These women are uninformed about postpartum pelvic floor problems. They discuss their pelvic floor dysfunction with close initiates who feed their hope that the problems will resolve spontaneously. The women are not stimulated to seek professional help. However, the women do indicate they need professional information. They want to understand their problems and know how to deal with them. It is time for doctors and midwives to focus on the mother's health after delivery so that mothers will suffer less from pelvic floor problems, have more awareness of what they can do about them and call in medical aid.

Integrating gender into the basic medical curriculum has been largely successful. Block co-ordinators' personal recognition of the importance of gender in patient care greatly facilitated implementation. The evaluation stimulated the forming of new ideas. It is recommended that these factors and those mentioned above should be taken into consideration when integrating gender into other faculties.

A total of 110 women who had reported urinary incontinence to their general practitioners were randomly assigned to a treatment or control group. Treatment consisted of pelvic floor exercises in the case of stress incontinence and bladder training in the case of urge incontinence. The results were measured after 3 and 12 months by a research assistant on the basis of a constructed severity scale, an incontinence diary, and a comparison by the patients themselves of their previous and current conditions. After 3 months the control group were given the same treatment. After a further 3 and 12 months, they were assessed in exactly the same way as the treatment group. After 3 months about 60% of the patients were either dry or only mildly incontinent; the mean number of wet episodes had gone down from 20 to 7, and 74% of the women felt improved or cured. These results were later corroborated by the control group. After 12 months this successful outcome was improved slightly further. It may be concluded that the majority of women with incontinence can be successfully treated by the general practitioner. The effect of this treatment continues after one year.

No abstract

Objectives To compare, in a randomized trial, the effects of individual and group physiotherapy for urinary incontinence in women referred by their general practitioner (GP). Patients and methods The study included women of all ages (mean 47.8 years) with stress, urge or mixed incontinence; 126 received individual and 404 group treatment. Both groups undertook the same pelvic oor exercises and bladder training, and received the same information. The effects were measured soon after treatment and again 9 months later. The main outcome measures were objective changes in the severity of incontinence, frequency of urine loss and frequency of nocturnal urine loss. The trial was nationwide; 25 physiotherapists and 337 GPs participated. Results There were no signi®cant differences in effect between the groups; after individual treatment the severity of incontinence improved in 60% of the patients and the mean (95% con®dence interval, CI) frequency of urine loss decreased, by x8.7 (x6.4 to x11.1) times/week. After group therapy continence improved in 57% and the frequency of urine loss decreased, by ± 8.4 (x6.8 tox10.0) times/week. For women who had nocturnal urine loss (at baseline), the frequency decreased after individual treatment by x11.2 (4 tox26.4) and after group therapy by x14 (x9.1 to x18.9) times/month. All improvements persisted in full for up to 9 months. Conclusion Individual and group physiotherapy are equally effective for at least 9 months in improving incontinence in women. Factors should be sought that can predict the effectiveness of therapy, and thus better select those patients most likely to bene®t from therapy.