Mode of delivery and severe stress incontinence. A cross‐sectional study among 2625 perimenopausal women

Abstract

Objective To estimate the prevalence of severe stress urinary incontinence (SUI) among perimenopausal women and to examine potential obstetric risk factors. Design Mail survey of female volunteers for epidemiological research.Setting Postal questionnaire on SUI.Population Three thousand one hundred and fourteen women aged 49 -61 years who comprised the GAZEL cohort. Methods Logistic regression using data from the entire cohort to estimate the impact of risk factors. A second logistic regression using data from women who had given birth included obstetric history. Main outcome measure Prevalence of severe SUI defined by the response 'often' or 'all the time' to the question 'Does urine leak when you are physically active, cough or sneeze?' Results Two thousand six hundred and twenty-five women (85%) completed and returned the questionnaireThe frequency of SUI reported in the preceding four weeks was as follows: 'never' 32%, 'occasionally' 28%, 'sometimes' 26%, 'often' 10% and 'all the time' 5%. Prevalence of severe SUI was lowest among nulliparous women (7%), but it was similar among parous women regardless of birth number (14 -17%). The prevalence of severe SUI was not associated with mode of delivery (14% for women delivered by caesarean only vs 16% for vaginal births). Significant risk factors for severe SUI were high body mass index (BMI >30), diabetes mellitus, previous incontinence surgery, parity and first delivery under the age of 22 years. Conclusion Previous pregnancy itself is a risk factor for severe SUI among women who reach the age of 50.In this age group the impact of the mode of delivery (spontaneous, forceps or caesarean) on severe SUI is slight.

Incontinência urinária de esforço em mulheres pertencentes ao Programa de Saúde da Família de Dourados (MS)

“…20 A study that included 182 Jordanian women between 50 and 65 years showed that body mass index (BMI) had no significant correlation with SUI. 21 Fritel et al analyzed questionnaires answered by 2,625 women between 49 and 61 years and found increased prevalence of SUI associated with parity, but did not find a correlation with vaginal delivery, 22 and this finding does not agree the finding by other authors describing vaginal delivery as a leading cause of neuromuscular impairment of pelvic floor and UI. 23 Donforth et al found an association between type 2 diabetes mellitus and smoking with UI.…”

Systematic review and economic modelling of the effectiveness and cost-effectiveness of non-surgical treatments for women with stress urinary incontinence

“…29 A history of gynaecological surgery for prolapse increased the risk of developing stress leakage over twofold, and hysterectomy and other gynaecological procedures also doubled the risk. 30,31 …”

The French GAZEL Cohort Study: 20 years of epidemiologic research

“…This work made it possible to show that urinary incontinence and pelvic organ prolapse have a significant impact on women's quality of life, such that one can talk of a urinary or pelvic handicap (Saadoun et al, 2006;Fritel et al, 2009). Contrary to generally accepted ideas, stress urinary incontinence, anal incontinence, and prolapse symptoms do not appear to be associated with women's obstetric history or hormonal status (Fritel et al, 2005(Fritel et al, , 2007. …”