Persistent urinary incontinence and delivery mode history: a six‐year longitudinal study

Abstract

Objective To investigate the prevalence of persistent and long term postpartum urinary incontinence and associations with mode of first and subsequent delivery.Design Longitudinal study.Setting Maternity units in Aberdeen (Scotland), Birmingham (England) and Dunedin (New Zealand).Population Women (4214) who returned postal questionnaires three months and six years after the index birth.Methods Symptom data were obtained from both questionnaires and obstetric data from case-notes for the index birth and the second questionnaire for subsequent births. Logistic regression investigated the independent effects of mode of first delivery and delivery mode history.Main outcome measures Urinary incontinence-persistent (at three months and six years after index birth) and long term (at six years after index birth).Results The prevalence of persistent urinary incontinence was 24%. Delivering exclusively by caesarean section was associated with both less persistent (OR = 0.46, 95% CI 0.32-0.68) and long term urinary incontinence (OR = 0.50, 95% CI 0.40-0.63). Caesarean section birth in addition to vaginal delivery, however, was not associated with significantly less persistent incontinence (OR 0.93, 95% CI 0.67-1.29). There were no significant associations between persistent or long term urinary incontinence and forceps or vacuum extraction delivery. Other significantly associated factors were increasing number of births and older maternal age.Conclusions The risk of persistent and long term urinary incontinence is significantly lower following caesarean section deliveries but not if there is another vaginal birth. Even when delivering exclusively by caesarean section, the prevalence of persistent symptoms (14%) is still high.

Prevalence of urinary incontinence in reproductive women and its impact on quality of life

“…21 Multiple logistic regression of persistent UI showed that compared to single vaginal delivery, women who had multiple deliveries had higher incidence of UI. 22 Odds ratio is higher for increase in number of deliveries. Odds of UI was 1.36 (95% CI-1.06-1.74; P value-0.015) in women who had 2 deliveries, in those with 3 deliveries had OR of 1.85 (95% CI-1.42 -2.42; P value < 0.001), whereas in those with four or more deliveries had OR of 2.16 (95% CI-1.57-2.97; P value < 0.001).…”

Effect of Delivery and Episiotomy on the Emergence of Urinary Incontinence in Women: Review of Literature

“…A study in 4200 women conducted six years after delivery showed that those that had only vaginal delivery and those that had delivered both vaginally and by cesarean section had an approximately equal prevalence of urinary leakage (26% and 28%, respectively). However, the prevalence among those having delivered only by cesarean section was 14% 35 . A large retrospective population-based observational study 12 in a population of 15,300 women found the prevalence of urinary leakage of 10% in the nulliparous group and 16% in the cesarean section group, while in the group that had only vaginal deliveries the rate was 24%.…”

“…Th is research implies that cesarean delivery might not protect against urinary incontinence 12 . It appears that a woman must have all children delivered by cesarean section in order to achieve protection against long-term incontinence 35 . Urinary incontinence in pregnancy increases the risk of later urinary incontinence, both postpartum and later in life 17,38 , but nevertheless it is not a predictor of benefi t from giving birth by cesarean section to protect against urine leakage 17,39 .…”

A multicentre, randomised controlled trial of position during the late stages of labour in nulliparous women with an epidural: clinical effectiveness and an economic evaluation (BUMPES)

“…17 There may also be an increased risk of urinary incontinence, although this may be more closely associated with a longer second stage of labour; 18,19 however, women who have a caesarean section have a lower risk of symptoms. 20,21 Other bowel problems such as haemorrhoids 19,22,23 and constipation 24 are more common after IVD, as are perineal pain and dyspareunia. 24,25 Caesarean section has many adverse sequelae, but, with the exception of faecal incontinence, most of these symptoms are less likely to occur in association with this delivery mode.…”