Anatomical and functional changes in the lower urinary tract during pregnancy

Abstract

Objective To assess the prevalence and the development of urinary incontinence in nulliparous pregnant women, both subjectively and objectively, and to investigate the relation of incontinence with the mobility of the urethro-vesical junction measured by perineal ultrasound. Design A prospective longitudinal study.Setting University Hospital and Martini Hospital Groningen, the Netherlands. Population A cohort of 117 nulliparous pregnant women and 27 nulliparous non-pregnant controls.Methods Urinary incontinence was measured by a questionnaire and by a 24-hour pad test. The position of the urethro-vesical junction and its mobility were measured by perineal ultrasound.Main outcome measure Prevalence of urinary incontinence; mobility of the urethro-vesical junction, indicated by the displacement/pressure coef®cient.Results Up to 35% of the women reported urinary incontinence in pregnancy, and 20% of the women had a positive pad test. The angle of the urethro-vesical junction angle at rest and the displacement/pressure coef®cient during coughing showed a signi®cant increasing trend during pregnancy, but no changes were seen during the Valsalva manoeuvre. No relationship was found between subjective and objective incontinence data and the position and mobility of the urethro-vesical junction.Conclusion The prevalence of incontinence in nulliparous women as found by the pad test was signi®cantly higher in pregnancy (20%) than in the non-pregnant control group (4%). Perineal ultrasound of the urethrovesical junction showed lowering of the pelvic¯oor occurring as early as 12-16 weeks of pregnancy. Serial measurements of the displacement/pressure coef®cient suggest that the dynamic characteristics of the connective tissues of the pelvic¯oor remain unaltered,whereas a signi®cant decrease in pelvic¯oor muscle contraction occurs. Since no relation was found between measurements of the urethro-vesical junction and incontinence, urinary incontinence in pregnancy is most likely explained by other factors.

Urinary symptoms and pelvic floor muscle function during the third trimester of pregnancy in nulliparous women

“…who had findings of 49%. However, most studies show a smaller prevalence 6,7,10,17 . Nocturnal enuresis was reported by 5.2% of pregnant women, a percentage that was similar to that described by Scarpa et al 5 .…”

Stress urinary incontinence in pregnant women: a review of prevalence, pathophysiology, and treatment

“…This damage reduces PFM strength and may lead to increased bladder-neck and urethral mobility [63, 64] and cause mobility of the urethrovesical junction [11]. Wijma et al [65] found increased bladder-neck mobility from early pregnancy onward to near term. Jundt et al [66] found that pregnant women with SUI had more a mobile bladder neck than continent pregnant women.…”

“…They put direct pressure on the bladder, which may lead to changing the bladder-neck position [66] and reducing bladder capacity, contributing to bladder pressure that exceeds urethral pressure [65, 83]. This results in urine leakage.…”

Reliability of pelvic floor measurements on three- and four-dimensional ultrasound during and after first pregnancy: implications for training

“…These studies have demonstrated moderate to almost perfect reliability for measuring levator hiatal dimensions and substantial reliability for levator–urethra gap (LUG) measurements, the latter being associated with levator avulsion. However, since hormonal influences in pregnancy lead to alterations in connective tissue and pelvic floor function, the quality of ultrasound images may differ from that in non‐pregnant women, which may affect the reliability of these measurements. In addition, there is insufficient knowledge about the amount of training and experience necessary for competence in obtaining these measurements using 3D/4D ultrasound; investigating the learning process could assist specialists who would like to perform them.…”