Risk of Urinary Incontinence After Childbirth

Altman, Daniel; Ekström, Åsa; Gustafsson, Catharina; López, Annika; Falconer, Christian; Zetterström, Jan

doi:10.1097/01.aog.0000233172.96153.ad

Cited by 78 publications

(21 citation statements)

References 18 publications

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“…With the loss of some muscle strength or innervation to the urethral sphincter due to aging or other injuries, the symptoms of SUI become apparent, usually many years after the first delivery. A clinical study showed an increase in the prevalence of moderate to severe SUI after vaginal delivery from 2% to 12% 10 yr after delivery [25]. …”

Section: Discussionmentioning

confidence: 99%

Recovery of Continence Function following Simulated Birth Trauma Involves Repair of Muscle and Nerves in the Urethra in the Female Mouse

Lin

Liu

et al. 2010

European Urology

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Background The natural history and the mechanisms behind the alteration of vaginal distension (VD) in a mouse model are not clear. Objective We examined the temporal sequelae of VD and pudendal nerve transection (PNT) on leak-point pressure (LPP) and the muscular and nerve components of the urethra in mice. Design, setting, and participants Seventy-two virgin female C57BL/6 mice were equally distributed into three groups. The VD group underwent VD for 1 h. The PNT group received bilateral PNT. A control group underwent sham VD. Intervention Each group was divided into four subgroups of six mice for measurement of LPP at 0, 4, 10, and 20 d after VD or PNT. Measurements LPP was measured. Morphology and neurofilament-immunoreactive nerve of the urethra were assessed. Results and limitations LPP was decreased at 0, 4, and 10 d but not at 20 d after VD. Decreased LPP persisted to 20 d in the PNT group. The external urethral striated muscle appeared wavy and disrupted in three mice at 0 d, in two mice at 4 d, in one mouse at 10 d, and in one mouse in 20 d after VD. The density of neurofilament-immunoreactive nerve in the urethra was reduced at 4 and 10 d after VD, but not at 20 d, and at 4, 10, and 20 d after PNT compared with the corresponding values of the sham VD group. The limitation of this animal model is that the pelvic floor structure of the mouse is different from that of female humans. Therefore, results of this study should be carefully applied to human subjects. Conclusions VD causes reversible stress urinary incontinence in female mice. Recovery of continence function following VD is associated with repair of the external urethral sphincter and reinnervation of the urethra. This mouse model will be useful for mechanistic investigation and targeting of therapeutic intervention by taking advantage of genetic manipulation.

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Section: Discussionmentioning

confidence: 99%

Recovery of Continence Function following Simulated Birth Trauma Involves Repair of Muscle and Nerves in the Urethra in the Female Mouse

Lin

Liu

et al. 2010

European Urology

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“…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) .…”

Section: Introductionmentioning

confidence: 99%

“…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) . 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) .…”

Section: Introductionmentioning

confidence: 99%

“…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.…”

Section: Introductionmentioning

confidence: 99%

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Risk factors for postpartum urinary incontinence

Leroy

Lúcio

Lopes

2016

Rev. esc. enferm. USP

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OBJECTIVE: To investigate the risk factors for postpartum urinary incontinence (UI) and its characteristics. METHOD: This was a case-control study with 344 puerperal women (77 cases and 267 controls) with up to 90 days postpartum. In a single session, participants were given a questionnaire with sociodemographic and clinical data and two others that assessed urine leakage, leakage situations, and type of UI. RESULTS: Stress UI was present in 45.5% of the women, incidents of urine leakage several times a day in 44.2%, of which 71.4% were in small amounts and 57.1% when coughing or sneezing. In 70.1% of cases, UI began during pregnancy and remained through the postpartum period. After running a binary logistic regression model, the following factors remained in the final model: UI during pregnancy (OR 12.82, CI 95% 6.94 - 23.81, p<0.0001), multiparity (OR 2.26, CI 95% 1.22 - 4.19, p=0.009), gestational age at birth greater or equal to 37 weeks (OR 2.52, CI 95% 1.16 - 5.46, p=0.02) and constipation (OR 1.94, CI 95% 1.05 - 5.46, p=0.035). CONCLUSION: Most often, UI first appeared during pregnancy and remained through the postpartum period. Urinary incontinence during pregnancy, multiparity, gestational age at birth greater or equal to 37 weeks, and constipation were presented as risk factors. In the studied group, stress UI was more frequent.

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“…Altman et al (2006) conducted a prospective observational cohort study over 10 years and also found that the risk of UI increased significantly after a first vaginal birth. One team (Groutz et al, 2004) concluded that cesarean without labor confers more of a benefit to the pelvic floor than labored cesarean, and that operative vaginal delivery causes more sequelae than spontaneous vaginal birth.…”

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confidence: 99%

A Review of Issues Surrounding Medically Elective Cesarean Delivery

Miesnik

Reale

2007

Journal of Obstetric, Gynecologic & Neonatal Nursing

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The rate of cesarean delivery has increased dra matically over the past decade. Medically elective cesareans are a major factor contributing to this rise. This article discusses the most recent evidence on the perinatal risks of cesarean delivery versus vaginal birth, the economic impact of elective cesarean delivery, and ethical principles related to cesareans performed without medical indication. Physicians ' rationales and responses to the issues are reviewed and the recommendations and guidelines of professional organizations are summarized. Available evidence does not lend support to a current shift in clinical practice. Research is needed to adequately compare outcomes of planned cesarean delivery and planned vaginal birth. Until evidence supports medically elective cesarean as a birth option that optimizes outcomes for low-risk mothers and their infants, obstetric care providers should continue to support evidenced-based decision making that includes advocacy for vaginal delivery as the optimal mode of birth. JOGNN , 36, 605-615;

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Risk of Urinary Incontinence After Childbirth

Abstract: II-2.

Cited by 78 publications

References 18 publications

Recovery of Continence Function following Simulated Birth Trauma Involves Repair of Muscle and Nerves in the Urethra in the Female Mouse

Recovery of Continence Function following Simulated Birth Trauma Involves Repair of Muscle and Nerves in the Urethra in the Female Mouse

Risk factors for postpartum urinary incontinence

A Review of Issues Surrounding Medically Elective Cesarean Delivery

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