Obstetric risk factors for urinary incontinence and preventative pelvic floor exercises: Cohort study and nested randomized controlled trial

Abstract

We conducted a cohort study assessing risk factors for developing urinary incontinence following childbirth, and a pilot randomized controlled trial of a physiotherapist-led intervention to reduce incidence of incontinence. A total of 723 women were recruited to the cohort study, of which 234 entered the nested trial and were randomized to intensive training in pelvic floor exercises or standard information. At 6 months post-partum, 45% of women reported some incontinence problems. A pre-existing incontinence problem was the best predictor of future incontinence (odds ratio 4.49, 95% confidence interval (CI) 3.09-6.53). Chronic constipation (1.86, 1.03-3.34) and episiotomy in at least one delivery (1.96, 1.25-3.07) were also independent risk factors, while an epidural or spinal (0.62, 0.42-0.92) was protective. The intervention as designed did not help in preventing future incontinence (relative risk 1.28, 95% CI 0.98-1.67), but this may be due to the failure to persuade the women to return for the classes. Any intervention aimed at promoting postnatal pelvic floor exercises should be limited to women who have already been experiencing incontinence problems.

Factors related to lower urinary tract symptoms among a sample of employed women in Taipei

“…As reported by others, 8,9,26,31 the finding of this study confirmed that vaginal delivery is a significant predictor for UI. Also, in agreement with the findings of previous work that obstetric and/or gynecological surgery are significantly associated with UI, 8,28,31 teachers who had obstetric and/or gynecological surgery were more than twice as likely to experience UI as those without in this study.…”

“…1,5,13,25,26 Procedures Institutional review board (IRB) approval was obtained from the University of North Carolina at Chapel Hill IRB for this study and the procedures are more fully described in a recent publication. 18 Twenty six elementary schools were selected from the 152 elementary schools in Taipei by using the systematic sampling method with pps and a second stage simple random sampling of 20 female teachers in each school was conducted.…”

Risk factors for postpartum urinary incontinence

“…This is probably due to the greater time and pressure of the pregnant uterus on pelvic suspensory (ligaments) and supporting (endopelvic fascia and muscles) structures, as suggested by other authors (25) . A previous study also demonstrated an association between constipation with postpartum UI (16) . This association is justified because constipation is related to repeated pelvic pressure and tension, occurring more often than birth (26) .…”

“…One study that assessed whether rectal distension influenced the results of a urodynamic test showed that rectal distension can cause detrusor hyperactivity in some women; however, the data were inconclusive and further research is needed (27) . A cohort study conducted six months postpartum showed that chronic constipation was a risk factor for postpartum UI (OR 1.86, CI 95% 1.03 -3.34) (16) . Another cross-sectional study conducted with non-puerperal women indicated that constipation was just as significant as obstetric trauma in causing pelvic floor problems (OR 2.35, CI 95% 1.27 -4.34) (26) .…”

“…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) . Other factors such as: color or race, episiotomy, perineal tears, newborn' s head circumference, newborn' s weight, gestational age at birth, smoking, and constipation require further studies in order to prove their association with postpartum UI (7,12,(14)(15)(16) . Urinary incontinence results in decreased quality of life during pregnancy (1) and the puerperal period (17) , pointing to the importance of research on factors that can result in this condition.…”