The prevalence of urinary incontinence 20 years after childbirth: a national cohort study in singleton primiparae after vaginal or caesarean delivery

Abstract

Objective To investigate the prevalence and risk factors for urinary incontinence (UI) 20 years after one vaginal delivery or one caesarean section.Design Registry-based national cohort study.Setting Women who returned postal questionnaires (response rate 65.2%) in 2008.Population Singleton primiparae who delivered in the period [1985][1986][1987][1988] with no further births (n = 5236).Methods The Swedish Pregnancy, Obesity and Pelvic Floor (SWEPOP) study linked Medical Birth Register (MBR) data to a questionnaire about UI.Main outcome measures Prevalence of UI and UI for more than 10 years (UI > 10 years) were assessed 20 years after childbirth.Results The prevalence of UI (40.3 versus 28.8%; OR 1.67; 95% CI 1.45-1.92) and UI > 10 years (10.1 versus 3.9%; OR 2.75; 95% CI 2.02-3.75) was higher in women after vaginal delivery than after caesarean section. There was no difference in the prevalence of UI or UI > 10 years after an acute caesarean section or an elective caesarean section. We found an 8% increased risk of UI per current body mass index (BMI) unit, and age at delivery increased the UI risk by 3% annually.Conclusions Two decades after one birth, vaginal delivery was associated with a 67% increased risk of UI, and UI > 10 years increased by 275% compared with caesarean section. Our data indicate that it is necessary to perform eight or nine caesarean sections to avoid one case of UI. Weight control is an important prophylactic measure to reduce UI.

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

“…Gyhagen et al compared the prevalence of UI between women who delivered vaginally and by cesarean section. 20 UI was 67% higher after a vaginal delivery (40.3%) compared to women who had undergone caesarean section (28.8%), (OR 1.67; 95% CI 1.45-1.92). Follow up of women 10 years after delivery, showed that prevalence was 10.1% after vaginal delivery compared with 3.9% after caesarean section (odds ratio [OR] 2.75; 95% CI 2.02-3.75).…”

Pelvic pain, pelvic organ prolapse, urinary and colorectal distress incidence and relationship to quality of life and birth mode

“…Movahedi et al, found a 1% higher occurrence of UI in caesarean section versus vaginal delivery [22]. Another study concluded the protective effects of CS upon incontinence are complex, yet there seems to be a strong effect on the prevention of pelvic organ prolapse and elective caesarean section [23].…”

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

“…According to Pregazzi et al 66 , detailed classifi cation of perineal ruptures immediately after delivery is not proven to be a good predictor of the occurrence of pelvic relaxation and stress urinary incontinence. Th e risk of developing urinary incontinence was found to be by 67%-71% higher after vaginal delivery as compared to cesarean section in a population-based cohort of singleton primiparae 67 . Fritel et al state that routine mediolateral episiotomy in a population of primiparae does not protect against the appearance of urinary incontinence in 4-year period after vaginal delivery, while the risk of anal incontinence is increased 68 .…”