Should we systematically ask about postnatal incontinence?

Abstract

This is one of the questions put forward in the study of Stephanie Brown et al. Their work shows, in a sample of around 1400 women interviewed postpartum, that the majority of women did not report their incontinence symptoms to health professionals consulted in postpartum, and also that they do not seem to have been systematically asked about continence by the health professionals they meet. It is well-known that urinary and faecal incontinence are common symptoms in postpartum and that conservative and effective treatments exist. The absence of spontaneous reporting of symptoms by women may be explained in several ways. Symptoms of postpartum incontinence are usually mild or moderate, and in most cases are resolved spontaneously. In Brown's study at 12 months postpartum, 78% of women with urinary incontinence considered it ‘a minor problem’, and 84% with faecal incontinence reported that ‘It does not happen very often and I just cope when it does’. However, not only women with mild symptoms, but also a large majority of women with moderate or severe symptoms (78% of women with severe urinary incontinence and 81% of women with moderate or severe fecal incontinence) have not reported it to their GP. The study by Brown et al. does not precisely explain the reasons why, so often, severe continence disorders are not reported to the doctor; this is possibly due to shame, fear of stigma, or a belief that incontinence is a normal condition after childbirth, or that treatments are invasive or not efficient. In this study, it is disturbing to note that the health professionals consulted postpartum are generally not concerned about urinary and anal continence of women after birth. There is, of course, a possible bias because the information gathered was based only on women's statements, which were not verified with health professionals. That said, the study by Brown fails to elucidate why the health professionals who are aware that these symptoms are common in postpartum, have not asked themselves more questions. Do they not know that women tend to under-report incontinence? Do they believe there is no treatment to offer or that the existing treatments are not effective? To conclude, it would be interesting to clarify the reasons why both women and health professionals so frequently refrain from addressing the issue of urinary and faecal continence after childbirth. The results of the study by Brown et al. should encourage us to improve both the information received by women and the training of health professionals on postpartum continence promotion. None to declare.