Prevalence of urinary incontinence and pelvic floor muscle dysfunction in primiparae two years after cesarean section: cross-sectional study

Abstract

CONTEXT AND OBJECTIVE: There is uncertainty in the literature regarding the theory that obstetric events and pelvic floor injuries give rise to lower risk of subsequent urinary incontinence among women delivering via cesarean section than among women delivering vaginally. The objective of this study was to assess the two-year postpartum prevalence of urinary incontinence and pelvic floor muscle dysfunction and the factors responsible for them. DESIGN AND SETTING: Cross-sectional study, conducted in a public university. METHODS: 220 women who had undergone elective cesarean section or vaginal childbirth two years earlier were selected. Their urinary incontinence symptoms were investigated, and their pelvic floor muscle dysfunction was assessed using digital palpation and a perineometer. RESULTS:The two-year urinary incontinence prevalences following vaginal childbirth and cesarean section were 17% and 18.9%, respectively. The only risk factor for pelvic floor muscle dysfunction was weight gain during pregnancy. Body mass index less than 25 kg/m 2 and normal pelvic floor muscle function protected against urinary incontinence. Gestational urinary incontinence increased the risk of two-year postpartum urinary incontinence. CONCLUSION: Gestational urinary incontinence was a crucial precursor of postpartum urinary incontinence. Weight gain during pregnancy increased the subsequent risk of pelvic floor muscle dysfunction, and elective cesarean section did not prevent urinary incontinence. RESUMOCONTEXTO E OBJETIVO: É ainda controversa na literatura a teoria de que eventos obstétricos e traumas no assoalho pélvico representariam menor risco para mulheres submetidas ao parto cesárea do que para aquelas submetidas a parto vaginal, no tocante a subsequente incontinência urinária. O objetivo do estudo foi avaliar a prevalência de incontinência urinária e disfunção muscular do assoalho pélvico dois anos após o parto e os fatores responsáveis por elas. TIPO DE ESTUDO E LOCAL: Estudo transversal conduzido em universidade pública. MÉTODOS: Foram selecionadas 220 mulheres dois anos após parto cesáreo eletivo ou parto vaginal. Foram avaliados sintomas de incontinência urinária e disfunção muscular do assoalho pélvico por palpação digital e perineômetro. RESULTADOS: A prevalência de incontinência urinária dois anos após parto vaginal e cesárea foi de 17% e 18,9% respectivamente. O único fator de risco para disfunção muscular do assoalho pélvico foi o ganho de peso durante a gestação. Índice de massa corporal inferior a 25 kg/m 2 e disfunção muscular do assoalho pélvico normal foram fatores de proteção contra incontinência urinária. Incontinência urinária na gestação aumentou o risco de incontinência urinária dois anos pós-parto. CONCLUSÃO: Incontinência urinária gestacional foi um precursor crucial de incontinência urinária pós-parto. O ganho de peso durante a gestação aumentou o risco posterior de disfunção muscular do assoalho pélvico e o parto cesárea eletivo não foi uma ação de prevenção para a incontinência urinária.

Associated factors to urinary incontinence in women undergoing urodynamic testing

“…In our study, 21% of women reported UI during pregnancy. This is a lower proportion than that found in the literature which reveals that lifestyle may have had an influence and that protective measures against the appearance of UI may have been employed even before being pregnant (23)(24) . A relationship between UI in pregnancy and weight gain of pregnant women has been reported as a risk factor for pelvic floor muscle dysfunction (25) .…”

“…However, there is scientific evidence that indicates that well-conducted vaginal delivery is more beneficial to both mother and baby. The literature indicates equality in the prevalence of UI among women who had vaginal delivery and those with Cesarean section, reporting an even higher proportion of UI among women who only underwent Cesarean section (24)(25)(26)(27) . The frequency of UI in women who had vaginal delivery or Cesarean section in the present study was similar.…”

Pelvic floor muscle strength in primiparous women according to the delivery type: cross-sectional study

“…Although gravidic changes may contribute to UI after childbirth 21 , some authors present evidence that, when present in pregnancy, this condition becomes a risk factor for its occurrence also in postpartum 7 , 21 - 22 . …”

“…However, the authors concluded that eight to nine women having cesarean sections would be necessary to avoid one case of UI, using the amount needed to be treated 6 . On the other hand, in another study no significant difference was identified between the prevalence of UI two years after vaginal childbirth, compared to cesarean section 7 .…”

Effect of breathing technique of blowing on the extent of damage to the perineum at the moment of delivery: A randomized clinical trial

“…[1] One of the factors affecting perineal injuries during childbirth is the way the mother pushes in the second stage of labor. [2] There are two methods for handling the second stage of labor.…”