Can the delivery method influence lower urinary tract symptoms triggered by the first pregnancy?

Abstract

(2), persisting after delivery in 6% to 29% of women (3). Estimating the post-partum prevalence of urinary incontinence is complex because the prevalence may depend upon the number of previous births, type of delivery, and history of previous inVol. 38 (2): 267-276; March -April, 2012 Introduction and Objectives: The increase of the intensity of urinary symptoms in late pregnancy and postpartum has been well documented by several authors, but their causes remain uncertain, partly because of its probable multifactor origin. There are also controversies whether the etiology of lower urinary tract symptoms during pregnancy is the same as postpartum and whether the method of delivery could infl uence the risk of onset of urinary symptoms. This study aimed to evaluate the urinary symptoms triggered during pregnancy and its evolution in the late puerperium, correlating them with the delivery method. Materials and Methods: A longitudinal study was conducted, which included 75 primigravidae women, classifi ed according to method of delivery as: (VD) vaginal delivery with right mediolateral episiotomy (n = 28); (CS) elective caesarean section (n = 26); and (EC) emergency caesarean section (n = 21). Urinary symptoms were assessed in the last trimester of pregnancy and at 45 days (± 10) of puerperium with validated versions for Portuguese language of the following questionnaires: International Consultation on Incontinence Questionnaire -Urinary Incontinence Short Form (ICIQ-UI SF) and the International Consultation on Incontinence Questionnaire Overactive Bladder (ICIQ-OAB). Results: It was observed that frequency, urgency, nocturia and urge incontinence, triggered during pregnancy, decreased signifi cantly in the postpartum period, regardless of the delivery method (p = 0.0001). However, symptoms related to urinary loss due to stress persisted after vaginal delivery (p = 0.0001). Conclusions: Urgency, frequency and nocturia triggered during pregnancy tend to disappear in the late postpartum period, regardless of the delivery method, but the symptoms related to urinary loss due to stress tend to persist in late postpartum period after vaginal delivery.

Associated factors to urinary incontinence in women undergoing urodynamic testing

“…In the present study, the majority of the women had babies weighing more than 3,000g (1,25,30) . Many complications can be reduced or prevented with appropriate obstetric care, but in Brazil, and especially in the region of São José do Rio Preto, obstetric care is exceedingly interventionist, technocratic, medicalized and hospitalcentric, resulting in owning the dishonorable title of being the world champion of caesarean sections.…”

“…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) . A postpartum strategy for UI prevention is pelvic floor muscle training and postpartum weight loss (26) .…”

“…A postpartum strategy for UI prevention is pelvic floor muscle training and postpartum weight loss (26) . It is also known that certain symptoms such as frequency, nocturia and urge incontinence (common in pregnancy) decrease significantly and tend to disappear in the postpartum period (25) . Parity has been reported as a risk factor for UI (25)(26)(27) , which was also demonstrated in this study.…”

“…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.…”

Risk factors for postpartum urinary incontinence

“…Generally, episodes of urine leakage are infrequent and the amount of urine leakage is small (3)(4)(7)(8)(9)(10) . Maternal age greater than 35 years, UI during pregnancy, elevated body mass index (BMI), multiparity, and normal birth are considered risk factors for postpartum UI (4,7,(9)(10)(11)(12)(13)(14) . A 10-year cohort study developed with the goal of assessing the effect of the first normal birth on urinary symptoms showed that it was associated with an increase in SUI, in addition to UUI, regardless of maternal age or number of births (14) .…”