preventing continence issues resulting from birth trauma. Twenty-three studies, published between 2023 and 2024, were included in this review: 20 systematic reviews of clinical effectiveness and three economic evaluations. A number of key findings, research implications and evidence gaps were identified. The findings support the use of exercise-based interventions including pelvic floor muscle training for prenatal and postnatal women to prevent urinary incontinence. However, there is limited evidence supporting their long-term effectiveness. Incontinence is a potential long-term burden as pregnancy and childbirth can weaken the pelvic floor, making women more susceptible to incontinence in later life. Menopause often exacerbates these issues due to hormonal changes and by further weakening the pelvic floor muscles. Non exercise-based interventions, such as prenatal perineal massage and vaginal devices were less represented in the available evidence base, especially for faecal incontinence outcomes. There was a paucity of economic evaluations assessing the cost-effectiveness of interventions for incontinence, however, the substantial economic burden of incontinence on the NHS necessitates investment in clinically effective, preventative options. Our findings present the case for investing in exercise-based interventions. Further research is needed to evaluate the maintenance and long-term effects of exercise-based therapy. More research is also needed that focus on alternative type interventions and the prevention of faecal incontinence. Future reviews need to consider qualitative findings of womens experiences and the acceptability and feasibility of rolling out interventions for the prevention of incontinence.