Long-term Impact of Mode of Delivery on Stress Urinary Incontinence and Urgency Urinary Incontinence: A Systematic Review and Meta-analysis

Abstract

ContextStress urinary incontinence (SUI) and urgency urinary incontinence (UUI) are associated with physical and psychological morbidity, and large societal costs. The long-term effects of delivery modes on each kind of incontinence remain uncertain.ObjectiveTo investigate the long-term impact of delivery mode on SUI and UUI.Evidence acquisitionWe searched Medline, Scopus, CINAHL, and relevant major conference abstracts up to October 31, 2014, including any observational study with adjusted analyses or any randomized trial addressing the association between delivery mode and SUI or UUI ≥1 yr after delivery. Two reviewers extracted data, including incidence/prevalence of SUI and UUI by delivery modes, and assessed risk of bias.Evidence synthesisPooled estimates from 15 eligible studies demonstrated an increased risk of SUI after vaginal delivery versus cesarean section (adjusted odds ratio [aOR]: 1.85; 95% confidence interval [CI], 1.56–2.19; I2 = 57%; risk difference: 8.2%). Metaregression demonstrated a larger effect of vaginal delivery among younger women (p = 0.005). Four studies suggested no difference in the risk of SUI between spontaneous vaginal and instrumental delivery (aOR: 1.11; 95% CI, 0.84–1.45; I2 = 50%). Eight studies suggested an elevated risk of UUI after vaginal delivery versus cesarean section (aOR: 1.30; 95% CI, 1.02–1.65; I2 = 37%; risk difference: 2.6%).ConclusionsCompared with cesarean section, vaginal delivery is associated with an almost twofold increase in the risk of long-term SUI, with an absolute increase of 8%, and an effect that is largest in younger women. There is also an increased risk of UUI, with an absolute increase of approximately 3%.Patient summaryIn this systematic review we looked for the long-term effects of childbirth on urinary leakage. We found that vaginal delivery is associated with an almost twofold increase in the risk of developing leakage with exertion, compared with cesarean section, with a smaller effect on leakage in association with urgency.

Impacto dos tipos de incontinência urinária na qualidade de vida de mulheres

“…Thus, studies evaluating UI risk factors point to DM and SAH (Systemic Arterial Hypertension) as important factors (10,(18)(19) . Regarding the type of UI, MUI was the most prevalent in some studies (10,16,(18)(19) . However, data from other studies were in disagreement, and found SUI was more prevalent (14,(20)(21) .…”

“…A large Norwegian survey of 27,936 women found that SUI was more prevalent among younger women (15) , corroborating the data presented here. Although the relationship between obstetric factors and development of incontinence is clear (1) , a limited number of authors associate them with types of UI (16)(17) . A meta-analysis associated vaginal delivery with a nearly double increase in SUI and approximately 3% increase in UUI risk (16) .…”

“…Although the relationship between obstetric factors and development of incontinence is clear (1) , a limited number of authors associate them with types of UI (16)(17) . A meta-analysis associated vaginal delivery with a nearly double increase in SUI and approximately 3% increase in UUI risk (16) . However, a study of 656 incontinent women showed a less significant association of UUI and MUI with vaginal delivery (17) .…”

The Effect of Perineal Lacerations on Pelvic Floor Function and Anatomy at 6 Months Postpartum in a Prospective Cohort of Nulliparous Women

“…A meta-analysis of mode of delivery demonstrated an increased likelihood of stress urinary incontinence for women who were at one year or more postpartum from a vaginal delivery compared to cesarean delivery (Odds ratio 1.85 ;95% CI 1.56-2.19). 1 . The risk of future pelvic organ prolapse is also increased for vaginal, compared to cesarean births.…”

Pelvic Floor Disorders 6 Months after Attempted Operative Vaginal Delivery According to the Fetal Head Station: A Prospective Cohort Study

“…Many studies have assessed pelvic floor symptoms, urinary incontinence (UI), anal incontinence (AI) and perineal pain during the postpartum period according to the mode of delivery (spontaneous vaginal delivery, OVD, caesarean), or complications of pregnancy or delivery [3–13]. Findings vary widely.…”