Hege Hølmo Johannessen

• Schizas, Alexis; Hainsworth, Alison; Albuquerque, Andreia; Haylen, Bernard; Johannessen, Hege Hølmo & Igualada-Martinez, Paula [Show all 9 contributors for this article] (2026). An international continence Society (ICS) report on the terminology for male anorectal dysfunction. Continence. 20. doi: 10.1016/j.cont.2026.102824. Full text in Research Archive
• Lauwereins, L.; D'Hoore, A.; Coeckelberghs, E.; Wolthuis, A.; Bislenghi, G. & Haustermans, K. [Show all 95 contributors for this article] (2026). Development of S.Tool: An electronic diary for assessing bowel symptoms after rectal cancer surgery. European Journal of Surgical Oncology. ISSN 0748-7983. 52(5). doi: 10.1016/j.ejso.2026.111755. Full text in Research Archive
• Haukeland-Parker, Stacey Marie; Jervan, Øyvind; Ghanima, Waleed; Spruit, Martijn A.; Holst, Rene & Gleditsch, Jostein [Show all 13 contributors for this article] (2025). Exercise capacity, dyspnea, and quality of life 6 months after exercise-based rehabilitation in patients with persistent dyspnea following pulmonary embolism. Research and Practice in Thrombosis and Haemostasis (RPTH). 9(2). doi: 10.1016/j.rpth.2025.102736. Full text in Research Archive Show summary

  Background Exercise is safe and effective in the short-term following pulmonary embolism. To date, little is known about the long-term effects. Objectives The aim of the study was to investigate whether the effects of exercise-based rehabilitation are maintained 6 months after completion in patients with persistent dyspnea following pulmonary embolism when compared with usual care. Methods A 2-center, randomized controlled trial compared 8 weeks of exercise-based rehabilitation with usual care. Patients were reassessed postintervention and 6 months later. Exercise capacity was measured with the incremental shuttle walk test (ISWT). Dyspnea was assessed with the Shortness of Breath Questionnaire, and health-related quality of life was assessed with disease-specific (Pulmonary Embolism Quality of Life Questionnaire) and generic questionnaires. Results In total, 159 of 211 randomized patients attended follow-up 6 months postintervention. The significant improvement on the ISWT in the rehabilitation group was maintained at the 6-month follow-up (96 m; SE: 15 m; 95% CI: 66, 127). There were no changes on the ISWT in the control group at either time point. From postintervention to 6×-month follow-up, the rehabilitation group had further improvements in dyspnea compared with the control group (−3 points; SE: 1.4; 95% CI: −6, −1; P = .02). Health-related quality of life improved in both groups although superior improvements were seen in the rehabilitation group. Conclusion The improvement in exercise capacity after 8 weeks of exercise-based rehabilitation in patients with pulmonary embolism and persistent dyspnea was maintained at the 6-month follow-up, while no improvement was observed in the control group, highlighting the relevance of offering rehabilitation to these patients.

• Haukeland-Parker, Stacey Marie; Jervan, Øyvind; Ghanima, Waleed; Spruit, Martijn A.; Hubin, Aliaksandr & Tavoly, Mazdak [Show all 10 contributors for this article] (2025). The effect of exercise-based rehabilitation on objective physical activity levels in patients with persistent dyspnoea following pulmonary embolism. Thrombosis Research. ISSN 0049-3848. 252. doi: 10.1016/j.thromres.2025.109362. Full text in Research Archive Show summary

  Background Rehabilitation improves exercise capacity following pulmonary embolism (PE), but it is unclear whether this improvement is transferred into increased physical activity. Objectives. To explore the effect of exercise-based rehabilitation on objective measures of physical activity in patients with persistent dyspnoea following PE compared to standard care. Methods This pre-planned substudy compared an eight-week exercise-based rehabilitation program to usual care. Number of steps per day and time spent in sedentary, low, moderate and vigorous physical activity (in number of metabolic equivalent of tasks) were measured for seven consecutive days at baseline prior to intervention start and at post-intervention using accelerometery. Data were analysed with a mixed-effect generalised linear model. Results Complete data was provided by 48 patients at both timepoints (mean age 58 years, 54 % men) with 54 % randomised to rehabilitation. There were no significant differences between groups at baseline. The majority of time (717 min per day) was spent in sedentary activity and mean number of steps per day was 6701. At post-intervention, there were no significant differences between groups in any of the objectively measured physical activity parameters (p > 0.05). Conclusion In this cohort, exercise-based rehabilitation following PE did not change daily physical activity levels compared to usual care control group.

• Haukeland-Parker, Stacey Marie; Jervan, Øyvind; Ghanima, Waleed; Spruit, Martijn A.; Holst, Rene & Tavoly, Mazdak [Show all 8 contributors for this article] (2024). Physical activity following pulmonary embolism and clinical correlates in selected patients: a cross-sectional study. Research and Practice in Thrombosis and Haemostasis (RPTH). 8(2). doi: 10.1016/j.rpth.2024.102366. Full text in Research Archive Show summary

  Background: There is limited knowledge regarding physical activity and clinical correlates among people who have suffered a pulmonary embolism (PE). Objectives: To assess physical activity levels after PE and potential clinical correlates. Methods: One hundred forty-five individuals free of major comorbidities were recruited at a mean of 23 months (range, 6-72) after PE diagnosis. Physical activity was assessed by steps/day on the Sensewear monitor for 7 consecutive days, exercise capacity with the incremental shuttle walk test, and cardiac function with left ventricular ejection fraction (LVEF). The association between physical activity and other variables was analyzed by a mixed-effects model. Results: Participants achieved a mean of 6494 (SD, 3294; range, 1147-18.486) steps/day. The mixed-effects model showed that physical activity was significantly associated with exercise capacity (β-coefficient, 0.04; 95% CI, 0.03-0.05) and LVEF (β-coefficient, −0.81; 95% CI, −1.42 to −0.21). The analysis further showed that men became less physically active with increasing age (β-coefficient, −0.14; 95% CI, −0.24 to −0.04), whereas no change with age could be detected for women. Conclusion: In selected post-PE patients, physical activity seems to be associated with exercise capacity and LVEF but not with quality of life, dyspnea, or characteristics of the initial PE. Men appear to become less physically active with increasing age.

• Jervan, Øyvind; Haukeland-Parker, Stacey Marie; Gleditsch, Jostein; Tavoly, Mazdak; Klok, Frederikus A. & Steine, Kjetil [Show all 14 contributors for this article] (2023). The Effects of Exercise Training in Patients With Persistent Dyspnea Following Pulmonary Embolism: A Randomized Controlled Trial. Chest. ISSN 0012-3692. 164(4), p. 981–991. doi: 10.1016/j.chest.2023.04.042. Full text in Research Archive Show summary

  Bakgrunn Vedvarende dyspné, funksjonelle begrensninger og redusert livskvalitet (QoL) er vanlig etter lungeemboli (PE). Rehabilitering er et potensielt behandlingsalternativ , men den vitenskapelige dokumentasjonen er begrenset. Forskningsspørsmål Forbedrer et treningsbasert rehabiliteringsprogram treningskapasiteten hos PE-overlevere med vedvarende dyspné? Studiedesign og metoder Denne randomiserte kontrollerte studien ble utført ved to sykehus. Pasienter med vedvarende dyspné etter PE diagnostisert 6 til 72 måneder tidligere, uten kardiopulmonale komorbiditeter, ble randomisert 1:1 til enten rehabiliterings- eller kontrollgruppen. Rehabiliteringsprogrammet besto av to ukentlige økter med fysisk trening i 8 uker og en pedagogisk økt. Kontrollgruppen fikk vanlig pleie. Det primære endepunktet var forskjellen i Incremental Shuttle Walk Test mellom grupper ved oppfølging. Sekundære endepunkter inkluderte forskjeller i Endurance Shuttle Walk Test (ESWT), QoL (EQ-5D og lungeemboli-QoL spørreskjemaer) og dyspné (Shortness of Breath spørreskjema). Resultater Totalt 211 forsøkspersoner ble inkludert: 108 (51 %) ble randomisert til rehabiliteringsgruppen og 103 (49 %) til kontrollgruppen. Ved oppfølging presterte deltakerne fordelt på rehabiliteringsgruppen bedre på ISWT sammenlignet med kontrollgruppen (gjennomsnittlig forskjell, 53,0 m; 95 % KI, 17,7-88,3; P = 0,0035). Rehabiliteringsgruppen rapporterte bedre skårer på spørreskjemaet lungeemboli-kvalitet (gjennomsnittlig forskjell, –4 %; 95 % KI, –0,09 til 0,00; P = 0,041) ved oppfølging, men det var ingen forskjeller i generisk livskvalitet, dyspné. score, eller ESWT. Ingen uønskede hendelser oppsto under intervensjonen. Tolkning Hos pasienter med vedvarende dyspné etter PE hadde de som gjennomgikk rehabilitering bedre treningskapasitet ved oppfølging enn de som fikk vanlig behandling. Rehabilitering bør vurderes hos pasienter med vedvarende dyspné etter PE. Ytterligere forskning er imidlertid nødvendig for å vurdere optimal pasientvalg, tidspunkt, modus og varighet av rehabilitering.

• Flaathen, Eva Marie; Johannessen, Hege Hølmo; Bakke, Julie; Holm, Ida Cecilie; Mørkved, Siv & Salvesen, Kjell Åsmund Blix [Show all 7 contributors for this article] (2023). Does regular antenatal exercise promote exclusive breastfeeding during the first 3 months of life? Secondary analyses of a randomized controlled trial. European Journal of Midwifery (EJM). 7(August), p. 1–9. doi: 10.18332/EJM/167807. Full text in Research Archive Show summary

  Introduction: Exclusive breastfeeding (EBF) and antenatal exercise are independently associated with positive short- and long-term health effects for women and their children. The aims of the study were to investigate whether antenatal exercise promotes EBF three months postpartum and further to explore factors associated with EBF at three months postpartum. Methods: This study was a follow-up of a Norwegian two-center randomized controlled trial to assess the effect of an antenatal exercise protocol. The recruited pregnant women were randomized to either a 12-week standardized antenatal exercise program with one weekly group training led by a physiotherapist and two weekly home training sessions or standard antenatal care. Women reported breastfeeding status in a questionnaire at three months postpartum. Results: Of the 726 women, 88% were EBF at three months postpartum. There was no significant difference in EBF rates between the intervention group (87%) and the control group (89%). EBF was positively associated with maternal education (AOR=3.4; 95% CI: 1.7–6.7) and EBF at discharge from the hospital (AOR=22.2; 95% CI: 10–49). Admission to neonatal intensive care unit was identified as a significant barrier to EBF (AOR=0.2; 95% CI: 0.1–0.4). Significantly more women in the non-EBF group had sought professional help compared to women in the EBF group (p≤0.001). Conclusions: Regular physical exercise during pregnancy did not influence the exclusive breastfeeding rates at three months postpartum. Considering the health effects of exclusive breastfeeding and antenatal physical exercise, studies with follow-up periods beyond three months postpartum are warranted.

• Garnæs, Kirsti Krohn; Mørkved, Siv; Tønne, Torgrim; Furan, Lars; Vasseljen, Ottar & Johannessen, Hege Hølmo (2022). Mental health among patients with chronic musculoskeletal pain and its relation to number of pain sites and pain intensity, a cross-sectional study among primary health care patients. BMC Musculoskeletal Disorders. 23. doi: 10.1186/s12891-022-06051-9. Full text in Research Archive Show summary

  Background Chronic musculoskeletal pain (CMP) is characterised by pain related to the muscles or the joints with a duration of three months or more and is associated with high symptomatic burden in patients in primary health care. CMP is commonly associated with impaired mental health, which may affect the rehabilitation process. The primary aim of this study was to compare symptoms of anxiety, depression, fatigue, and insomnia in patients in primary health care with and without CMP. The secondary aim was to assess difference in mental health symptoms related to number of pain sites and pain intensity. Methods This cross-sectional study was conducted in Trondheim, Norway. All patients aged 21–58 from randomly selected general practitioners (GPs) were invited to participate. Participants were classified into two groups according to presence of CMP. Symptoms of anxiety, depression, fatigue, and insomnia were assessed by the Hospital Anxiety and Depression Scale (HADS), Chalder Fatigue Questionnaire (CFQ), and Insomnia Severity Index (ISI), respectively, using an online survey system. Results From the patient lists of six GPs, we included 969 patients. Mean age 46 years (SD: 10.1), and 517 reported CMP. CMP patients reported higher mean symptom score for anxiety (5.4 vs 3.7), depression (3.4 vs 2.0), fatigue (14.2 vs 11.2), and insomnia (8.1 vs 4.4), all p < 0.01 compared to no-CMP patients. Symptoms of impaired mental health increased with increasing number of pain sites and pain intensity (p < 0.001). Conclusions Primary health care patients with CMP reported significantly more symptoms of anxiety, depression, fatigue, and insomnia than patients without CMP. The higher number of pain sites and pain intensity, the more mental health symptoms, especially of anxiety. Primary health care personnel have to address mental health issues when treating patients with CMP.

• Dalbye, Rebecka & Johannessen, Hege Hølmo (2022). Two midwives during the second stage of labour to reduce severe perineal trauma. The Lancet. ISSN 0140-6736. 399(10331), p. 1203–1205. doi: 10.1016/S0140-6736(22)00381-6. Full text in Research Archive
• Gleditsch, Jostein; Jervan, Øyvind; Haukeland-Parker, Stacey Marie; Tavoly, Mazdak; Geier, Oliver & Holst, Rene [Show all 10 contributors for this article] (2022). Effects of pulmonary rehabilitation on cardiac magnetic resonance parameters in patients with persistent dyspnea following pulmonary embolism. International journal of cardiology: Heart and Vasculature (IJCHA). 40(June). doi: 10.1016/j.ijcha.2022.100995. Full text in Research Archive Show summary

  Background Persistent dyspnea and reduced exercise capacity is common in pulmonary embolism (PE) survivors. Although improved right ventricular function after pulmonary rehabilitation has been demonstrated in chronic thromboembolic pulmonary hypertension, it is still unknown whether a similar effect also occurs in other patients with dyspnea after pulmonary embolism. Purpose The aim of this study was to explore potential effects of a pulmonary rehabilitation program on cardiac structure and function as assessed with cardiac magnetic resonance (CMR). Material and methods Twenty-six PE survivors with persistent dyspnea were included. Right and left ventricular assessment with CMR was performed before and after an eight-week pulmonary rehabilitation program. Results Dyspnea as measured by the Shortness of Breath Questionnaire improved significantly after rehabilitation: 15 (IQR: 7–31) versus 8 (IQR: 3–17). Absolute right ventricular global longitudinal strain by CMR was reduced from 19% to 18% (95% CI of difference: 0–3 percent points), and absolute RV lateral strain from 26% to 24% (95% CI of difference: 1–4 percent points). Right ventricular mass was reduced after rehabilitation from 49 g to 44 g (95% CI of difference: 2–8 g). Conclusion Although there was a substantial improvement in dyspnea after rehabilitation, we found only a minor reduction in absolute right ventricular longitudinal strain and right ventricular mass. No other CMR parameter changed. We therefore suggest that rehabilitation effect of in this patient group was not primarily mediated by cardiac adaptions.

• Haukeland-Parker, Stacey Marie; Frisk, Bente; Spruit, Martijn A.; Stafne, Signe Nilssen & Johannessen, Hege Hølmo (2021). Treatment of urinary incontinence in women with chronic obstructive pulmonary disease—a randomised controlled study. Trials. 22(1), p. 1–10. doi: 10.1186/s13063-021-05816-2. Full text in Research Archive Show summary

  Background Little is known regarding treatment of urinary incontinence (UI) in women with chronic obstructive pulmonary disease (COPD). The aim of the study was to explore the efficacy of pelvic floor muscle training (PFMT) or cough-suppression techniques (CST) on UI in women with COPD. Methods A three-armed, two-centred, single-blinded, randomised controlled study was performed. Subjects were randomised to (a) PFMT for 16 weeks, (b) 2–3 educational sessions in CST, or (c) written information only. All participants completed questionnaires about UI, cough symptoms, and health status and underwent clinical examinations to evaluate the strength of the pelvic floor muscles and exercise capacity. Daily physical activity levels were measured using an activity monitor and lung function with spirometry. With a significance level of 5% and an 80% chance of detecting a significant difference between groups of 2.5 points on the ICIQ UI SF score, our sample size calculation showed that a total of 78 women, 26 in each group, was required to complete the study. Results During the period 2016 to 2018, 95 women were invited to the study. A total of 42 were recruited, three were excluded and 10 (24%) dropped out during the follow-up period. Mean ICIQ-UI SF total baseline score was 9.6 (range: 1–17) and 7.0 (range: 0–16) at follow-up. Changes in subjective UI as measured with the ICIQ-UI SF questionnaire were seen in the PFMT group and control group, but not in the CST group. Conclusion Due to the low number of available participants and recruitment difficulties including practical issues such as travel distance, lack of interest, poor state of health, and high number of comorbidities, our results are inconclusive. However, reduced subjective UI was observed in the PFMT and control groups with a trend towards best effect in the PFMT group. Screening for UI is advisable in all women with COPD to be able to identify and treat these women to reduce symptom burden and improve quality of life. Future studies should focus on barriers to recruitment as well as randomised controlled studies with larger sample sizes. Trial registration ClinicalTrials.gov NCT02614105. 25th November 2015.

• Stafne, Signe Nilssen; Dalbye, Rebecka; Kristiansen, Oda Margrete; Hjelle, Yvonne Enger; Salvesen, Kjell Å & Mørkved, Siv [Show all 7 contributors for this article] (2021). Antenatal pelvic floor muscle training and urinary incontinence: A randomized controlled 7-year follow up study. International Urogynecology Journal. ISSN 0937-3462. p. 1–9. doi: 10.1007/s00192-021-05028-x. Full text in Research Archive Show summary

  Introduction and hypothesis: Urinary incontinence is common postpartum. Our aims were to assess whether antenatal exercise including pelvic floor muscle training (PFMT) has long-term effects on urinary incontinence (UI) and to explore factors associated with UI 7 years postpartum. Methods: A follow-up of a two-centre randomized controlled trial performed at St. Olavs Hospital and Stavanger University Hospital, Norway. In the original trial women were randomized to a 12-week structured exercise protocol including PFMT or standard antenatal care during pregnancy. Link to an electronic questionnaire was sent by postal mail 7 years postpartum. Prevalence of UI was assessed with Sandvik severity index and compared between groups. Factors associated with UI were studied using multivariable logistic regression analysis. Results: The response rate was 35% (298/855). UI was reported by 78 (51%) in the intervention group and 63 (57%) in the control group (p = 0.539). In the multivariable logistic regression analyses, women with UI at inclusion had a five-fold increase in odds of UI at 7 years (OR 5.4, 95% CI 2.6, 11.5). Engaging in regular exercise was not significantly associated with UI at 7 years; however, UI was associated with lower exercise intensity (OR 2.4, 95% CI 1.2, 4.6). Conclusions: We found no group differences of antenatal exercise including PFMT on UI after 7 years among the responders. UI in pregnancy increased the risk of long-term UI. Regular exercise was not associated with UI at 7 years; however, women with UI were more than twice as likely to exercise at lower intensity than continent women.

• Garnæs, Kirsti Krohn; Mørkved, Siv; Salvesen, Øyvind; Tønne, Torgrim; Furan, Lars & Grønhaug, Gudmund [Show all 8 contributors for this article] (2021). What factors are associated with health‐related quality of life among patients with chronic musculoskeletal pain? A cross‐sectional study in primary health care. BMC Musculoskeletal Disorders. 22. doi: 10.1186/s12891-020-03914-x. Full text in Research Archive Show summary

  Background: Chronic musculoskeletal pain (CMP) affects daily life function and is the most prevalent disorder in primary health care. The primary objective was to examine demographic factors and pain characteristics associated with reduced health-related quality of life (HRQoL) among patients in primary care reporting CMP. Our secondary objective was to compare HRQoL in patients with and without CMP. Method: This cross-sectional study was conducted in Trondheim, Norway. Twenty randomly selected GPs, and their listed patients aged 21-58 were invited to participate. Self-reported CMP data was collected using online questionnaires. HRQoL was measured by the 15D questionnaire, total score of 0.9 was used as cut-off for clinical reduced HRQoL. Results: A total of 969 patients (650 females) were recruited from six GPs' patient lists, mean age 45.6 (SD 10.1). CMP was reported by 517 (53%). Factors significantly associated with reduced HRQoL were gender (OR 2.0, 95% CI 1.2, 3.4), disability pension (OR 26.6, 95% CI 3.1, 228.0), mood (OR 1.3, 95% CI 1.1, 1.6), relations with other people (OR 0.8, 95% CI 0.6, 0.9), sleep (OR 1.2, 95% CI 1.0, 1.3) and enjoyment (OR 1.2, 95% CI 1.0). CMP patients had significantly lower total HRQoL score compared to patients without CMP (Between group difference 0.08, 95% CI 0.07-0.09). Half of the CMP patients reported a HRQoL score < 0.9 compared to 14% in the no CMP group. Conclusions: Being female, receiving disability pension, and several psychosocial factors were found highly associated with reduced HRQoL in CMP patients, whereas pain characteristics were not. Patients with CMP reported statistically and clinically significant lower HRQoL than patients without CMP. Due to low response rate the conclusions must be handled with caution.

• Haukeland-Parker, Stacey Marie; Jervan, Øyvind; Johannessen, Hege Hølmo; Gleditsch, Jostein; Stavem, Knut & Steine, Kjetil [Show all 11 contributors for this article] (2021). Pulmonary rehabilitation to improve physical capacity, dyspnea, and quality of life following pulmonary embolism (the PeRehab study): study protocol for a two-center randomized controlled trial. Trials. 22, p. 1–9. doi: 10.1186/s13063-020-04940-9. Full text in Research Archive Show summary

  Background Recently, a large group of patients with persistent dyspnea, poor physical capacity, and reduced health-related quality of life (HRQoL) following pulmonary embolism (PE) has been identified and clustered under the name “post pulmonary embolism syndrome” (PPS). These patients seem good candidates for pulmonary rehabilitation. The aim of the study is to explore whether a pulmonary rehabilitation program can improve physical capacity, dyspnea, and HRQoL in PPS patients. Methods A two-center randomized controlled trial (RCT) is being performed at Østfold Hospital and Akershus University Hospital in Norway. Patients with PPS are 1:1 randomized into an intervention or a control group. The intervention consists of a supervised, outpatient rehabilitation program twice weekly (1 h) for 8 weeks provided by experienced physiotherapists. The intervention involves individually adapted exercises based on existing pulmonary rehabilitation programs (relaxation, interval, and resistance training), and an educational session including topics such as normal anatomy and physiology of the respiratory and circulatory system, information on PE/PPS, breathing strategies, and benefits of exercise/physical activity. Patients randomized to the control group receive usual care without specific instructions to exercise. Participants in the intervention and control groups will be compared based on assessments conducted at baseline, 12 weeks, and 36 weeks after inclusion using the incremental shuttle walk test (primary outcome) and endurance shuttle walk test (exercise capacity), Sensewear activity monitor (daily physical activity), the modified Medical Research Council scale, the Shortness of Breath Questionnaire (dyspnea), and EQ-5D-5L and the Pulmonary Embolism Quality of Life Questionnaire (HRQoL). Recruitment of 190 patients is currently ongoing. Discussion Results from this study may provide a currently untreated group of PPS patients with an effective treatment resulting in reduced symptoms of dyspnea, improved exercise capacity, and better HRQoL following PE. Trial registration Clinical Trials NCT03405480 . Registered prospectively on September 2017. Protocol version 1 (from original protocol September 2017). The study protocol has been reported in accordance with the Standard Protocol Items: Recommendations for Clinical Interventional Trials (SPIRIT) guidelines (Additional file 1).

• Haukeland-Parker, Stacey Marie; Hasvik, Eivind; Jelsness-Jørgensen, Lars-Petter; Birring, Surinder S. & Johannessen, Hege Hølmo (2021). Cross-cultural adaptation and validation of the Norwegian version of the Leicester Cough Questionnaire in chronic obstructive pulmonary disease. Physiotherapy Theory and Practice. ISSN 0959-3985. doi: 10.1080/09593985.2021.1911012. Full text in Research Archive
• Johannessen, Hege Hølmo; Frøshaug, Betina Ekelund; Lysåker, Pernille JG; Salvesen, Kjell Å; Lukasse, Mirjam & Mørkved, Siv [Show all 7 contributors for this article] (2020). Regular antenatal exercise including pelvic floor muscle training reduces urinary incontinence 3 months postpartum-Follow up of a randomized controlled trial. Acta Obstetricia et Gynecologica Scandinavica. ISSN 0001-6349. 100(2), p. 294–301. doi: 10.1111/aogs.14010. Full text in Research Archive Show summary

  Introduction Urinary incontinence is a frequently reported condition among women with pregnancy and delivery as established risk factors. The aims of this study were to evaluate the effect of an antenatal exercise program including pelvic floor muscle training on postpartum urinary incontinence, and to explore factors associated with urinary incontinence three months postpartum. Material and methods This is a short-term follow-up and secondary analysis of a randomized controlled trial conducted at two Norwegian University Hospitals including healthy, pregnant women aged >18 years with a singleton live fetus. Women in the exercise group received a 12-week standardized exercise program including pelvic floor muscle training, with once weekly group exercise classes led by a physiotherapist and twice weekly home exercise sessions. The controls received standard antenatal care. Data were obtained from questionnaires answered in pregnancy weeks 18–22, and three months postpartum. Urinary incontinence prevalence in the exercise and control groups was compared, and multivariable logistic regression analyses were applied. Urinary incontinence prevalence three months postpartum was assessed by the Sandvik severity index. Results Among the 722 (84%) women who responded three months postpartum, significantly fewer women in the exercise group (29%) reported urinary incontinence compared with the standard antenatal care group (38%, P = .01). Among women who were incontinent at baseline, 44% and 59% (P = .014) were incontinent at three months postpartum in the exercise and control groups, respectively. Urinary incontinence three months postpartum was associated with age (OR 1.1, 95% CI 1.0-1.1), experiencing urinary incontinence in late pregnancy (OR 3.6, 95% CI 2.3-5.9), birthweight ≥4000 g (OR 1.8, 95% CI 1.2-2.8), and obstetric anal sphincter injuries (OR 2.6, 95% CI 1.1-6.1). Cesarean section significantly reduced the risk of urinary incontinence three months postpartum compared with spontaneous vaginal delivery (OR 0.2, 95% CI 0.1-0.5). Conclusions A moderate-intensity exercise program including pelvic floor muscle training reduced prevalence of urinary incontinence 3 months postpartum in women who were incontinent at baseline.

• Johannessen, Hege Hølmo; Mørkved, Siv; Stordahl, Arvid; Wibe, Arne & Falk, Ragnhild Sørum (2020). Evolution and risk factors of anal incontinence during the first 6 years after first delivery: a prospective cohort study. BJOG: An International Journal of Obstetrics and Gynaecology. ISSN 1470-0328. 127(12), p. 1499–1506. doi: 10.1111/1471-0528.16322. Full text in Research Archive Show summary

  Complicated vaginal delivery, age and bowel emptying problems increase the risk of long-term anal incontinence.

• Johannessen, Hege Hølmo & Cartwright, Rufus (2020). Constipation during and after pregnancy. BJOG: An International Journal of Obstetrics and Gynaecology. ISSN 1470-0328. 128(6), p. 1065–1065. doi: 10.1111/1471-0528.16603. Full text in Research Archive
• Stafne, Signe Nilssen; Mørkved, Siv; Gustafsson, Miriam Katarina; Syversen, Unni; Stunes, Astrid Kamilla & Salvesen, Kjell Å [Show all 7 contributors for this article] (2020). Vitamin D and stress urinary incontinence in pregnancy: a cross-sectional study. BJOG: An International Journal of Obstetrics and Gynaecology. ISSN 1470-0328. 127(13), p. 1704–1711. doi: 10.1111/1471-0528.16340. Full text in Research Archive Show summary

  Objective To assess the association between levels of vitamin D and urinary incontinence (UI) in pregnancy. Design A cross‐sectional study. Secondary analysis of a randomised controlled trial. Setting Two university hospitals in Norway. Population A total of 851 healthy, pregnant women >18 years in gestational weeks 18–22 with a singleton live fetus. Methods Data on UI were collected from a questionnaire at inclusion and serum analysis of 25‐hydroxy vitamin D (25(OH)D) was performed. Univariable and multivariable logistic regression analyses were applied to study associations between exposure and outcomes. Main outcome measures Prevalence of self‐reported UI, stress (SUI) and urge (UUI) or mixed UI. Results In total, 230/851 (27%) of the participants were vitamin D insufficient (25(OH)D <50 nmol/l) and 42% reported to have any UI. Women with 25(OH)D <50 nmol/l were more likely to report any UI (P = 0.03) and SUI (P < 0.01) compared with women with 25(OH)D ≥50 nmol/l. In a univariable logistic regression analysis, serum levels of 25(OH)D <50 nmol/l was associated with increased risk of any UI (odds ratio [OR] 1.5 with 95% CI 1.0–2.1), SUI only (OR 1.7, 95% CI 1.2–2.4), but not mixed UI or UUI only (OR 0.8, 95% CI 0.5–1.5). In a multivariable logistic regression model, serum levels of 25(OH)D <50 nmol/l were associated with a higher risk of experiencing SUI only (OR 1.5, 95% CI 1.1–2.2). Conclusions Serum 25(OH)D <50 nmol/l was associated with increased risk of any UI, and SUI in particular.

• Norderval, Stig; Rydningen, Mona Birgitte; Falk, Ragnhild Sørum; Stordahl, Arvid & Johannessen, Hege Hølmo (2019). Strong agreement between interview-obtained and self-administered Wexner and St. Mark's scores using a single questionnaire. International Urogynecology Journal. ISSN 0937-3462. 30(12), p. 2102–2102. doi: 10.1007/s00192-019-03945-6. Full text in Research Archive
• Johannessen, Hege Hølmo; Stafne, Signe Nilssen; Falk, Ragnhild Sørum; Stordahl, Arvid; Wibe, Arne & Mørkved, Siv (2018). Prevalence and predictors of double incontinence 1 year after first delivery. International Urogynecology Journal. ISSN 0937-3462. 29, p. 1529–1535. doi: 10.1007/s00192-018-3577-7. Full text in Research Archive Show summary

  Introduction and hypothesis Urinary (UI) and anal incontinence (AI) are common pelvic floor disorders (PFD), and postpartum women experiencing double incontinence (DI), the combination of UI and AI, tend to have more severe symptoms and a greater impact on quality of life. Our objective was to investigate the prevalence and predictors of postpartum DI and UI alone 1 year after first delivery. Methods In this prospective cohort study, 976 women reported the prevalence of DI and UI alone 1 year after their first delivery in one of two hospitals in Norway using the St Marks score and the ICI-Q UI SF. Results DI was significantly reduced from 13% in late pregnancy to 8% 1 year later, whereas 30% reported UI at both time points. Incontinence in late pregnancy predicted incontinence 1 year after delivery. Higher age was associated with UI alone. Compared with caesarean delivery, normal vaginal or instrumental delivery increased the risk of UI alone more than three and four times respectively. Obstetric anal sphincter injuries showed a four-fold increase in the risk of DI. Conclusions Nearly 50% reported incontinence symptoms 1 year after first delivery. Continence status during pregnancy was one of the main predictors of postpartum continence status. Mode of delivery increased the risk of postpartum UI, whereas obstetric anal sphincter injuries increased the risk of postpartum DI.

• Schei, Berit; Johannessen, Hege Hølmo; Rydning, Astrid; Sultan, Abdul & Mørkved, Siv (2018). Anal incontinence after vaginal delivery or cesarean section. Acta Obstetricia et Gynecologica Scandinavica. ISSN 0001-6349. 98(1), p. 51–60. doi: 10.1111/aogs.13463. Full text in Research Archive
• Johannessen, Hege Hølmo; Stafne, Signe Nilssen; Falk, Ragnhild Sørum; Stordahl, Arvid; Wibe, Arne & Mørkved, Siv (2018). Prevalence and predictors of anal incontinence 6 years after first delivery. Neurourology and Urodynamics. ISSN 0733-2467. 38(1), p. 310–319. doi: 10.1002/nau.23854. Full text in Research Archive Show summary

  Aims The main aim of the present study, was to explore prevalence and predictors of anal incontinence (AI) experienced 6 years after first delivery. Methods In this longitudinal prospective cohort study, participants in a previous study answered questions about AI 6 years after first delivery using postal or digital questionnaires. Prevalence of AI was calculated, and multivariable logistic regression analyses were applied. Results A total of 731 (48%) of the original participants who gave birth to their first child between May 2009 and December 2010 responded 6 years after first delivery. There was a significant reduction in reports of one or more AI symptoms from late pregnancy (33%; 95%CI: 30.3, 37.2) to 6 years after first delivery (21%; 95%CI:18.4, 24.4, P = 0.028). Older age at first delivery, BMI (≥35), active bowel disease, and previous problems with bowel evacuation and urgency when going to the toilet predicted AI at 6 years. Long‐term AI was also associated with instrumental first delivery (Odds ratio (OR):1.8; 95%CI:1.1, 2.8) and sustaining a perianal tear grade three or four at first delivery (OR:3.0; 95%CI:1.3, 6.8). Conclusions Prevalence of AI was significantly reduced from late pregnancy, still 21% experienced AI 6 years after first delivery. Findings from the present study indicate that an added focus on modifiable risk factors for AI such as BMI, OASIS and history of PFDs increase the risk of AI in the long term, may be beneficial in reducing incontinence problems the short‐ and long‐term.

• Johannessen, Hege Hølmo; Norderval, Stig; Stordahl, Arvid; Falk, Ragnhild Sørum & Wibe, Arne (2017). Interview-based versus self-reported anal incontinence using St Mark's incontinence score. International Urogynecology Journal. ISSN 0937-3462. p. 1–5. doi: 10.1007/s00192-017-3363-y. Full text in Research Archive
• Johannessen, Hege Hølmo; Wibe, Arne; Stordahl, Arvid; Sandvik, Leiv & Mørkved, Siv (2016). Do pelvic floor muscle exercises reduce postpartum anal incontinence? A randomised controlled trial. BJOG: An International Journal of Obstetrics and Gynaecology. ISSN 1470-0328. 124(4), p. 686–694. doi: 10.1111/1471-0528.14145. Full text in Research Archive
• Johannessen, Hege Hølmo; Wibe, Arne; Stordahl, Arvid; Sandvik, Leiv & Mørkved, Siv (2015). Anal incontinence among first time mothers - What happens in pregnancy and the first year after delivery? Acta Obstetricia et Gynecologica Scandinavica. ISSN 0001-6349. 94(9), p. 1005–1013. doi: 10.1111/aogs.12689. Full text in Research Archive
• Johannessen, Hege Hølmo; Wibe, Arne; Stordahl, Arvid; Sandvik, Leiv; Backe, Bjørn & Mørkved, Siv (2014). Prevalence and predictors of anal incontinence during pregnancy and 1 year after delivery: a prospective cohort study. BJOG: An International Journal of Obstetrics and Gynaecology. ISSN 1470-0328. 121(3), p. 269–280. doi: 10.1111/1471-0528.12438. Full text in Research Archive Show summary

  Objective To evaluate the prevalence and predictors of anal incontinence (AI) in late pregnancy and 1 year after delivery. Design Prospective population-based cohort study. Setting Two maternity units in Norway 2009–2010. Population Primiparae aged 18 years or over. Methods Primiparae answered questions on the St. Mark's score about AI during the last 4 weeks of pregnancy. One year later, the same questionnaires were distributed by postal mail. Socio-economic and delivery-related data were obtained from hospital records. Main outcome measures Self-reported AI. Results Answers on AI in late pregnancy were obtained from 1571 women, and 1030 responded 1 year later. Twenty-four per cent experienced one and 4.7% experienced three or more AI symptoms in late pregnancy. One year later, this was reduced to 19% and 2.2%, respectively. Multivariate logistic regression analyses were applied. Formed and loose stool incontinence were strongly associated at both time points. The main predictor of AI 1 year after delivery was AI in late pregnancy. Obstetric anal sphincter injury increased the risk of incontinence of stool and flatus (odds ratio [OR], 4.1; 95% confidence interval [CI], 1.7–9.6) after delivery. Urgency was associated with greater age (OR, 1.8; 95% CI, 1.0–3.3) and operative delivery (OR, 2.0; 95% CI, 1.3–2.9). Conclusion One in four primiparae experienced AI in late pregnancy. One year later, still one in five suffered from incontinence. Sphincter injury predicted incontinence of stool and flatus, whereas greater age and operative delivery predicted urgency. The identification and adequate follow-up of pregnant women with AI may reduce AI after delivery.

• Johannessen, Hege Hølmo; Mørkved, Siv; Stordahl, Arvid; Sandvik, Leiv & Wibe, Arne (2014). Anal incontinence and Quality of Life in late pregnancy: A cross-sectional study. BJOG: An International Journal of Obstetrics and Gynaecology. ISSN 1470-0328. 121(8), p. 978–987. doi: 10.1111/1471-0528.12643. Full text in Research Archive

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• Haukeland-Parker, Stacey; Jervan, Øyvind; Ghanima, Waleed; Spruit, Martijn A.; Hubin, Aliaksandr & Gleditsch, Jostein [Show all 10 contributors for this article] (2026). The effect of exercise-based rehabilitation on objectively measured daily physical activity levels in patients with persistent dyspnoea after pulmonary embolism. Full text in Research Archive
• Haukeland-Parker, Stacey; Jervan, Øyvind; Ghanima, Waleed; Spruit, Martijn A.; Holst, Rene & Gleditsch, Jostein [Show all 13 contributors for this article] (2026). Exercise capacity, dyspnoea and health-related quality of life six months after exercise- based rehabilitation in patients with persistent dyspnea following pulmonary embolism. Full text in Research Archive
• Solem, Ingrid Futsæter & Johannessen, Hege Hølmo (2024). Raskt og presist. Sammenligning av vitalparametere og legemiddeldosering for barn i FRAm og AkutBarn. Full text in Research Archive
• Semb, Martin Gjessing; Dikken, Job den & Johannessen, Hege Hølmo (2024). Hvilke faktorer hindrer ambulansepersonell i å sende inn bekymringsmelding til barnevernet? Full text in Research Archive
• Johannessen, Hege Hølmo & Mørkved, Siv (2024). Physical Therapy After OASIs. In Sultan, Abdul H.; Thakar, Ranee & Lewicki-Gaupp, Christina (Ed.), Pelvic Floor, Perineal, and Anal Sphincter Trauma During Childbirth Diagnosis, Management and Prevention. Springer Nature. ISSN 9783031430954. doi: 10.1007/978-3-031-43095-4_18. Full text in Research Archive
• Guttormsen, Selma Elise Hegge; Eklo, Aslaug & Johannessen, Hege Hølmo (2024). Hvilke utfordringer møter ambulansepersonell på når de skal sende bekymringsmelding til barnevernet? Full text in Research Archive
• Prøsch-Bilden, Tone; Johannessen, Hege Hølmo; Rydningen, Mona Birgitte & Norderval, Stig (2024). Is a second sphincter repair for anal incontinence worthwhile? Results from a national quality registry. Full text in Research Archive
• Johansen, Madeleine Sørstad & Johannessen, Hege Hølmo (2024). Hvordan kan paramedisinere redusere undertriagering av eldre med fall fra egen høyde? Full text in Research Archive
• Prøsch-Bilden, Tone; Johannessen, Hege Hølmo; Rydningen, Mona Birgitte & Norderval, Stig (2024). Is a second sphincter repair for anal incontinence worthwhile? Results from a national quality registry. Full text in Research Archive
• Haukeland-Parker, Stacey Marie; Jervan, Øyvind; Ghanima, Waleed; Spruit, Martijn A.; Holst, Rene & Gleditsch, Jostein [Show all 8 contributors for this article] (2024). The effect of exercise-based rehabilitation on daily physical activity following pulmonary embolism. Full text in Research Archive
• Kjetså, Ingvild; Johannessen, Hege Hølmo; Stensli, Elisabeth & Stafne, Signe Nilssen (2024). Prevalence and severity of multiple pelvic floor dysfunctions up to one year postpartum: A Norwegian cross-sectional study. Full text in Research Archive
• Stafne, Signe Nilssen & Johannessen, Hege Hølmo (2024). Postpartum Pelvic Floor Dysfunctions Among 1371 Norwegian Women. Full text in Research Archive
• Kjetså, Ingvild; Johannessen, Hege Hølmo; Elisabeth, Stensli & Stafne, Signe Nilssen (2024). Postpartum Pelvic Floor Dysfunctions Among 1371 Norwegian Women. Full text in Research Archive
• Johannessen, Hege Hølmo (2023). Evidence for Pelvic Floor Muscle Training for Anal Incontinence Related to the Peripartum Period. In Bø, Kari; Berghmans, Bary; Mørkved, Siv & Kampen, Marijke Van (Ed.), Evidence-Based Physical Therapy for the Pelvic Floor Bridging Science and Clinical Practice. Elsevier. ISSN 9780702083082. Full text in Research Archive
• Jervan, Øyvind; Haukeland-Parker, Stacey Marie; Gleditsch, Jostein; Tavoly, Mazdak; Klok, Frederikus A. & Steine, Kjetil [Show all 14 contributors for this article] (2023). Rehabilitation to improve exercise capacity and quality of life after pulmonary embolism. Full text in Research Archive
• Haukeland-Parker, Stacey Marie; Jervan, Øyvind; Ghanima, Waleed; Spruit, Martijn A.; Tavoly, Mazdak & Gleditsch, Jostein [Show all 7 contributors for this article] (2023). Objectively measured physical activity in patients after pulmonary embolism and its clinical correlates. Full text in Research Archive
• Johannessen, Hege Hølmo (2023). Graviditet, fødsel og fysioterapi etter sfinkterruptur. Full text in Research Archive
• Johannessen, Hege Hølmo; Stafne, Signe Nilssen; Cartwright, Rufus & Mørkved, Siv (2021). Anxiety and depression among women with pelvic floor disorders. Full text in Research Archive
• Johannessen, Hege Hølmo & Stafne, Signe Nilssen (2021). International Continence Society podcast 2; can we prevent pelvic floor injury/ dysfunction in pregnancy? [Internet]. Spotify -podcast. Full text in Research Archive
• Haukeland-Parker, Stacey Marie; Hasvik, Eivind Olay; Jelsness-Jørgensen, Lars-Petter; Birring, Surinder & Johannessen, Hege Hølmo (2020). THE TRANSLATION AND VALIDATION OF THE NORWEGIAN VERSION OF THE LEICESTER COUGH QUESTIONNAIRE. Full text in Research Archive
• Haukeland-Parker, Stacey Marie; Jervan, Øyvind; Spruit, Martijn A.; Ghanima, Waleed Khalid & Johannessen, Hege Hølmo (2020). REHABILITAION TO IMPROVE PHYSICAL CAPACITY, DYSPNEA AND QUALITY OF LIFE FOLLOWING PULMONARY EMBOLISM – STUDY PROTOCOL (THE PE-REHAB STUDY). Full text in Research Archive
• Johannessen, Hege Hølmo (2019). WS#23 – ICS Core Curriculum (Free): The evidence base for Physiotherapy in the Peri-partum Period and Male Pelvic Pain. Full text in Research Archive
• Haukeland-Parker, Stacey Marie; Stafne, Signe Nilssen; A, Spruit Martijn; Lerdal, Anners & Johannessen, Hege Hølmo (2019). Urinary incontinence women with chronic obstructive pulmonary disease. Full text in Research Archive
• Johannessen, Hege Hølmo; Stafne, Signe Nilssen; Mørkved, Siv; Stordahl, Arvid; Wibe, Arne & Trevor, Julia Jønsson [Show all 7 contributors for this article] (2019). Longitudinal risk of urinary and double incontinence during six years after first delivery. Full text in Research Archive
• Johannessen, Hege Hølmo; Mørkved, Siv; Salvesen, Kjell Å & Stafne, Signe Nilssen (2019). Risk of anal incontinence three months postpartum. Full text in Research Archive
• Haukeland-Parker, Stacey Marie; Stafne, Signe Nilssen; Lerdal, Anners; Spruit, Martijn & Johannessen, Hege Hølmo (2018). Effekt av bekkenbunnstrening og teknikker for å dempe hoste på kvinner med KOLS og urininkontinens – preliminære resultater fra en RCT. Full text in Research Archive
• Stafne, Signe Nilssen; Gustafsson, Miriam; Syversen, Unni; Stunes, Kamilla; Mørkved, Siv & Salvesen, Kjell Å [Show all 7 contributors for this article] (2018). The association between urinary incontinence (UI) and Vitamin D insufficiency in pregnancy. Full text in Research Archive
• Stafne, Signe Nilssen; Gustafsson, Miriam; Syversen, Unni; Stunes, Astrid Kamilla; Mørkved, Siv & Salvesen, Kjell Å [Show all 7 contributors for this article] (2018). The association between urinary incontinence (UI) and Vitamin D insufficiency in pregnancy. Full text in Research Archive
• Johannessen, Hege Hølmo & Mørkved, Siv (2018). Effektive lavterskeltilbud for behandling av inkontinens. Full text in Research Archive
• Johannessen, Hege Hølmo; Wibe, Arne; Stordahl, Arvid; Sandvik, Leiv & Mørkved, Siv (2017). Authors' reply re: Do pelvic floor muscle exercises reduce postpartum anal incontinence? A randomised controlled trial. BJOG: An International Journal of Obstetrics and Gynaecology. ISSN 1470-0328. 124(4), p. 698–699. doi: 10.1111/1471-0528.14262. Full text in Research Archive
• Johannessen, Hege Hølmo (2017). Author Insights, Do pelvic floor muscle exercises reduce postpartum anal incontinence? A randomized controlled trial. [Internet]. Royal College of Obstetricians and Gynaecologists. Full text in Research Archive
• Johannessen, Hege Hølmo & O'Reilley, Barry (2017). Point-counterpoint discussion: Long-term results of peripartum pelvic floor muscle training: Door open or not? Full text in Research Archive
• Mørkved, Siv; Stafne, Signe Nilssen & Johannessen, Hege Hølmo (2017). Chapter 20. Pelvic Floor Physiotherapy for Childbirth Trauma. In Doumouchtsis, Stergios (Eds.), Childbirth Trauma. Springer. ISSN 9781447167112. p. 271–301. Full text in Research Archive
• Johannessen, Hege Hølmo; Wibe, Arne; Stordahl, Arvid & Mørkved, Siv (2017). Prevalence and predictors of anal incontinence six years after delivery. Full text in Research Archive
• Johannessen, Hege Hølmo (2017). Door to door: Should women train their PF during pregnancy, if yes, when to start and what to do? Debate and panel discussion. Panel: Dr Alex Digesu, Dr Hege Hølmo Johannessen, Dr Maura Seleme, Dr Steven Swift. Full text in Research Archive
• Johannessen, Hege Hølmo & Digesu, Alex (2017). Prevention of pelvic floor disorders in peripartum women. Needed or luxury? Full text in Research Archive
• Johannessen, Hege Hølmo; Norderval, Stig; Stordahl, Arvid; Falk, Ragnhild Sørum & Wibe, Arne (2017). Interview-based or Self-administered St. Mark’s incontinence score, - is there a difference? Full text in Research Archive
• Johannessen, Hege Hølmo (2016). Does incontinence precede pregnancy and delivery, or do pregnancy and delivery result in incontinence symptoms? -and does it matter? 123(7), p. 1212–1212. doi: 10.1111/1471-0528.12643. Full text in Research Archive
• Johannessen, Hege Hølmo; Wibe, Arne; Stordahl, Arvid; Karoliussen, Clara; Trevor, julia Jønsson & Sandvik, Leiv [Show all 7 contributors for this article] (2016). Do pelvic floor muscle exercises reduce postpartum anal incontinence? A randomized controlled trial. Neurourology and Urodynamics. ISSN 0733-2467. 35(8), p. s381–382. Full text in Research Archive
• Johannessen, Hege Hølmo; Wibe, Arne; Stordahl, Arvid & Mørkved, Siv (2016). Prevalence and predictors of experiencing urinary or double incontinence as compared to being continent 1 year postpartum: A prospective cohort study. Full text in Research Archive
• Haukeland-Parker, Stacey Marie; Stafne, Signe Nilssen; Lerdal, Anners; Spruit, Martijn & Johannessen, Hege Hølmo (2016). Urinary incontinence amongst women with chronic obstructive pulmonary disease. Full text in Research Archive
• Johannessen, Hege Hølmo; Wibe, Arne; Sandvik, Leiv; Stordahl, Arvid & Mørkved, Siv (2015). Prediction of continence status one year after delivery. Full text in Research Archive
• Johannessen, Hege Hølmo; Wibe, Arne; Sandvik, Leiv; Stordahl, Arvid & Mørkved, Siv (2014). Changes and predictors of anal incontinence in late pregnancy and the first year postpartum. Neurourology and Urodynamics. ISSN 0733-2467. 33(6), p. 886–888. Full text in Research Archive
• Johannessen, Hege Hølmo; Wibe, Arne; Sandvik, Leiv; Stordahl, Arvid & Mørkved, Siv (2013). Anal incontinence in late pregnancy and one year after delivery. Prevalence and predictors of anal incontinence and impact of Quality of Life. Full text in Research Archive
• Johannessen, Hege Hølmo; Wibe, Arne; Sandvik, Leiv; Stordahl, Arvid & Mørkved, Siv (2013). Prevalence and predictors of anal incontinence in late pregnancy and one year after delivery. International Urogynecology Journal. ISSN 0937-3462. 24, p. s31–s32. Full text in Research Archive
• Johannessen, Hege Hølmo; Wibe, Arne; Stordahl, Arvid & Mørkved, Siv (2012). Prevalence of anal and urinary incontinence in first time mothers and impact on Health Related Quality of Life. Neurourology and Urodynamics. ISSN 0733-2467. 31(6), p. 1089–1091. Full text in Research Archive
• Johannessen, Hege Hølmo; Stordahl, Arvid; Wibe, Arne & Mørkved, Siv (2011). Anal and urinary incontinence in late pregnancy among first time mothers. Full text in Research Archive
• Johannessen, Hege Hølmo; Stordahl, Arvid; Engh, Elisabeth; Hjørnegaard, Anne-Gro & Morten, Jacobsen (2007). Reliability of EMG measurements of the sphincter ani muscles in patients with anal insufficiency compared to healthy individuals. Full text in Research Archive
• Morten, Jacobsen; Johannessen, Hege Hølmo; Hjørnegaard, Anne-Gro; Elisabeth, Engh & Stordahl, Arvid (2007). Short time response to presacral nerve stimulation in anal incontinence. Full text in Research Archive
• Schizas, Alexis; Hainsworth, Alison; Albequerque, Andreia; Haylen, Bernard T.; Johannessen, Hege Hølmo & Igualada-martinez, Paula [Show all 9 contributors for this article] (2022). AN INTERNATIONAL CONTINENCE SOCIETY (ICS) REPORT ON THE TERMINOLOGY FOR MALE ANORECTAL DYSFUNCTION – VERSION 15. International Continence Society. Full text in Research Archive
• Johannessen, Hege Hølmo (2014). Anal incontinence in primiparae: Prevalence, Predictors and Quality of Life. Norges teknisk-naturvitenskapelige universitet. ISSN 9788232603961. Full text in Research Archive Show summary

  Anal incontinence (AI) is a symptom-based diagnosis and involves involuntary loss of solid or loose stool, flatus or faecal urgency defined as the inability to defer defecation. The main aetiology is considered to be related to pregnancy and childbirth. AI is often viewed as a woman’s problem, with as many as one in five Norwegian women over the age of 30 experiencing symptoms of AI. Due to the socially debilitating consequences of AI, and that few health professionals routinely ask questions related to patients’ continence status, symptoms may be under-reported. Patients with symptomatic AI are reluctant to seek medical advice, and it is estimated that only one in five patients with AI seek medical help. The prevalence of AI increases with age and particularly after menopause. However, findings from other countries suggest that the onset of AI symptoms is often reported in relation to a woman’s first pregnancy or delivery. The prevalence of AI in pregnancy and postpartum in Norway was scarcely documented at the start of the project. The present study is a prospective cohort study conducted in the period May 2009-April 2011. A total of 1571 primiparae were included from the maternity wards at Ostfold Hospital Trust Fredrikstad and St. Olavs Hospital Trondheim. The participants answered questions on standardised questionnaires regarding the prevalence and frequency of AI and how symptoms of AI affected their health-related Quality of Life in late pregnancy and one year after delivery. Sociodemographic and deliveryrelated data were collected from the participants’ hospital records. The main aim of this study was to estimate the prevalence of AI among primiparous women, and to evaluate the impact of AI on health-related quality of life in late pregnancy and the first year after delivery. More specifically, the aims of the three separate papers were: Paper I: To evaluate the prevalence and predictors of specific AI symptoms, including urgency, in late pregnancy and one year after delivery. Paper II: To explore how experiencing different types of AI in late pregnancy affects health-related quality of life among primiparous women. Paper III: To explore the changes in continence status from late pregnancy and throughout the first year postpartum among healthy primiparae and investigate factors associated with persistent and new onset AI symptoms twelve months postpartum The results from the three papers were: Paper I: AI was reported by 37% in late pregnancy, compared to 25% one year after delivery. Urgency was the most frequently reported symptom at both time points. Being unemployed and younger than 22 years at first delivery increased the risk of AI in late pregnancy. Higher education on the other hand, reduced the risk. Experiencing AI in late pregnancy was the strongest predictor of AI one year after delivery. Women with obstetric anal sphincter injury were at increased risk of flatus or stool incontinence, whereas operative delivery was associated with increased risk of urgency. Paper II: Between 20 and 30% of the women experiencing AI in late pregnancy, reported this to affect their Quality of Life. The majority reported only a low impact on Quality of Life. Those experiencing urgency alone reported little or no impact on Quality of Life, whereas women experiencing more than one symptom reported moderate to severe impact on Quality of Life. Compared to urgency only, women experiencing flatus alone weekly or more or women reporting a combination all AI symptoms reported the highest impact in the QoL domain “Embarrassment”. Paper III: One in three of the 862 participants responding in late pregnancy, six and twelve months postpartum experienced AI in late pregnancy and one third of these experienced persistent symptoms six and twelve months after delivery. New onset AI was reported by 15% both at six and twelve months postpartum. AI at one year after delivery was associated with young age and AI in late pregnancy or at six months. Occiput posterior presentation was the only delivery related risk factor increasing the risk of postpartum AI. The results from the present study confirm previous findings that AI is relatively common in late pregnancy as well as one year after delivery. Experiencing symptoms of AI in late pregnancy is the strongest predictor of AI one year after delivery, and approximately half of women incontinent in pregnancy remained incontinent one year later. Women reporting more than one symptom of AI had a poorer Quality of Life compared with those experiencing only one symptom. Further, weekly or daily incontinence of flatus was the single symptom most strongly affecting Quality of Life. These results indicate that hormonal and mechanical changes occurring during pregnancy may have more impact on postpartum AI than vaginal delivery.

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