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Urinary incontinence: Prevalence and risk factors at 16 weeks of gestation
Abstract
To evaluate the prevalence of urinary incontinence at 16 weeks of gestation and to identify possible maternal and obstetric risk factors.
Cross-sectional study and cohort study.
Department of Obstetrics and Gynaecology, Aarhus University Hospital, Denmark.
Cross-sectional study: 7795 women attending antenatal care. Cohort study: a sub-group of 1781 pregnant women with one previous delivery at our department.
Prevalence and maternal risk factors: the prevalence of urinary incontinence within the preceding year was 8.9% among women at 16 weeks of gestation (nulliparae, 3.9%, para 1, 13.8%, para 2+, 16.2%). Stress or mixed incontinence occurred at least weekly in 3% of all the women. After adjusting for age, parity, body mass index, smoking, previous abortions, and previous lower abdominal or urological surgery in a logistic regression model, primiparous women who had delivered vaginally had higher risk of stress or mixed urinary incontinence than nulliparous women (OR 5.7; 95% CI 3.9-8.3). Subsequent vaginal deliveries did not increase the risk significantly. Young age, body mass index > 30, and smoking were possible risk factors for developing urinary incontinence. Obstetric factors: weight of the newborn > 4000 g (OR 1.9; 95% CI 1.0-3.6) increased the risk of urinary incontinence; mediolateral episiotomy in combination with birthweight > 4000 g also increased the risk (OR 3.5; 95% CI 1.2-10.2); a number of other intrapartum factors did not increase the risk of urinary incontinence.
The first vaginal delivery was a major risk factor for developing urinary incontinence; subsequent vaginal deliveries did not increase the risk significantly. Birthweight > 4000 g increased the risk; episiotomy in combination with birthweight > 4000 g also increased the risk.
... Hojberg et al. [13] realizaram uma pesquisa referente à IU com 7795 gestantes. Destas, 4136 eram primigestas, das quais 3-9% relataram IU. ...
... Hojberg et al. [13] não encontraram aumento do risco de desenvolvimento de incontinência urinária com o aumento da No presente estudo, um maior número de gestantes referiu sinais e sintomas relacionados à incontinência urinária aos esforços, no entanto apenas uma apresentou sinais e sintomas relacionados à incontinência por instabilidade do detrusor, e duas relacionados a incontinência urinária mista. Apenas uma gestante referiu enurese noturna, que é definida como perda urinária durante o sono [23]. ...
... Hojberg et al. [13] concluíram após a aplicação de um questionário para verificação da prevalência IU em gestantes que, das 163 primigestas com incontinência urinária, 76 (46,7%) apresentavam IU aos esforços; 26 (16%) apresentavam incontinência por instabilidade do detrusor; 38 (23,3%) incontinência mista. Em relação à enurese noturna, em um total de 130 gestantes primigestas, o sintoma foi diagnosticado em 4 (3,1%) das gestantes entrevistadas em um estudo realizado por Scarpa et al. [5]. ...
Este estudo teve como objetivo verificar a presença de sinais e sintomas de disfunção do trato urinário inferior em gestantes. Trata-se de uma pesquisa de campo, de corte transversal, realizada em Unidades Básicas de Saúde no interior do Estado de São Paulo. A amostra foi composta por primigestas, que realizavam acompanhamento pré-natal em Unidades Básicas de Saúde. Foi aplicado um questionário com questões sobre o funcionamento do trato urinário inferior. A coleta ocorreu durante junho e julho de 2008. Foram avaliadas 18 gestantes e 100% apresentava algum sinal ou sintoma de disfunção do trato urinário. Nove (50%) relataram perder urina em alguma situação, das quais 6 (66,7%) apresentaram incontinência urinária aos esforços. Em 5 (55,5%) gestantes do estudo, a incontinência urinária teve início no 2º trimestre de gestação. Conclui-se que todas as gestantes avaliadas apresentaram sinais e sintomas de disfunção do trato urinário inferior a partir do segundo trimestre de gestação, das quais metade apresentava perda involuntária de urina, principalmente, aos esforços.Palavras-chave: incontinência urinária, gravidez, Fisioterapia.
... Hormonal changes during pregnancy and the mechanical pressure eff ects with the peak in the third trimester and at term are the factors that aff ect the pelvic fl oor structures 18 . First pregnancy and delivery are believed to carry a particularly high risk of developing stress incontinence 19,20 , although the symptoms may resolve during puerperium 19 . ...
... Degenerative changes in the autonomic nervous system of the lower urinary tract or mechanical pressure eff ect of the gravid uterus may be contributing factors 22 (Fig. 1). Although the prevalence of stress incontinence is higher during pregnancy than after delivery, it is generally believed that delivery carries a higher risk of initiating long-term symptoms than pregnancy itself 19,20 . In one longitudinal cohort study, the risk of stress incontinence 5 years after the fi rst delivery was, however, not signifi cantly diff erent in women with the onset of symptoms during pregnancy as compared to women with the onset of symptoms during puerperium 23 . ...
... Some fi ndings suggest that fi rst pregnancy and delivery in particular predispose development of stress incontinence, which is in accordance with a study in a large group of young multiparous women 20 . Th ere are reports supporting a theory that pelvic fl oor innervation is likely to be injured predominantly after the fi rst delivery and subsequent deliveries could possibly aggravate the already existing injury 29 . ...
Episiotomy is obstetric procedure during which the incision extends the vestibule of the vagina during the second stage of labor. Episiotomy was extensively spread with gradual increase of rates in the first half of the 20th century and was performed mediolaterally in all nulliparous women with the idea to protect fetal head from trauma and pelvic floor from injuries. However, reports claiming that episiotomy had no such benefits were published. It was shown that routine mediolateral episiotomy did not protect against the appearance of urinary incontinence after vaginal delivery, while the risk of anal incontinence could be increased. The role of episiotomy in development of pelvic floor dysfunction remains quite unclear. Due to the mentioned reason, restricted episiotomy approach should be accepted. The origin of stress incontinence during pregnancy is controversial and not definitely scientifically proven. Pregnancy per se and older age at first delivery may have impact on the onset of pelvic floor dysfunction. Urinary incontinence in pregnancy increases the risk of later urinary incontinence, both postpartum and later in life. Vaginal delivery is just one of the potential risk factors for development of urinary incontinence. Mechanical pressure by fetus on the pelvic floor structures, limited denervation of the pelvic floor and soft tissue damage during delivery are some of explanations for the onset of stress urinary incontinence. On the other hand, cesarean delivery might not be protective against emergence of urinary incontinence. Further research in this field is needed.
... Another factor affecting the development of UI is the childbirth with a birth weight over 4 kg. Its probable consequence is the damage to the pudendal nerve, connective tissue and pelvic floor muscles (Højberg et al. 1999). In the present study, it was determined that history of a big baby was not a risk factor for UI. ...
... Several studies showed that the childbearing with a birth weight over 4 kg did not cause the development of UI (Connolly et al. 2007;Viktrup et al. 1992). On the other hand, in some studies, it was found that childbearing with a birth weight over 4 kg affected UI (Højberg et al. 1999;Oliveira et al. 2010). In the present study, it was found that episiotomy did not affect the development of UI. ...
... The present study and other studies could not reveal any correlation between UI and smoking habits (Erata et al. 2002;Højberg et al. 1999). Sampselle et al. (2002) conducted a case-control study on 606 women and found that the risk of the urinary incontinence among smoking women was 2.5 times higher. ...
Background
The objective of this study is to determine the incidence and the risk factors of the urinary incontinence in women visiting the Health Family Center. Methods430 women, who visited three Family Health Centers in the city center of Erzurum for any reason between 25 November and 20 January 2016, were included in this study without any sampling. The data were collected by using the face-to-face interview method. Percentage distribution, Chi square test, and logistic regression analysis were used in order to analyze the data. ResultsIt was determined that 37.2 % of these women had urinary incontinence, but only 29.3 % of them visited a physician because of this complaint. Among a total of 160 women with urinary incontinence findings, stress type incontinence was observed at the highest rate (33.7 %), which was followed by mixed type (31.8 %), urge type (20.6 %) and other types (overflow, continuous urinary incontinence) (13.7 %). It was found that urinary incontinence had a significant correlation with the number of children, genital prolapse, duration of delivery longer than 24 h, diabetes and urogenital infection, but not with the age at the first and last childbirth, presence of the episiotomy, birth weight over 4 kg, and smoking. Conclusions
It was determined that one-third of the women had urinary incontinence and certain medical and obstetric conditions were affecting the development of urinary incontinence. It is thought that it is important for the healthcare personnel to take the progression of the urinary incontinence under control by preventing the risk factors and to encourage the patients to seek treatment with the help of the proper information indicating that urinary incontinence is a treatable and preventable condition.
... The aetiology is multifactorial, although many risk factors have been identifi ed. Pregnancy and vaginal delivery are regarded as main risk factors in the development of UI [1][2][3][4][5][6] . However, there is some evidence not confi rming this presumption [7] . ...
... According to epidemiological studies [4,6,10,[13][14][15][16][17][18][19][20][21][22][23], UI during pregnancy occurs in 23-70% of the pregnant women. Some studies also documented risk factors -e.g., race, age, body mass index (BMI), and smoking. ...
... Our baseline (before pregnancy) prevalence of UI was almost 17%. According to other studies [4,5,10,14,17] , the prevalence of UI before pregnancy is usually reported as being 3-8%, i.e., our prevalence rate is higher than previously published. This may be due to our categorizing of the answers [28,29] -all women who fi lled in occasional leakage of urine, i.e., 'sometimes', were categorized as giving a 'positive answer' to this question. ...
... Furthermore, there is a significantly higher prevalence of SUI in pregnant women than in non-pregnant women [43,[46][47][48]. ...
... In contrast, few studies show the association between women with younger age and SUI. Hojberg et al. [46] reported that younger pregnant women aged between 15 to 24 years had a significantly higher risk for SUI than those aged between 25 to 29 years (OR=1.5; 95% CI 1.0-2.4). ...
... Furthermore, multiparous women are associated with greater risk for SUI than primiparae [46,91]. ...
Midwives are a key profession in the care of women during the childbearing process, and research results indicate that they can have a major effect upon their wellbeing and health as well as upon their attitude to future births and to their new born child. Women's need for caring in the childbearing process and the great importance of the caring midwife has been established by listening, through research, to women who have given birth. The detrimental effects of uncaring has also been demonstrated in the same way. What is caring then? What is uncaring? How can we recognize and avoid uncaring? More importantly, how can we teach caring and how can we help midwifery students to avoid being perceived as uncaring? Finally, how should midwifery education be organized in order to educate caring midwives? These are the basic questions we will try to answer in this discussion paper. We conclude that during revision of midwifery education programmes the focus should always be on how all the different aspects of the complicated project of educating a "good midwife" be included in the curriculum and that the importance of caring will not be left out.
... Dessa maneira, os sintomas urinários que afetam negativamente a vida de muitas mulheres têm sua prevalência estimada com grande variabilidade 3,4 , gerando problema de Saúde Pública. Embora pareça ser mais grave o quadro clínico e de pior prognóstico com o avanço da idade, não se exclui a presença de sintomas urinários em mulheres adultas jovens. ...
... A literatura mostra que sintomas urinários são comuns entre as mulheres e sua prevalência é alta e estimada com grande variabilidade (25 a 69% segundo a faixa etária, a população, o tipo de incontinência e o tipo de estudo). Não se exclui a presença de sintomas urinários em mulheres jovens, embora pareça ser mais grave o quadro clínico e de pior prognóstico com o avanço da idade [3][4][5][15][16][17][18][19][20][21][22][23] . Por outro lado, há estudos que não encontraram relação entre o risco de IU e a idade, apesar da sua alta prevalência também considerada 6,24 . ...
... Acredita-se que a principal etiologia da IU é um ou mais partos vaginais, com aumento do risco com a multiparidade e que outros fatores intraparto, como uso de fórceps e extração a vácuo, não estariam associados ao problema 4,10,26 . Uma possível explicação para o fato é que distensões ou rupturas imperceptíveis dos músculos, ligamentos e nervos, responsáveis pelo controle do esvaziamento da bexiga, aconteceriam durante o parto vaginal 27 . ...
CONTEXTUALIZAÇÃO: A incontinência urinária é doença com alta prevalência na população feminina e possui destacadas repercussões físicas, mentais e sociais. OBJETIVO: Investigar a prevalência de sintomas urinários característicos de incontinência urinária associado aos fatores obstétricos. MÉTODOS: Estudo analítico transversal em que foram investigadas 194 mulheres adultas, funcionárias da Universidade do Vale do Paraíba, que responderam questões do King's Health Questionnaire. Os sintomas urinários foram relacionados à história obstétrica e analisados pelo teste t de Student não-pareado e pelo teste exato de Fisher. RESULTADOS: A prevalência de sintomas urinários foi de 54,3%, sendo maior para incontinência urinária por esforço (55,7%), seguida por nictúria (27,8%), urgência (24,1%), polaciúria (16,7%) e enurese noturna (10,2%). Mulheres que engravidaram pelo menos uma vez tiveram 1,75 vezes mais chance de desenvolver os sintomas comparadas as nulíparas, sendo significativo para duas gestações ou mais (p=0,009). Dois partos ou mais aumentaram o risco em 1,57 vezes, independente da via (p=0,019). CONCLUSÕES: A prevalência de sintomas urinários foi alta e estes estão associados a fatores obstétricos, mostrando-se proporcionalmente maior de acordo com o número de gestações e partos.
... Dessa maneira, os sintomas urinários que afetam negativamente a vida de muitas mulheres têm sua prevalência estimada com grande variabilidade 3,4 , gerando problema de Saúde Pública. Embora pareça ser mais grave o quadro clínico e de pior prognóstico com o avanço da idade, não se exclui a presença de sintomas urinários em mulheres adultas jovens. ...
... A literatura mostra que sintomas urinários são comuns entre as mulheres e sua prevalência é alta e estimada com grande variabilidade (25 a 69% segundo a faixa etária, a população, o tipo de incontinência e o tipo de estudo). Não se exclui a presença de sintomas urinários em mulheres jovens, embora pareça ser mais grave o quadro clínico e de pior prognóstico com o avanço da idade [3][4][5][15][16][17][18][19][20][21][22][23] . Por outro lado, há estudos que não encontraram relação entre o risco de IU e a idade, apesar da sua alta prevalência também considerada 6,24 . ...
... Acredita-se que a principal etiologia da IU é um ou mais partos vaginais, com aumento do risco com a multiparidade e que outros fatores intraparto, como uso de fórceps e extração a vácuo, não estariam associados ao problema 4,10,26 . Uma possível explicação para o fato é que distensões ou rupturas imperceptíveis dos músculos, ligamentos e nervos, responsáveis pelo controle do esvaziamento da bexiga, aconteceriam durante o parto vaginal 27 . ...
BACKGROUND: Urinary incontinence is a disease with high prevalence among the female population and it has important physical, mental and social repercussions.OBJECTIVE: To investigate the prevalence of urinary incontinence symptoms and the relationship of these symptoms with obstetric factors.METHODS: This was an analytical cross-sectional study in which 194 adult women employed at the Universidade do Vale do Paraíba were investigated. They answered questions from the King's Health Questionnaire. Urinary symptoms were linked to the obstetric history and analyzed by unpaired t test and by the Fisher exact test.RESULTS: The prevalence of urinary symptoms was 54.3%. Stress urinary incontinence was the most frequent symptom (55.7%), followed by nocturia (27.8%), urgency (24.1%), pollakiuria (16.7%) and nocturnal enuresis (10.2%). The women who had been pregnant at least once were 1.75 times more likely to develop these symptoms than nulliparae, and the difference was significant when compared with women who had two or more pregnancies (p=0.009). Two or more deliveries increase the risk 1.57 times, regardless of the method of delivery (p=0.019).CONCLUSIONS: The prevalence of urinary symptoms was high. They were associated with obstetric factors and became proportionally greater with increasing numbers of pregnancies and deliveries.
... Hojberg ve ark gebelik öncesi VKİ >30-35kg/m 2 olan kadınlarda (OR = 1.7; 95% CI 0.9-3.2) normal VKİ'ne sahip kadınlara (OR = 2.5; 95% CI 1.0-6.0) göre SÜİ gelişmesi bakımından önemli derecede daha yüksek riske sahip olduğunu bildirmişlerdir (19). Arrue ve ark gebelikte aşırı kilo alımının doğum sonrası SÜİ gelişiminde riski arttırdığını bildirirken Scarpa ve ark, Chiarelli ve ark. ...
... 95% CI 1.1-1.9) (19). Bununla birlikte sigara içilmesi SÜİ'dan çok urge inkontinans ile ilişkili olduğu da bildirilmektedir (27). ...
Gebelik, stres üriner inkontinans gelişimindeki en önemli risk faktörüdür. Stres üriner inkontinans, gebe kadınlarda en sık görülen üriner inkontinans tipidir ve yaşam kalitesi üzerine olumsuz etkileri bulunmaktadır. Bu çalışma, primigravid gebelerde, stres üriner inkontinansın prevalansve risk faktörlerini incelemek amacıyla planlanmıştır. Bu anket çalışması, Kasım 2019–Haziran 2020tarihleri arasında, Aksaray Üniversitesi Tıp Fakültesi Aksaray Eğitim ve Araştırma Hastanesi Kadın Hastalıkları ve Doğum Polikliniği ve Üroloji Polikliniği’ne başvuran primigravid gebeler üzerinde yapıldı. Çalışmanın etik kurul onayı, Aksaray Üniversitesi Tıp Fakültesi Etik Kurulu’ndan alındı. Çalışmaya katılan tüm katılımcılardan yazılı onam alındı.Çalışmaya512primigravid gebe katılımcı dahil edildi. Katılımcıların demografik özellikleri, inkontinans varlığı ve şekli kaydedildi. Bu çalışmada, stres üriner inkontinans prevalansı %20.1 olarak bulundu. Stres üriner inkontinansı olan grupta, vücut kitle indeksi ve sigara içme öyküsü, stres üriner inkontinans olmayan gruba göre daha yüksekti. Gebelikte kilo alımı ile stres üriner inkontinans arasında ters bir ilişki vardı. Gebelik öncesi vücut kitle indeksi yüksekliği ve sigara içme, stres üriner inkontinans gelişiminde önemli ve modifiye edilebilir risk faktörlerindendir. Antenatal dönemde stres üriner inkontinans gelişimini önleyici stratejilerin uygulanması ve üriner inkontinans ve risk faktörlerinin azaltılması hakkında farkındalığın artırılması önemlidir.
... Martinez Fanco et al. 36 did not find an association between parity and UI in the first trimester (χ 2 test p = 0.43) but included only 58 women. Hojberg et al. 28 examined the impact of parity on different types of UI at 16 weeks' gestation. Women who already had one (OR: 5.0 [3.8-6.5]; ...
... 45,49 Bo et al. 48 found women of parity one or more to be more likely to have UI at 28 One study asked 340 women in the third trimester if they had had SUI but did not state the exact gestation of participants. They did not find an association with parity (χ 2 test, p = 0.25). ...
Aims
To systematically review the literature on possible associations between parity and urinary incontinence (UI) during pregnancy and in the first year postpartum.
Methods
We searched the databases Pubmed, CINAHL, Embase, the Cochrane Library, PsycINFO, MIDIRS, ClinicalTrials.gov (inception-18 April 2020). One reviewer screened all titles. Two reviewers independently selected studies by abstract and full text. Risk of bias was assessed using the Quality In Prognosis Studies tool. Findings were synthesised in meta-analysis or narratively. We assessed the certainty of evidence using the Grading of Recommendations, Assessment, Development and Evaluation Working Group approach adopted for prognostic studies.
Results
We identified 16 643 records and 39 were included. Thirty studies examined UI during pregnancy and 12 examined UI postpartum. Multiparity was associated with UI at any point in the last pregnancy (odds ratio [OR]: 1.59 [1.26–2.00], 5 studies, 1565 participants) and in the third trimester when measured by ICIQ-SF (OR: 2.67 [1.53–4.67], 4 studies, 1150 participants), but not when studies measured the UI point prevalence (OR: 2.48 [0.91–6.79], 4 studies, 52 976 participants), or if they measured the prevalence at one point in any trimester (OR: 1.09 (0.60–1.95), 3 studies, 872 participants). At 3 months postpartum, UI was associated with multiparity (OR: 2.03 [1.35–3.06], 4 studies, 6781 participants).
Conclusions
Increased parity was associated with UI in the first year postpartum, but studies on UI during pregnancy had conflicting results. The evidence was (very) uncertain. Future studies should use comparable definitions and further explore UI sub-types.
... La détermination de la causalité en épidémiologie repose sur un faisceau d'arguments dont les principaux sont la force de l'association, la cohérence externe, l'antériorité de l'exposition sur l'évènement, l'existence d'un gradient de risque, l'analogie, l'explication physiopathologique et la preuve expérimentale. 57 78 La prévalence de l'IU à ce terme était supérieure chez les pares comparées aux nullipares, mais elle était similaire chez les femmes avec enfant quel que soit le nombre d'accouchements ( figure 24). Ce travail a pour intérêt de réduire le biais lié à la fertilité, puisque toutes les femmes étaient enceintes. ...
... La durée de la deuxième partie du travail (de dilatation complète à l'accouchement) n'est pas un facteur de risque significatif pour l'incontinence urinaire. 78,98,101,102,111 Ce facteur de risque est retrouvé par Viktrup pour l'IUE à 1 an (p=0,01) mais n'est plus significatif à 12 ans (p=0,06). 32,33 Un travail italien retrouve cependant plus de symptômes urinaires (β0 versus 9%) 1β mois après l'accouchement quand la durée de l'expulsion (du début des efforts expulsifs à l'accouchement) est supérieure à 60 minutes. ...
Virginie RINGA, Co-directeur de Thèse
... Uobi~ajeno je pitanje pove}ava li se rizik za inkontinenciju i za poreme}aj funkcije dna zdjelice sa sljede}im trudno}ama ili je ve}ina o{te}enja nastala tijekom prvog poroda? Neki od radova 19,21,22 dr`e da je trudno}a do prvog poroda od minimalnog utjecaja na neurofiziologiju zdjeli~nog dna te da se ve}ina o{te}enja pudendalnog `ivca doga|a tijekom prvog vaginalnog poroda. Hojberg i sur. ...
... Hojberg i sur. 22 izvje{}uju da je prvi vaginalni porod bio najva`niji rizi~ni ~imbenik za inkontinenciju, dok su sljede}i porodi bili malog u~inka. Me|utim, druga su opa`anja kao i prospektivna istra`ivanja pokazala sna`nu zdru`enost izme|u broja trudno}a i stresne inkontinencije mokra}e. ...
... An increased BMI correlated with an increased intraabdominal pressure during urodynamic assessments and increased risk for SUI later in life [36,37]. In the study of Hojberg et al. [38] pregnant womenwith pre-pregnancy BMI of more than 30 kg/m 2 and 35 kg/m 2 were reported to be at a significantly higher risk for SUI than those with a normal pre-pregnancy BMI (OR = 1.7; 95% CI 0.9-3.2 and OR = 2.5; 95% CI 1.0-6.0, respectively). ...
... Chronic nicotinic detrusor muscle stimulation accompanied by increased intra-abdominal pressure contributes to urine leakage [50]. Hojberg et al. [38] reported pregnant women who smoke to be at significantly greater risk for SUI during pregnancy compared to non-smoking pregnant women (OR = 1.4; 95% CI 1.1-1.9). Similarly, Liang et al. [3] found 6.8% of pregnant women to have reported smoking in pregnancy, an incident associated with urge UI, but found no association with SUI. ...
The most common type of urinary incontinence (UI) in pregnant women is stress urinary incontinence (SUI). The number of pregnant women with SUI was variable, the prevalence ranged from 18.6% to 75% and increased with gestational age. It can affect the quality of life (QoL) of approximately 54.3% of all pregnant women in four domains including physical activity, travel, social relationships and emotional health. Pregnancy is one of the main risk factors for the development of SUI in young women. Physiological changes during pregnancy, such as increasing pressure of the growing uterus and fetal weight on the pelvic floor muscle (PFM) throughout pregnancy, together with pregnancy-related hormonal changes such as increased progesterone, decreased relaxin, and decreased collagen levels, may lead to reduced strength and supportive and sphincteric function of the PFM. Pregnancy may associate with the reduction of the PFM strength which can develop the SUI. However, the exact causes of pregnancy-related SUI remain unclear. Multiple factors have been found to be associated with the development of SUI during pregnancy. In genetic risk factors, aging is an important role in SUI development. The other risk factors such as obesity, smoking, constipation, pre-pregnancy SUI, gestational diabetes mellitus (GDM), and pelvic floor muscle exercise (PFME) that utilized preventive strategies can reduce SUI in pregnant women. The purpose of this review is to identify the risk factors for the development of SUI in pregnant women. These understanding can be useful for health professions to inform and counsel the pregnant women to prevent and reduce the risk factors that contribute to the development of SUI during pregnancy and postpartum period.
... Stress urinary incontinence (SUI), the complaint of involuntary loss of urine on effort or physical exertion or on sneezing or coughing [1], is the most prevalent type among peri-partum women [2][3][4]. During pregnancy prevalence of UI is reported between 9 and 75%, and post-partum between 10 and 63% [5][6][7][8]. UI reduces quality of life (QoL) but nonetheless, many women tend to accept their problems because they are embarrassed, think it is normal and will diminish by itself [8][9][10]. ...
... I 2 : 99.0%), regardless of parity or type of UI (Fig. 2). The lowest prevalence of UI found in the included studies was 10% [51] and the highest prevalence 63% [52]. Prevalence figures for studies with low (n = 3), moderate (n = 20 studies) and high risk of bias (n = 1) were 28% (95% CI 17.0-39.0), ...
Introduction and hypothesis
Urinary incontinence (UI) is a common complaint for post-partum women. Reported prevalence and incidence figures show a large range due to varying study methodology. The crude prevalence of post-partum UI may differ when accounting for bother. Precise prevalence and incidence figures on (bothersome) UI are of relevance for health care providers, research planning, and policy makers. Therefore, we conducted a systematic review and meta-analysis to investigate the prevalence and incidence of UI in post-partum women in the Western world for relevant subgroups and assessed experienced bother in relation to UI.
Methods
Observational studies, published between January 1998 and March 2020 and reporting on prevalence and incidence between 6 weeks and 1 year post-partum, were included, regardless of type of UI or setting. We used a random effects model with subgroup analyses for post-partum period, parity and subtype of UI.
Results
The mean (weighted) prevalence based on 24 included studies, containing a total of 35.064 women, was 31.0%. After an initial drop in prevalence at 3 months post-partum, prevalence rises up to nearly the same level as in the third trimester of pregnancy at 1 year post-partum (32%). Stress UI (54%) is the most prevalent type. UI prevalence is equal among primi- and multiparous women. Experienced bother of UI is heterogeneously assessed and reported to be mild to moderate.
Conclusions
Post-partum UI is highly prevalent in women in the Western world. After an initial drop it rises again at 1 year post-partum. Experienced bother is mild to moderate.
... I 2 : 99.77%), regardless of trimester, parity or type of UI (Fig. 2). The lowest prevalence of UI found in the included studies was 9% [28] and the highest prevalence 75% [29]. Prevalence figures for low, moderate and high risk of bias studies were 38% (95% 18.0-58.0), ...
Introduction and hypothesis
Urinary incontinence (UI) is a common and embarrassing complaint for pregnant women. Reported prevalence and incidence figures show a large range, due to varying case definitions, recruited population and study methodology. Precise prevalence and incidence figures on (bothersome) UI are of relevance for health care providers, policy makers and researchers. Therefore, we conducted a systematic review and meta-analysis to investigate the prevalence and incidence of UI in pregnancy in the general population for relevant subgroups and assessed experienced bother.
Methods
All observational studies published between January 1998 and October 2018 reporting on prevalence and/or incidence of UI during pregnancy were included. All women, regardless of weeks of gestation and type of UI presented in all settings, were of interest. A random-effects model was used. Subgroup analyses were conducted by parity, trimester and subtype of UI.
Results
The mean (weighted) prevalence based on 44 included studies, containing a total of 88.305 women, was 41.0% (range of 9–75%). Stress urinary incontinence (63%) is the most prevalent type of UI; 26% of the women reported daily loss, whereas 40% reported loss on a monthly basis. Bother was experienced as mild to moderate.
Conclusions
UI is very prevalent and rising with the weeks of gestation in pregnancy. SUI is the most common type and in most cases it was a small amount. Bother for UI is heterogeneously assessed and experienced as mild to moderate by pregnant women.
... 5 The incidence increases especially after the 20th week of pregnancy. 8 In a study, age, parity, urinary tract infection history, constipation, UI history in previous pregnancy etc. variables such as pregnancy were determined as risk factors for UI. 9 Risk factors should first be determined in order to prevent the emergence of UI of pregnant women. Women may think of UI occurring during pregnancy as a temporary or permanent disease related to pregnancy. ...
Objective: The research was carried out to determine the life experiences of pregnant women who have urinary incontinence problems.
Methods: The type of the research is of qualitative type. Views of pregnant women were coded according to repeating frequencies; then thematic grouping was done. Both common views and individual repetitions of the pregnant women were coded. During the study, 52 pregnant women stated that they had urinary incontinence problems. However, five pregnant women did not want to participate in the study and six pregnant women wanted to leave during the interview. Interviews ended with 41 pregnant women.
Results: In the study, the mean age of the pregnant women was determined as 29.75±4.83, and the mean gestational week was 27.85 ± 5.60. The views of pregnant women are divided into five main themes and 16 sub-themes. The main themes for the urinary incontinence life experiences of pregnant women were determined as “strategies to take precautions, psychological effects, pregnancy and baby-specific effects, physical effects and changes in their relationship with the spouse.”
Conclusion: As a result, it was determined that urinary incontinence problem negatively affected the life experience of pregnant women.
... Además existen estudios que indican que un peso mayor a 4kg en el recién nacido puede estar asociado significativamente con el desarrollo de IU en la madre. Esto, en parte, explica el daño que se produce en los nervios pudendos, tejido conectivo y músculos del suelo pélvico (26,27). En el presente estudio el IMC no demostró una relación significativa frente a la IU, por lo tanto, tuvo un impacto leve según los valores Beta (0.275). ...
L., Quinteros M. Prevalencia de la incontinencia urinaria en mujeres de 45-65 años del Hospital Padre Carollo. MEDICIENCIAS UTA.2019;3 (2):69-78. Prevalencia de la incontinencia urinaria en mujeres de 45-65 años del Hospital Padre Carollo. Prevalence of urinary incontinence in women 45-65 years of Padre Carollo Hospital. Resumen. Introducción: La incontinencia urinaria (IU) es una enfermedad que afecta principalmente a mujeres y adultos mayores repercutiendo en su calidad de vida. Además, su tratamiento y sus secuelas representan un costo económico relevante en los sistemas de salud. Objetivo: Estimar la prevalencia y los factores de riesgo de la IU en mujeres de 45 a 65 años, atendidas en el Hospital "Padre Carollo", en el periodo 2016-2017. Material y Métodos: Estudio de Casos y Controles retrospectivo revisando 887 historias clínicas. Se analizó la asociación entre variables (Chi2), los "odd ratios" (Regresión múltiple) y los valores Beta. Los factores de riesgo analizados fueron número de gestas, edad, ocupación, tipo de parto, IMC, hipertensión y tipo de tratamiento. Resultados: Cuarenta y cinco pacientes fueron diagnosticadas con IU (5.07%; IC95%:3.62-6.51), 44 tuvieron IU de esfuerzo y 1 tuvo IU mixta. La prueba Chi2 determinó una asociación entre IU, el número de gestas (p=0.002) y la hipertensión (p=0.025). La regresión múltiple encontró asociaciones significativas para el número de gestas (p=0.003), hipertensión (p=0.030) y partos por cesáreas (p=0.016). Los valores Beta ratificaron estos resultados. Conclusión: La prevalencia de IU en este estudio fue de 5.07%. El tipo de IU más frecuente fue por incontinencia urinaria de esfuerzo. El número de gestas fue el factor de riesgo más significativo en relación con las variables edad, ocupación, tipo de parto, IMC, hipertensión y tipo de tratamiento. Existió una relación significativa entre el número de gestas e IU, para primíparas, multíparas y gran multíparas. Los factores de predicción de la presencia de IU más importantes fueron mujeres gran multíparas, multíparas, primíparas, hipertensión, IMC y edad. Palabras clave: Incontinencia urinaria, Factores de Riesgo, Diafragma pélvico Abstract. Introduction: Urinary incontinence (IU) is a disease that mainly affects women and older adults, affecting their quality of life. In addition, its treatment and its sequelae represent a relevant economic cost in health systems. Objective: To estimate the prevalence and risk factors of IU in women from 45 to 65 years, attended in the Hospital "Padre-Rollo", in the period 2016-2017. Material and Methods: Retrospective case-control study reviewing 887 clinical histories. We analyzed the association between variables (CHI2), the "odd ratios" (multiple regression) and Beta values. The risk factors analyzed were number of pregnancies, age, occupation, type of birth, BMI, hypertension and type of treatment.
... Thus, Hunskaar, in 2008 [2], after a systematic review, concluded that overweight and obesity were important risk factors for UI. Other risk factors highlighted by the ICS were parity, pregnancy and mode of delivery [3,4], ethnicity and race [5], hysterectomy [6], menopausal replacement therapy [7], diets, such as coffee intake [8], socioeconomic status [3], smoking [9], physical activity [10] and other comorbidities (i.e., depression, physical impairment, diabetes . . . ). ...
Pelvic floor muscle training is commonly used for urine loss. However, research studies have not determined which training load is the most effective for women with stress urinary incontinence (SUI). Moreover, none of the previous reviews or studies have described the total effectiveness of pelvic floor muscle training (PFMT) with an objective test such as the pad test. The objectives were to analyze the effectiveness of pelvic floor muscle training in women with SUI and to determine which training load produces the greatest adaptations for decreasing urine loss. The search was conducted in three databases (PubMed, Web of Science and Cochrane), for randomized controlled trials (RCTs) that evaluated the effects of PFMT. Studies were included if they met the following criteria: participants were women; were older than 18; had SUI; were treated with PFMT; and the assessments of the effects were measured with a pad test. Finally, 10 articles (293 women) analyzed the pad test in women with SUI who performed PFMT. The meta-analysis showed that PFMT, independent of the protocol used in the study, resulted in decreased urine loss in women suffering from SUI. However, for large effects, the program should last 6–12 weeks, with >3 sessions/week and a length of session <45 min.
... Factors related to delivery such as previous traumatic vaginal births, exposure to oxytocic drugs, vacuum-or forceps-assisted delivery and prolonged second stage are associated with an increased risk of urinary incontinence. 6 C H A P T E R 84 1492 Review Copy -Not for Redistribution Paul Hilton -Newcastle University -10/01/2018 ...
... A prevalência da IU em mulheres multíparas em relação às nulíparas, é alta. Højberg et al. [21] e Viktrup et al. [14] relataram que gravidez e parto podem constituir um fator de risco para IU. Alguns estudos epidemiológicos demostraram que com o aumento da paridade os riscos de desenvolver IU aumentam. ...
Esse estudo teve como objetivo realizar uma revisão literária acerca dos fatores de risco associados à incontinência urinária (IU). A revisão de literatura estendeu-se de fevereiro à novembro de 2005, mediante o levantamento bibliográfico em livros de acervos particulares e nas bases de dados Lilacs, Scielo, Pub Med, Cochrane, Medline utilizando-se as seguintes palavras-chave: incontinência urinária feminina, fatores de risco, epidemiologia e prevalência. A IU é definida como qualquer perda involuntária de urina e tem como etiologia alterações vesicais ou uretrais. O assoalho pélvico é responsável pela ação esfincteriana uretral, vaginal e retal e permite a passagem do feto durante o parto. Já a bexiga é responsável pelo armazenamento e eliminação da urina. Para que a micção ocorra de maneira adequada é necessário que haja uma interação sincrônica entre a bexiga, o assoalho pélvico, o sistema nervoso central (SNC) e sistema nervoso periférico (SNP), durante as fases de enchimento e esvaziamento. Qualquer alteração em uma dessas fases ou estruturas resulta em disfunções miccionais. Sendo assim, os fatores de risco que interferem nessas estruturas pode estar associadas ao aparecimento ou agravamento da IU.Palavras-chave: incontinência urinária feminina, fatores de risco, epidemiologia; prevalência.
... These values are above the reference population, with prevalence of UI 29.1% for the young women's group and for UUI and SUI 28.6% and 18.1%, respectively. Comparing these results with previous studies, we identified that prevalences of UI found in the adolescents' group are also above that found in the general population, which are around 23%-38% for UI in general, 22%-36% for SUI, and 5.5%-9% for UUI. 1, 35 Højberg et al 9 have shown an increased prevalence of UI in adolescent population in pregnancy, but did not give much importance to the fact, saying that it could be caused by reporting bias because young women may be more aware of UI and have a lower threshold of reporting symptoms of UI. ...
Purpose
To analyze the postpartum pelvic floor disorders (PFD) and mode of delivery among adolescents, late adolescents, and young women from Western Amazon.
Patients and methods
Cross-sectional study was carried out in the urban area of Western Amazon in the city of Rio Branco, Acre, Brazil, from October 2016 to February 2017. This is a convenience sample of women up to 30 years who completed six months postpartum, separated in three groups according to maternal age: adolescents (age ≤19 years), late adolescents (20–24 years), and young women (25–30 years). Participants were home interviewed and answered Pelvic Floor Distress Inventory-20 (PFDI-20). Delivery clinical data were collected from patient’s medical records.
Results
In total, 285 participants were interviewed: 41 adolescents, 103 late adolescents, and 141 young women. After controlling for confounding factors, prevalences of PFD were higher in the adolescents’ group compared with the young women’s group (urinary incontinence [UI], prevalence ratio [PR] = 1.75, 95% CI 1.14–2.69; urge urinary incontinence [UUI], PR = 1.88, 95% CI 1.02–3.47; stress urinary incontinence, PR = 2.00, 95% CI 1.11–3.62; fecal incontinence [FI], PR = 4.40, 95% CI 1.36–14.27). PFDI-20 scores also presented higher values in the adolescent group (Pelvic Organ Prolapse Distress Inventory [POPDI], PR = 2.02, 95% CI 1.49–2.75; urinary distress inventory [UDI], PR = 2.09, 95% CI 1.47–2.98; PFDI, PR = 2.12, 95% CI 1.47–2.98). Analyzing the influence of cesarean section, adolescents have higher prevalence of UI (PR = 1.84, 95% CI 1.04–3.26, P=0.037), UUI (PR = 2.36, 95% CI 1.03–5.40, P=0.042), and FI (PR = 4.09, 95% CI 1.21–13.81, P=0.023). In addition, POPDI (PR = 2.15, 95% CI 1.60–2.89, P<0.001), UDI (PR = 2.25, 95% CI 1.61–3.16, P<0.001), and PFDI (PR = 2.27, 95% CI 1.68–3.08, P<0.001) scores are also higher among adolescents where the baby is born by cesarean section.
Conclusion
Adolescents present higher prevalence and symptoms of PFD; furthermore, cesarean delivery has a greater negative influence on the pelvic floor of adolescents when compared with young women. This reinforces the importance of PFD investigation among the adolescent population, mainly in developing countries which have high rates of adolescent pregnancy and cesarean section.
... Nous avons aussi mis en évidence dans cette enquête un lien entre le nombre d'IVG et le risque d'IU mixte hebdomadaire. Ce facteur de risque a été retrouvé dans d'autres études transversales[223][224][225][226][227]. Une étude en Turquie a rapporté que le nombre d'IVG était lié à l'IU d'effort mais pas à l'IU par urgenturie[224]. ...
VERS UNE MODELISATION DE L’INCONTINENCE URINAIRE DES FEMMES Introduction : L’objectif principal était de mieux comprendre l’histoire naturelle de l’incontinence urinaire (IU) féminine grâce à une modélisation de sa prévalence sur ses facteurs de risque, en tenant compte de sa gravité et de ses types. Un objectif secondaire était de travailler sur la classification des circonstances des fuites urinaires.Matériel et méthodes : Nous avons utilisé les données de deux sondages téléphoniques sur une population représentative, Le Baromètre Santé 2010 (3089) et Fecond (5017) ; de deux enquêtes postales au sein de la cohorte GAZEL (3098), l’une générale et l’autre centrée sur les problèmes urinaires ; et enfin d’un sondage internet de volontaires adultes, NutriNet-Santé (85037). L’IU a été définie à partir d'un questionnaire validé, l’ICIQ-UI-SF et à partir d’une liste de problèmes de santé. Nous avons utilisé des modèles binomiaux et multinomiaux de régression logistique, des analyses de correspondances multiples et de classification ascendante hiérarchique.Résultats : La prévalence de l’IU tout venant (quel que soit son type ou sa gravité) variait de 1,5 % à 38,8 % selon les enquêtes et était égale à 17,3 % dans les 2 échantillons représentatifs. La conception de l’enquête, c’est-à-dire la nature de l’échantillon (représentatif ou non), son objectif (centré sur la santé générale ou l’IU), le mode de recueil des données et la mode de définition de l’IU (à partir d’un questionnaire spécifique validé ou basée sur une liste de maladies) étaient susceptibles de modifier à la hausse ou à la baisse les estimations de la prévalence de l’IU.Les fuites les plus fréquentes étaient les fuites à la toux, les fuites avant d’arriver aux toilettes et les fuites lors de l’exercice physique. Les femmes décrivant des circonstances attribuées aux principaux types d’IU, effort, par urgenturie et mixte, formaient un groupe distinct de celles déclarant des circonstances attribuées au type IU autre. De même, les femmes déclarant des circonstances attribuables à une IU d’effort se démarquaient de celles déclarant des circonstances attribuables à une IU par urgenturie. Les circonstances les plus discriminantes pour classer les femmes incontinentes étaient : fuites tout le temps, à la toux, pendant le sommeil et après la miction. Dans toutes les enquêtes nous avons identifié des associations significatives entre presque tous les facteurs de risque disponibles et l’incontinence ; mais certains facteurs étaient liés avec toutes les formes d’IU et d’autres seulement avec certaines formes. De plus nombreuses associations ont été observées avec l’IU grave, c’est-à-dire quotidienne, qu’avec l’IU hebdomadaire. Nous avons observé plus d’associations significatives avec l’IU mixte et l’IU autre qu’avec l’IU d’effort et l’IU par urgenturie. Les plus fortes associations ont été observées pour la dépression et l’obésité, liées avec presque toutes les formes d’IU. Les variables obstétricales étaient souvent liées à l’IU mixte. Conclusion : Le questionnaire ICIQ-UI-SF est approprié pour estimer la prévalence de l’incontinence urinaire dans des échantillons représentatifs mais il apparaît insuffisant pour définir tous les types d’IU. Nos résultats ont objectivé qu’il est possible d’utiliser les circonstances des fuites d’urine pour identifier des groupes spécifiques de femmes incontinentes, et que certaines circonstances peu utilisées en cliniques sont pourtant très discriminantes. Il y a probablement des travaux à faire et à poursuivre pour explorer dans quelle mesure les circonstances des fuites ont une valeur pronostique ou prédictive de réponse au traitement. Grâce à la modélisation, où nous avons pris en compte le type et la gravité de l’IU, nous avons pu constater quelles modalités de l’IU sont liées à certains facteurs de risque et quelles modalités ne le sont pas.
... Several studies have reported that there is no association between high infant birthweight (>4000 g) and UI after vaginal delivery. [156][157][158] In one study high birth weight (≥4000 g) was however associated with stress urinary incontinence. 135 We found that the prevalence of UI after VD was higher than after CS in all infant birthweight groups except for weights <3000 g. ...
http://hdl.handle.net/2077/31701
... Santos et al [19] reported that the onset of urinary incontinence complaints occurred at 27 gestational weeks on average. Hojberg et al [20] affirmed that there was an increase in the complaints prevalence from the 20th gestational week. ...
... Obstetric factors implicated include previous vaginal delivery, increasing parity, exposure to oxytocics, instrumental vaginal delivery, and fetal macrosomia. [9,12,13] Other factors associated with increase prevalence of LUTS are maternal obesity as reflected by high body mass index (BMI) and increasing maternal age. [14,15] LUTS especially stress or urge urinary incontinence is associated with psychological morbidity and adverse effects on the quality of life of women. ...
Background: Pregnancy and childbirth are thought to be associated with development of lower urinary tract symptoms (LUTS). The study aimed at ascertaining prevalence rates of LUTS before and during pregnancy, the determinants and perceived effects of these symptoms on the life of the women. Materials and Methods: Questionnaires in which LUTS were defi ned according to recommendations of International Continence Society was administered on consecutive women who delivered at ≥37 weeks’ gestation to ascertain
the presence or absence of LUTS before and during pregnancy and perceived effects on their life. Data was also collected on their socio-demographic and obstetric features. Descriptive statistics and relationship between LUTS and other variables were analyzed using SPSS version 16. Results: Prevalence rates of LUTS before and during pregnancy were 52.9% and 89.2%, respectively, and mostly included nocturia and stress urinary incontinence. Women were more likely to develop LUTS during pregnancy (P = 0.002, OR
4.99, 95% CI 1.793 – 13.906). Only 14.4% and 41.7% reported any burden on their daily life before and during pregnancy, respectively. Previous vaginal delivery (P = 0.01, OR 3.12, 95% CI 2.91-5.62), grand-multiparity (P = 0.04, OR 4.15, 95% CI 3.82-7.24) were associated with LUTS prior to pregnancy while presence of LUTS before pregnancy (P = 0.001, OR 10.80, 95% CI 4.24-27.52), previous
vaginal delivery (P = 0.002, OR 6.38, 95% CI 4.25-12.43) and moderate maternal obesity (P = 0.03, OR 2.56, 95% CI 1.82-3.47) were predictive of LUTS during pregnancy. Conclusion: LUTS are common among women both before and during pregnancy but most of them were not bothered by the LUTS. Those with previous vaginal delivery and are grand-multiparous are more likely to develop LUTS prior to pregnancy while the presence of LUTS before pregnancy, vaginal delivery and maternal obesity are determinants of LUTS during pregnancy.
... Bizim çalışmamızda iri bebek öyküsünün Üİ için önemli bir risk faktörü olduğu saptandı (OR: 1,947; p=0.021). Bazı çalışmalarda da iri bebek öyküsünün Üİ için önemli bir risk faktörü olduğu bildirilmiştir (5,69). Oysa, Connolly ve arkadaşları (70) yaptıkları bir çalışmada bebek doğum ağırlığı ile Üİ arasında bir ilişki bulunamadığını rapor etmişlerdir. ...
AIM: To determination of prevalence of Urinary incontinence (UI), and to evaluation of relationship between UI and depression in women. METHOD: This study is a cross-sectional type research, was realized between 05 July 2011 to 25 August 2011, among 20 and over aged women that living in Beylikova district centre. The study group was occurred 500 women. The presence of UI, its type and severity were evaluated according to criteria recommended by the International Continence Society. For the purpose of the questionnaire form prepared by the study, households were visited one by one, filled with face to face method. Beck Depression Inventory (BDI) was used for evaluation of depression. Chi-square test and Logistic Regression Analyses were used in statistical analyses. For statistical significance, p<0.05 were approved. RESULTS: The ages of women were between 20 to 81 years, and average age was 46.97±15.65 years. Prevalence of UI was found 41.4% (n=207). Of the UI cases were 35.7% stress incontinence, 15.5% urge incontinence, 48.8% mixed type. Of the cases were 95 (45.9%) low severity, 60 (29.0%) middle severity, 52 (25.1%) high severity. In this study, UI was an important risk factor in illiterates (OR: 6.617), no smoking (OR: 1.868), obes (OR: 2.777), persons with anyone chronicle disease that diagnosed by doctor (OR: 4.711), enuresis nocturna hystory in childhood age (OR: 2.600), large baby history in women who had given birth (OR: 1.947), and menopause (OR: 2.497). Prevalence of depression was found 25.4% (n=127). Prevalence of depression was higher found in the women with UI, stress type UI, and high severity UI (for each one; p<0.05). CONCLUSION: In this study, it was determinate that UI an important health problem in the women, and depression prevalence was higher in the women with UI.
... The prevalence of UI during pregnancy varies between 3-67%. [1][2][3] Both prevalence and severity of UI seem to increase through out pregnancy. It also compromised daily life of pregnant women. ...
Objectives: To assess the efficacy of antenatal pelvic floor muscle training (PFMT) for preventing urinary incontinence. Methods: 219 nulliparous women in first trimester, who visited the antenatal care clinic at Thammasat University Hospital, were recruited. They were asked to answer the Thai version of Kingûs health questionnaires and were randomly divided into two groups. One hundred and eleven women were allocated to non-PFMT group and 108 to PFMT group. The outcome was the prevalence of moderately to severe urinary incontinence in first trimester, 30-38 weeks gestation and 6 months postpartum. Results: Frequency and nocturia were the first and second most frequent of bladder problems, respectively. Only 1.4% in non-PMFT group and 1.8% in PMFT group had urge incontinence. No woman in PMFT group had stress incontinence in first trimester. During 30-38 weeks, the women in PMFT group reported moderate to severe stress incontinence less than the women in non-PMFT group with statistical significance (P = 0.03). At 6 months postpartum, the women in non-PMFT group reported that frequency, nocturia, urge incontinence and stress incontinence affected their life more frequent than the PMFT group but without significance. When compare the mean rank of rating score between the first trimester and 6 months postpartum, the PMFT group reported lower mean rank of urge incontinence than the non-PMFT group, with statistical significance. Discussion: The prevalence of urge incontinence and stress incontinence which had moderately to severely affected the quality of life in first trimester pregnancy was 3.2% and 1.4%, respectively. The antenatal PFMT seems to have the preventive effect on stress urinary incontinence at 30-38 weeks pregnancy (P = 0.03) but not in the 6 months postpartum (P = 0.82).
Objective: Primary objective was to find the prevalence of urinary incontinence during pregnancy by its type and see how predicative it was of urinary incontinence in the long term. Associated risk factors were identified as secondary objectives. Method: Antenatal clinics provide opportunistic screening for diseases of the breast, the heart or even the mind. Preventive gynaecological issues could also be addressed likewise. It was felt worth investigating the prevalence of urinary incontinence during pregnancy without undue harassment to the patients by way of a few routinely directed questions about urinary incontinence.This information is rarely volunteered due to embarrassment. 867 women attending antenatal clinics led by the author at teaching hospital Peradeniya, in 2007 and 2008 were interviewed during pregnancy and those incontinent were followed up post-partum at 6 weeks,one and two years till 2010. Patients were inquired regarding the predominant type of incontinence, when the symptoms were mixed(stress and urge both). Results: Of the 867 women analysed, 209 (24%) had some form of urinary incontinence. 110 (52%) of those affected had pure or predominant stress, and 15 (7%) pure or predominantly urge incontinence. The rest 41% had a mixed picture. 154 were still incontinent at 6 weeks post-partum. The proportion of the type of incontinence had changed. 97 (63%) had pure or predominantly stress incontinence, 6 (3.9%) had pure or predominantly urgency and the 33.1% had a mixed picture. 47 of them still complained of some degree of incontinence at the end of one year despite interventions of pelvic floor exercise (PFE),for urodynamic stress incontinence or mixed symptoms. The patterns were even more stress predominant. 33(70%). 2 patients (4.2%) had pure urgency and the rest 12 (25.5%) had a mixed pattern. End of 2 years only 43 patients of those incontinent at 1year were traceable at least over the telephone. Only 23 complained of persistence of the problems. Of the 23 with symptoms at 2 years, 2 were pregnant again. 18 (78%) had pure SI and the rest 5 (22%) had a mixed picture. This indicated that pure stress incontinence tended to persist more than urge incontinence probably indicating some form of permanent damage to the pelvic floor. Older and women of higher parity were found to be more affected again indicating possibility of such injury. Conclusions: The finding that of the initial 209 women who leaked urine during pregnancy 23 remained incontinent at the end of 2 years (11%), is evidence that incontinence during pregnancy is of some predictive value in finding those likely to have long term incontinence.The symptoms of stress incontinence persisted despite PFE. This places doubts on benign physiological and hormonal change theories which is discussed alongside these findings. Incontinence during pregnancy maybe a useful indicator of injury sustained to the pelvic floor providing early warning for trouble ahead with the sphincter mechanism. Questions about urinary incontinence as a routine during antenatal consultations may be a worthwhile exercise. This would take only a very short time and should be encouraged as a higher percentage would have remained incontinent had PFE not been initiated as an ethical intervention.
Amaç: Üriner inkontinans (Üİ) kadınları fiziksel, sosyal ve ekonomik yönden etkileyen; yaşam kalitelerini bozan yaygın bir sağlık sorunudur. Gebelik ve doğuma ek olarak anne yaşı, parite, önceki doğum öyküsü, beden kitle indeksi ve gebelik öncesi Üİ varlığı gebelikte Üİ için risk faktörleridir. Bu çalışmada nullipar gebelerde Üİ prevelansı ve risk faktörleri araştırıldı. Materyal-metot: 1 Mart–30 Aralık 2017 tarihleri arasında Kadın Hastalıkları ve Doğum polikliniğimize başvuran 18-45 yaş arası nullipar gebeler çalışmaya dahil edildi. Olgulara Uluslararası İdrar Kaçırma Konsültasyon Sorgulaması-Kısa Form ICIQ-SF(International Consultation on Incontinence Questionnaire Short Form) yüz yüze görüşme ile doldurtuldu. Olguların demografik bilgileri ve ICIQ-SF puanları değerlendirildi. Bulgular: Bu çalışmada nullipar gebelerde Üİ prevelansı % 15,9 olarak bulundu. >30 yaş olanlarda ICIQ-SF toplam puanları istatistiksel olarak anlamlı düzeyde yüksek bulundu (p<0,05). Çocukluk çağı enürezisi ve inkontinans öyküsü olanların olmayanlara göre ICIQ-SF toplam puanları istatistiksel olarak anlamlı düzeyde yüksek bulundu(p<0,05). Gebelik dönemi ile ICIQ-SF toplam puanları karşılaştırıldığında, gebelik dönemi 3.trimester olanların 1.trimester olanlara göre ICIQ-SF toplam puanları istatistiksel olarak anlamlı düzeyde bulundu(p<0,05). Sonuç: Bu çalışmada nullipar gebelerde Üİ prevelansı % 15,9 olarak bulundu. Üriner inkontinans prevelansı gebelik haftası ile artmaktadır. Çocukluk çağı enüresis ve üriner inkontinans öyküsü üriner inkontinans için risk faktörüdür.
Urinary incontinence, anal incontinence, pelvic organ prolapse, and sexual dysfunction-the major disorders of the female pelvic floor-are associated with a substantial public health burden. And for many women, pregnancy, labor, and delivery represent the most important physiological events predisposing to these conditions. Although many aspects of obstetrical pelvic floor injury have yet to be fully understood, our knowledge of etiological mechanisms and epidemiological risk factors has markedly expanded over the past several years. This chapter will explore the effects of pregnancy and childbirth on the pelvic floor, and the impact of obstetrical events on these prevalent postreproductive disorders.
Aufgrund von Verbesserungen der Operations- und Anästhesietechniken, der perioperativen Antibiotikagabe, der Thromboseprophylaxe sowie der modernen postoperativen Behandlung ist die Sectio caesarea in den letzten 20 Jahren im Hinblick auf die mütterliche Morbidität und Mortalität ein wesentlich risikoärmerer Eingriff geworden. sodass die Entscheidung zur abdominalen Schnittentbindung in vielen Fällen — vermeintlich — keiner strengen Indikationsstellung mehr bedarf.
Effects of childbirth on women’s health are often multiple, including changes in the mechanisms of urinary continence and pelvic floor support. Women after delivery may suffer from a wide range of lower urinary tract dysfunction such as voiding difficulty, urinary retention, urinary incontinence and acute or chronic injury to the urinary tract. Hormonal changes during pregnancy, regional anaesthesia and prolonged labour or instrumental delivery may predispose to postpartum urinary retention. Proper bladder care during and after labour is essential to prevent undiagnosed bladder overdistension and subsequent long-term bladder dysfunction. Stress urinary incontinence is the most common type associated with pregnancy and puerperium which results from levator ani damage, urethral and bladder neck hypermobility and/or ischaemic urethral injury. There is evidence that pelvic floor muscle training during antenatal and postnatal period can prevent urinary incontinence, while, the role of caesarean section in the prevention of incontinence is still debatable. Although intraoperative bladder and ureteric injury is uncommon, it is a potentially serious complication of caesarean delivery if unrecognised. Special attention in high risk patients is essential to avoid such injuries. Obstetric fistula is a devastating public health problem in the developing countries.
Behavior modification is an accepted treatment option for persons with urinary lower urinary tract symptoms (LUTS) which include urinary incontinence (UI) and overactive bladder (OAB), which include urgency, frequency, with or without urge UI and nocturia. These interventions improve symptoms through identification of lifestyle habits and changing a person’s behavior, environment or activity that are contributing factors or triggers (1). Interventions such as bladder retraining and pelvic floor muscle rehabilitation attempt to decrease incontinence and OAB symptoms through increasing awareness of the function and coordination of the bladder and pelvic floor muscle so as to gain muscle identification, control, and strength and to decrease bladder overactivity. These interventions are often referred to as behavioral treatments, and involve learning new skills through extensive one-on-one patient instruction on techniques for preventing urine loss, urgency, and other symptoms.
The goal of the current study was to systematically review the literature concerning urinary incontinence and pregnancy, in order to develop recommendations for clinical practice. The prevalence of urinary stress incontinence and overactive bladder symptoms increase with gestational age during pregnancy (from the first to the third trimester), and decrease during the third months following delivery. Obstetrics factors (position during delivery, length of the second part of the labour, forceps, episiotomy, epidural or pudendal anaesthesia) do not modify the risk of post-partum or long term urinary incontinence. At short term follow-up, caesarean delivery is associated with a lower rate of post-partum urinary incontinence. At long term follow-up, data are lacking. Non elective caesarean section is not associated with a decrease in the rate of post-partum or tong-term urinary incontinence. Elective caesarean section and systematic episiotomy are not recommended methods for the prevention of postpartum urinary incontinence (grade B), even in "high risk" women. Pelvic floor muscle therapy is the first line treatment for prenatal or post-partum urinary incontinence (grade A).
Background: Stress urinary incontinence, the most common urinary incontinence in women, occurs when the intra-abdominal pressure increases. Although many studies have introduced normal vaginal delivery as a risk factor for future stress urinary incontinence and considered cesarean as a preventive method, others have raised controversy about such a predictive effect. This study evaluated the frequency of stress urinary incontinence in primiparous mothers giving birth in Shahid Beheshti Hospital (Isfahan, Iran) to understand the effects of type of delivery on developing the condition.
Methods: This cross-sectional study was conducted on 300 women in three groups of normal vaginal delivery, elective cesarean, and emergency cesarean. The subjects had given birth in Shahid Beheshti Hospital within six months prior to the study. Stress urinary incontinence was assessed with the Bonney test.
Findings: The overall frequency of stress urinary incontinence was 5.6%. It was 6.0%, 4.0%, and 7.0% among women with normal vaginal delivery, elective cesarean, and emergency cesarean, respectively (P = 0.41).
Conclusion: No significant relation was observed between the prevalence of stress urinary incontinence and type of delivery.
Structure of the lower urinary tractFunctioning of the lower urinary tractPathophysiology of urinary incontinenceEpidemiologySpecial investigationsOther lower urinary tract disordersConclusion
Appendix: Levels of evidenceGrades of recommendations
Objective:
Lower urinary tract symptoms (LUTS) can frequently be seen in pregnant women. Pregnancy and delivery have been considered as risk factors in the occurrence of pelvic floor dysfunction and determinants of LUTS. The main associated risk factor is parity. In the present study, we aim to determine the frequency of LUTS and urinary incontinence (UI) during pregnancy and the associated risk factors.
Methods:
This prospective study was carried out in a total of 250 women during their 28- and 40-gestational week checks. The Urinary Distress Inventory-6, the Incontinence Impact Questionnaire-7, and International Consultation on Incontinence Questionnaire-Short Form were used to determine LUTS and its effect on quality of life.
Results:
The mean age and gestational age of the participants were 29.41 ± 5.70 year (range 18-44) and 35.45 ± 2.98 weeks (range 28-40), respectively. The prevalence of LUTS was 81.6%. The prevalence of UI during pregnancy was 37.2%. Stress urinary incontinence, urge urinary incontinence and mixed urinary incontinence were diagnosed as 15.6, 4.8 and 16.8%, respectively. We found that advanced age, smoking and multiparity were risk factors associated with incontinence. Incontinence reduced pregnant women's quality of life.
Conclusions:
Lower urinary tract symptoms are commonly seen among pregnant women and these symptoms negatively affect the quality of life of pregnant women. Advanced age, smoking and multiparity were risk factors associated with urinary incontinence and LUTS. Obstetricians should be on the lookout for individual urological problems in pregnancy. Resolving any urological issues and cessation of smoking for the affected individuals will help alleviate the problem.
Background. To evaluate fertile women's ability to recall the onset of stress incontinence. Methods. In a prospective cohort study 305 primiparae were interviewed after 1st delivery and again 5 years later using a tested questionnaire. In 83 women with stress incontinence 5 years after 1st delivery history of onset was compared with data from the initial questionnaire by grouping women with onset before 1st pregnancy, during 1st pregnancy, during 1st puerperium or after 1st puerperium. Results. Five years after 1st delivery only 26% recalled the onset of stress incontinence precisely. The statistical agreement for each of the four groups of women with different recall of onset varied with a Kappa from 0.02 to 0.38. Conclusion. Five years after 1st delivery stress incontinent women seem to recall the onset of the symptom imprecisely.
Urinary incontinence, the complaint of any involuntary loss of urine, is a troubling symptom experienced by men and women of all ages. Options for treatment include a range of behavioral, pharmacologic, and surgical therapies. Behavioral therapies, such as dietary modification, pelvic floor muscle training, and bladder training, are noninvasive, with little risk of side effects, and experts agree they should represent the first line of treatment whenever possible. These therapies can be initiated and monitored at the primary care level, thereby enhancing the accessibility of care for those affected. The purpose of this article is to methodically review what is and is not known about behavioral therapies, with attention to research needs. Although there is clear evidence for pelvic floor muscle training in women with urinary incontinence and modest evidence in men for a short time after radical prostatectomy, less is known about bladder training, prompted voiding, habit retraining, and timed voiding. Additional research is required to enhance our understanding of the comparative efficacy of behavioral interventions in specific populations. This research must take an increasingly long-term focus, given the potentially chronic nature of urinary incontinence.
Recent large-scale studies have revealed that approximately one third of the adult, community-dwelling women have some form of urinary incontinence (UI). Stress urinary symptoms are most prevalent, being apparent in 70%–88% of incontinent women, either as pure stress urinary incontinence (SUI) or mixed urinary incontinence (MUI). SUI continues to remain a taboo, though, with only a minority of incontinent women consulting a doctor about their problem. Reasons for these low consultation rates include shame and embarrassment, lack of information about available treatment options, fear for surgery and the misconception that becoming incontinent is an inevitable consequence of age and/or giving birth. Yet, most SUI patients indicate that the condition has a negative impact on their well-being. However, even among those looking for help, treatment rates remain low. Hence, most SUI patients suffer in silence and try to cope with it themselves by using pads or panty liners, restricting fluid intake, avoiding social activities and limiting physical exercise. Recent developments of treatment options including a new pharmacological agent to alleviate SUI symptoms have good potential for treating these women, provided that awareness is raised in patients and physicians on the high prevalence, bothersomeness and treatment options of SUI.
Objective. – The expulsive forces of childbirth can be included among the many potential risk factors implicated in the subsequent development of perineal disorders. The objective of this study was to devise a non-invasive way to measure abdominal pushing that would accurately represent the expulsive forces during childbirth.Patients and methods. – By means of intravesical and intrauterine manometry, and electromyography (EMG) of intercostal muscles, we quantified these forces in 21 women during vaginal delivery.Results. – A mixed Ancova model showed the integral of intravesical pressure to be significantly associated (P <0.001) with the integral of intercostal muscle electrical activity during the first 6 uterine contractions during the phase of fetal expulsion.Discussion and conclusion. – Electromyography is a non-invasive measurement that can replace intravesical determinations to quantify these forces as it reflects the real intra-abdominal pressure.
The goal of the current study was to systematically review the literature concerning urinary incontinence and pregnancy, in order to develop recommendations for clinical practice. The prevalence of urinary stress incontinence and overactive bladder symptoms increase with gestational age during pregnancy (from the first to the third trimester), and decrease during the third months following delivery. Obstetrics factors (position during delivery, length of the second part of the labour, forceps, episiotomy, epidural or pudendal anaesthesia) do not modify the risk of post-partum or long term urinary incontinence. At short term follow-up, caesarean delivery is associated with a lower rate of post-partum urinary incontinence. At long term follow-up, data are lacking. Non elective caesarean section is not associated with a decrease in the rate of post-partum or long-term urinary incontinence. Elective caesarean section and systematic episiotomy are not recommended methods for the prevention of post-partum urinary incontinence (grade B), even in "high risk" women. Pelvic floor muscle therapy is the first line treatment for prenatal or post-partum urinary incontinence (grade A).
Copyright © 2009 Elsevier Masson SAS. All rights reserved.
In a prospective study, pelvic floor muscle strength was investigated pre- and post partum in 87 women with uncomplicated pregnancies. Those vaginally delivered were 71 primiparas, while 16 underwent an elective cesarean section. The objective was to evaluate the effect of the delivery procedure on the pelvic floor muscle strength with the aid of vaginal cones. In the group of women with vaginal delivery three subgroups were identified: episiotomy, spontaneous laceration and intact perineum. Pelvic floor muscle strength was weakest in the episiotomy subgroup, the difference in values between this subgroup and each of the other subgroups and the elective cesarean section group being significant. No significant difference was evident between the spontaneous lacerations and intact perineum subgroups.
The aim of the study was to evaluate the use of feedback by graphical profiles of rates of episiotomy and the impact on clinical practice and perineal state after spontaneous vaginal deliveries assisted by midwives with different attitudes towards episiotomy. We defined an observation period in our labour ward followed by feedback to the midwives concerning their own and the other midwives' use of episiotomies. The periods prior to and following the intervention were compared. All women (n = 3919) delivering during the two periods assisted by one of 30 midwives with at least 20 deliveries during each period were included. The overall rate of episiotomy during the observation period was 37.1%. During the second period the rate was 6.6% lower (95% confidence interval (CI):3.6-9.6%) corresponding to a relative decrease of 17.8% (CI:10.1-24.7%). Higher rates of episiotomy during the observation period were associated with larger reductions in the second period. The decrease could be explained by the less frequent use of episiotomy in deliveries with rigid perineum or impending perineal tear. Compared with the observation period, 3.2% more women (CI:0.3-6.3%) had an intact perineum after delivery in the second period, and 3.4% more women (CI:0.4-6.2%) experienced perineal tears. The overall frequency of tears of the anal sphincter remained unchanged. However, women had slightly reduced frequency of tears of the anal sphincter if they were delivered by midwives who reduced a medium or high initial rate of episiotomy; and a tendency towards increased frequency of tears if they were assisted by midwives who reduced low initial rates (around 20%) of episiotomy.(ABSTRACT TRUNCATED AT 250 WORDS)
To evaluate the use of feedback by graphical profiles of rates of episiotomy and the impact on clinical practice and perineal state after spontaneous vaginal deliveries assisted by midwives with different attitudes towards episiotomy.
Observation period in labour ward followed by feedback to midwives about their own and other midwives' use of episiotomies. The periods before and after the intervention were compared.
All women (n = 3919) delivering during the two periods who had been assisted by one of 30 midwives; each midwife supervised at least 20 deliveries during each period.
Overall rates of episiotomies and indications, incidence of intact perineums, perineal lacerations, and tears of anal sphincter.
The overall rate of episiotomy during the observation period was 37.1% (615). During the second period the rate was 6.6% lower (95% confidence interval 3.6% to 9.6%), corresponding to a relative decrease of 17.8% (10.1% to 24.7%). Higher rates of episiotomy during the observation period were associated with larger reductions in the second period. The decrease could be explained by less use of episiotomy in deliveries with rigid perineum or impending perineal tear. Compared with the observation period, in the second period 3.2% more women (0.3% to 6.3%) had an intact perineum after delivery and 3.4% (0.4% to 6.2%) experienced perineal tears. The overall incidence of tears of the anal sphincter remained unchanged. Women had a slightly reduced incidence of tears of the anal sphincter, however, if they were delivered by midwives who reduced a medium or high initial rate of episiotomy and a tendency towards an increased incidence of tears if they were assisted by midwives who reduced low initial rates (around 20%) of episiotomy.
Changes in the use of episiotomy induced by awareness of clinical practice among midwives seem to increase the incidence of parturients with intact perineum without a concomitant rise in tears of the anal sphincter. To avoid the increase of such tears these changes should probably be restricted to midwives with rates of episiotomies above 30%.
The innervation of the pelvic floor musculature is damaged in both stress urinary incontinence and idiopathic (neurogenic) anorectal incontinence. Because childbirth has been considered to be a causative factor in stress incontinence we have assessed the effect of childbirth on the innervation of the pelvic floor musculature in 122 consecutively referred women. They were investigated 48-72 h and 2 months after delivery; 51 were also studied 6 months prior to delivery. In 45 of these 51 women delivered vaginally, EMG studies of the external anal sphincter muscle showed that the fibre density (FD) increased from 1.38 +/- 0.14 before delivery to 1.57 +/- 0.19 2 months after delivery (p less than 0.01). There was no change in the FD in the external anal sphincter muscle after delivery in 20 women delivered by Caesarean section. The pudendal nerve terminal motor latency (PNTML) measured 48-72 h after delivery was increased in the 102 women delivered vaginally compared to 34 nulliparous control subjects. Analysis of the whole group of 122 women showed that multiparity, forceps delivery, increased duration of the second stage of labour, third degree perineal tear and high birth weight were important factors leading to pudendal nerve damage. Epidural anaesthesia had no effect on pudendal nerve function. Modification of these obstetric risk factors may ultimately reduce the frequency of stress urinary and faecal incontinence in women.
Episiotomy is a widely-done intervention in childbirth, regardless of poor scientific evidence of its benefits. This randomised controlled trial compares selective with routine use of a mediolateral episiotomy for women having first and second deliveries in 8 public maternity units in Argentina. 2606 women participated; 1555 were nulliparous (778 in the selective group and 777 in the routine group) and 1051 primiparous (520 in the selective group and 531 in the routine group). The two interventions compared were selective (limited to specified maternal or fetal indications), and routine episiotomy (following the hospital's previous policy). Episiotomy was done in 30.1% of deliveries in the selective, and 82.6% in the routine group. The main outcome measure was severe perineal trauma. Severe perineal trauma was uncommon in both groups but was slightly less frequent in the selective group (1.2% vs 1.5%). Anterior perineal trauma was more common in the selective group but posterior perineal surgical repair, perineal pain, healing complications, and dehiscence were all less frequent in the selective group. Routine episiotomy should be abandoned and episiotomy rates above 30% cannot be justified.
Episiotomy is a widely-done intervention in childbirth,
regardless of poor scientific evidence of its benefits. This
randomised controlled trial compares selective with routine
use of a mediolateral episiotomy for women having first and
second deliveries in 8 public maternity units in Argentina.
2606 women participated; 1555 were nulliparous (778 in
the selective group and 777 in the routine group) and 1051
primiparous (520 in the selective group and 531 in the routine
group). The two interventions compared were selective (limited
to specified maternal or fetal indications), and routine
episiotomy (following the hospital's previous policy).
Episiotomy was done in 30-1% of deliveries in the selective,
and 82.6% in the routine group. The main outcome measure
was severe perineal trauma. Severe perineal trauma was
uncommon in both groups but was slightly less frequent in the
selective group (1.2% vs 1-5%). Anterior perineal trauma was
more common in the selective group but posterior perineal
surgical repair, perineal pain, healing complications, and
dehiscence were all less frequent in the selective group.
Routine episiotomy should be abandoned and episiotomy
rates above 30% cannot be justified.
In an epidemiological health survey, 515 45-year-old women were interviewed about urological problems, particularly incontinence. A pelvic examination was also conducted on 509 of the women. Twenty-two per cent or 114 women stated that they experienced incontinence, which took the form of stress incontinence in 75%, urge incontinence in 11 % and a mixture of the two in 14%. Only 14 women, 3% of all the women interviewed, desired medical treatment for incontinence. In the incontinent women, the pelvic examination significantly more often revealed a cystocele, uterine prolapse or impaired function of the levator muscles. No correlation was found between an enlarged uterus and incontinence. In 211 women with one or more of these findings at the gynaecological examination, the frequency of incontinence was 35%; in 298 women with no pathological findings, the frequency was 15%. The frequency of urinary incontinence was not increased in women with higher panty or in postmenopausal women.
Objective To examine the relation between obstetric factors and the prevalence of urinary incontinence three months after delivery.
Design 2134 postal questionnaires sent between August 1989 and June 1991.
Setting Teaching hospital in Dunedin, New Zealand.
Subjects All women three months postpartum who were resident in the Dunedin area.
Main outcome measure Prevalence of urinary incontinence.
Results 1505 questionnaires were returned (70.5% response rate). At three months postpartum 34.3% of women admitted to some degree of urinary incontinence with 3.3% having daily or more frequent leakage. There was a significant reduction in the prevalence of incontinence for women having a caesarean section, in particular in primiparous women with a history of no previous incontinence (prevalence of incontinence following a vaginal delivery 24.5%, following a caesarean section 5.2% P = 0.002). There was little difference between elective caesarean sections and those carried out in the first and second stages of labour. The odds ratios for women having a caesarean section were 0.4 (95% confidence interval (CI) 0.2–0.7) (all women and all primiparae) and 02 (95% CI 0.0–0.6) (primipara with no previous incontinence) in comparison with those having a normal vaginal delivery. The prevalence of incontinence was also significantly lower in women having had two caesarean sections (23.3%; P = 0.05) but similar in those women having three or more caesarean sections (38.9 YO) in comparison with those women who delivered vaginally (37.7%). Other significant independent odds ratios were found for daily antenatal pelvic floor exercises (PFE) (0.6, 95% CI 0.4–09), parity ≥5 (2.2, 95% CI 1.0–4.9) and pre‐pregnancy body mass index (1.07, 95% CI 1.04–1.10).
Conclusions Adverse risk factors for urinary incontinence at three months postpartum are vaginal delivery, obesity and multiparity (2 5). Caesarean section and daily antenatal PFE appear to be protective, although not completely so.
Objective To evaluate the influence of mediolateral episiotomy on the perineal state after spontaneous, singleton vaginal deliveries with fetus in the occiput anterior position.
Design The study was a population based, observational study. Two approaches were used in the analyses. Initially, we considered the parturients as quasi-randomised to one of three equally sized groups of midwives with different attitudes towards episiotomy. Secondly, we studied the effect of episiotomy on the state of the anal sphincter, controlling for birthweight, parity, and duration of second stage of labour.
Subjects 2188 pregnant women delivering consecutively.
Main outcome measures Perineal lacerations and tear of the anal sphincter.
Results Women allocated to the group of midwives with the lowest rate of episiotomy were more likely to have intact perineum after delivery (OR = l.8 (l.4–2.2)), had a slight tendency towards more perineal lacerations (OR = 1.3 (1.0–1.5)), but no increase risk of having tear of the anal sphincter, compared with the women allocated to the two groups of midwives with higher frequencies of episiotomy. The second approach showed that episiotomy was related to an increased risk of tear of the anal sphincter (OR = 2.3 (1.2–4.6)). However, this relation was not found among the group of parturients delivered by the midwives with the lowest rate of episiotomy (22%).
Conclusions Our results encourage a conservative approach to the use of mediolateral episiotomy, and in the light of previous findings, it seems reasonable to suggest that episiotomy should ideally be used in about one in five spontaneous vaginal deliveries.
A retrospective investigation into the prevalence of stress incontinence in women delivered by elective cesarian section (without experience of labor) in Lund from 1974 to 1979, was carried out in 1980. Of 264 women whose replies were solicited, 204 responded. The others had moved about and could not be reached.Permanent stress incontinence was reported by a significant number of patients without experience of labor. This supports our earlier findings which indicated that pregnancy and hereditary factors are more decisive in bringing about stress incontinence than the delivery itself.
To describe the prevalence of maternal physical and emotional health problems six to seven months after birth.
Statewide postal survey, incorporating the Edinburgh Postnatal Depression Scale, distributed to women six to seven months after childbirth.
All women who gave birth in a two-week period in Victoria, Australia in September 1993 except those who had a stillbirth or known neonatal death.
The response rate was 62.5% (n = 1336). Respondents were representative of the total sample in terms of mode of delivery, parity and infant birthweight; young women, single women and women of nonEnglish speaking background were under-represented. One or more health problems in the first six postnatal months were reported by 94% of the women; a quarter had not talked to a health professional about their own health since the birth. Of women reporting health problems, 49% would have liked more help or advice. The most common health problems were tiredness (69%), backache (43.5%), sexual problems (26.3%), haemorrhoids (24.6%) and perineal pain (21%); 16.9% of women scored as depressed. Compared with spontaneous vaginal births, women having forceps or ventouse extraction had increased odds for perineal pain (OR 4.69 [95% CI 3.2-6.8]), sexual problems (OR 2.06 [95% CI 1.4-3.0]), and urinary incontinence (OR 1.81 [95% CI 1.1-2.9]). These differences remained significant after adjusting for infant birthweight, length of labour and degree of perineal trauma.
Physical and emotional health problems are common after childbirth, and are frequently not reported to health professionals despite the fact that many women would like more advice and assistance in dealing with them.
The goal of this case control study was to evaluate the relationship between smoking and female urinary incontinence.
The study included 606 women whose smoking histories were known; 322 were incontinent and 284 were continent. The condition(s) causing each subject's incontinence was determined by urodynamic testing; 40% of the continent subjects had the same testing.
There were highly significant overall differences (p = 0.000009) in the distribution of current, former, and never smokers between incontinent (35%, 16%, 49%) and continent (24%, 8%, 68%) groups. The odds ratio for genuine stress incontinence was 2.20 for former (95% confidence interval 1.18 to 4.11) and 2.48 for current smokers (95% confidence interval 1.60 to 3.84); for motor incontinence it was 2.92 for former (95% confidence interval 1.58 to 5.39) and 1.89 (95% confidence interval 1.19 to 3.02) for current smokers. Increasing daily and lifetime cigarette consumption was associated with an increasing odds ratio for genuine stress incontinence but not for motor incontinence. The increased risk for incontinence was not due to differences in age, parity, weight, or hypoestrogenic status.
The data establish a strong statistical relationship between current and former cigarette smoking and both stress and motor urinary incontinence in women.
The aim was to investigate the possible association between parity, as indicated by the number of childbirths, and prevalence of urinary incontinence in an adult female population sample.
A sample of 3114 women aged 30-59 years was selected at random from the population of Aarhus, Denmark, and mailed a self administered questionnaire on urinary incontinence and, among other things, parity.
A total of 2631 questionnaires was returned (85%) with a slight but significant decrease in respondency by age.
The 1987 urinary incontinence period prevalence was 17%. Seventy eight percent were parous, and 24% had had three or more childbirths. In women aged 30-44 years, the prevalence of urinary incontinence was found to be associated with parity and, in women aged 45 years and more, with three or more childbirths. In parous women 30-44 years of age, the prevalence of urinary incontinence increased with age at least childbirth and, in women aged 45 years and over, it increased with increasing parity but decreased with increasing age at first childbirth. In parous women, no association was found with time since last childbirth. Among clinical types of urinary incontinence, stress incontinence consistently showed the strongest associations with indicators of parity. In women aged 30-44 years, nearly two thirds of the 1987 prevalence of stress incontinence could be attributed to parity.
These findings support the hypothesis that pregnancy and childbirth are potent causes of female urinary incontinence, so that they exert considerable impact on the level of population urinary incontinence prevalence. In the individual woman, the effect seems to be cumulative and long lasting but fades with age.
Three hundred five primiparas were interviewed repeatedly about stress incontinence before and during pregnancy and after delivery. Eleven (4%) had stress incontinence before pregnancy and 98 (32%) during pregnancy, whereas 21 (7%) developed it after delivery. According to the International Continence Society definition, the corresponding frequencies were one (0.3%), three (1%), and one (0.3%), respectively. Obstetric factors such as length of the second stage of labor, head circumference, birth weight, and episiotomy seemed to be associated with, whereas cesarean delivery seemed to protect against, the development of stress incontinence after delivery. Three months after delivery, the statistically significant influence of the obstetric factors had vanished, as stress incontinence had disappeared in most women. However, 1 year after delivery eight of 292 women (3%) had stress incontinence, three with onset during pregnancy and five with onset after delivery. Three of these eight had stress incontinence according to International Continence Society criteria; four women wanted treatment. The symptom of stress incontinence occurs as a natural consequence of pregnancy and delivery and generally resolves in the puerperium. However, pregnancy and delivery carry a small risk (1% or less) of initiating persistent stress incontinence. The importance of various obstetric factors seems transient and their etiologic role remains unclear.
Urinary leakage was reported in 53.5% of our patients at least once during pregnancy. Multigravidae and women older than 30 were affected more often than primigravidae or women younger than 30. 6.2% of all women, who were continent before pregnancy, developed permanent stress incontinence after vaginal delivery. As a conclusion, it can be said, that vaginal delivery itself predisposes for permanent stress urinary incontinence (SUI). Factors, which increase the trauma to the pelvic floor (tear, no episiotomy, forceps or vacuum extraction), show a higher incidence of postpartum persisting SUI without statistic significance. Labour management with epidural anaesthesia showed a statistically proven lower incidence of postpartum persisting SUI in comparison to the pudendal block.
To determine the correlation between lower urinary tract symptoms and urodynamic findings in early pregnancy.
The termination clinic and gynaecology ward at King's College Hospital.
Observational study.
47 women before termination of pregnancy at between 6 and 15 weeks.
Women filled in symptom questionnaires and then had urodynamic investigations, consisting of uroflowmetry and subtracted provoked cystometry.
The occurrence of lower urinary tract symptoms and their association with urodynamic findings.
Lower urinary tract symptoms were fairly common but there was poor correlation with the urodynamic findings.
The findings suggest that lower urinary tract symptomatology alone is insufficient to study lower urinary tract dysfunction in pregnancy.
The prevalence, incidence and correlates of urinary incontinence were studied in a community-based sample of 541 healthy, middle-aged women 42 to 50 years old. Participants were evaluated on 2 occasions approximately 3 years apart. Of the participants 58% reported urine loss at some time and 30.7% reported incontinence on a regular basis at least once per month. During 3 years the cumulative incidence of regular incontinence in previously continent women was 8.0%. Among those with regular incontinence 64.9% said the volume of loss was 1 or 2 drops, while 35.1% reported that they needed to change their garments. Only 25.5% of the patients had sought treatment. Continence status was significantly related to body mass index and race but not to patient age, parity, caffeine or alcohol intake, smoking, physical activity, prior gynecological surgery or several psychological variables. The results indicate that urinary incontinence is common among middle-aged women. That few seek treatment suggests a need for more information about women's attitudes toward incontinence and more attention to this problem by health care providers.
Three hundred twenty-six women filled out questionnaires to assess the relationship between exercise and incontinence. Two hundred ninety participants stated that they exercised regularly. Overall, 152 (47%) noted some degree of incontinence, which correlated positively with the number of vaginal deliveries (P less than .0005). Eighty-seven exercisers (30%) noted incontinence during at least one type of exercise. Incontinence exclusively during exercise was seen in only one woman. Exercises involving repetitive bouncing were associated with the highest incidence of incontinence. Seventeen incontinent exercisers (20%) stopped an exercise because of incontinence, whereas 16 (18%) changed the way a specific exercise was done and 48 (55%) wore a pad during exercise. Thirty-five percent had discussed their incontinence with a health care professional. These data suggest that incontinence during exercise is a common, although little known, problem. In addition to the behavioral adaptations which women initiate on their own, surgical and nonsurgical treatments may be of benefit.
A probability sample of noninstitutionalized elderly people in Washtenaw County, Michigan, was interviewed to determine the relationship between urinary incontinence and various health conditions. The results show that between both male and female respondents physical mobility problems, specific neurologic symptoms, lower urinary tract problems, bowel problems, respiratory problems, and history of genital surgery are more prevalent among those who are incontinent than among those who are continent. Additional factors associated with incontinence in females are: history of parent and sibling incontinence, incontinence either during pregnancy or postpartum, hearing problems, use of female hormones, and vaginal infections. Incontinence among males is associated with vision problems and a history of and symptoms of cardiovascular disease. These findings suggest urinary incontinence is part of a complex and multifactorial problem. Further studies are needed to confirm and explain these findings.
3,114 women were randomly selected among the 30-59 years old female inhabitants of the Municipality of Aarhus, Denmark, and mailed a questionnaire on experience of urinary incontinence (UI) through adult life. Eighty-five % responded, and 26% reported to have experienced UI in adult life. Fourteen % had perceived it a social of hygienic problem, in accordance with the International Continence Society (ICS) definition. The total period prevalence year 1987 and the period prevalence according to the ICS definition were found to be 17 and 10%, respectively. The estimated incidence of UI increased with age, especially through ages 25-29 and 45-49. By the age of 59, 30 and 18% were estimated to have had one or more episodes of UI in general and ICS defined UI, respectively. Pure stress UI and combined stress and urge UI seemed to be the predominant clinical types.
Women who had participated in a randomised controlled trial of policies of restricted (10%) versus liberal (51%) episiotomy during spontaneous vaginal delivery were recontacted by postal questionnaire three years after delivery. Altogether 674 out of 1000 responded, and there was no evidence of a differential response rate between the two trial groups. Similar numbers of women in the two groups reported further deliveries, almost all of which had been vaginal and spontaneous. Fewer women allocated to restrictive use of episiotomy required perineal suturing after subsequent delivery, but this difference was not significant. Pain during sexual intercourse and incontinence of urine were equally reported in the two groups. The similarity in incontinence rates persisted when severity, type of incontinence, and subsequent deliveries were taken into account. Liberal use of episiotomy does not seem to prevent urinary incontinence or increase long term dyspareunia.
To determine the prevalence of urinary incontinence and other urinary symptoms a questionnaire was sent to all women aged 25 and over and to women under 21 taking oral contraceptives registered with a rural practice (n = 937); the questionnaire was completed by 833 women (89%). The overall prevalence of urinary incontinence was 41% (343/833); rates were lower in nulliparous and postmenopausal women (30/181 (17%) and 120/344 (35%) respectively) than parous and premenopausal women (313/652 (48%) and 225/479 (47%) respectively). Incontinence was significantly associated with perineal suturing after childbirth, being present in 201 of 376 (53%) women with sutures compared with 113 of 270 (42%) without. Of the 166 women with a history of minor gynaecological surgery, 100 had symptoms of incontinence, compared with 263 of the 657 (37%) without such a history. Incontinence was not related to type of delivery, and postnatal exercises for the pelvic floor were not beneficial. Inappropriate leakage of urine is perceived by many women as common and therefore not serious; thus it is often not reported to the doctor. Nevertheless, the 6% of women who always require protection against leakage could be helped by treatment.
In a series of 368 incontinent women who presented to our urodynamic clinic for assessment, 232 (63%) were diagnosed as having genuine stress incontinence, and 136 (27%) as having detrusor instability. Obesity (greater than 20% more than average weight for height and age) was significantly more common in women with genuine stress incontinence and detrusor instability than in the normal population. In those with detrusor instability the body mass index was found to increase with age and parity. In women with genuine stress incontinence the body mass index increased with age and the number of previous incontinence operations; it was higher in nulliparous than in parous women. There was no significant difference between obese and nonobese women in any of the urodynamic variables measured in the two incontinence groups.
In an epidemiological health survey, 515 45-year-old women were interviewed about urological problems, particularly incontinence. A pelvic examination was also conducted on 509 of the women. Twenty-two per cent or 114 women stated that they experienced incontinence, which took the form of stress incontinence in 75%, urge incontinence in 11% and a mixture of the two in 14%. Only 14 women, 3% of all the women interviewed, desired medical treatment for incontinence. In the incontinent women, the pelvic examination significantly more often revealed a cystocele, uterine prolapse or impaired function of the levator muscles. No correlation was found between an enlarged uterus and incontinence. In 211 women with one or more of these findings at the gynaecological examination, the frequency of incontinence was 35%; in 298 women with no pathological findings, the frequency was 15%. The frequency of urinary incontinence was not increased in women with higher parity or in postmenopausal women.
A retrospective follow-up investigation dealing with the frequency of stress incontinence was carried out among maternities at the Women's Clinic in Lund over a period of 15 months. Of 1400 newly-delivered women whose interviews were solicited, 1411 responded. Twenty-two percent indicated symptoms of stress incontinence. These were examined gynecologically, including Bonney's test. The material may be divided into four groups according to the onset and type of stress incontinence:--Onset of stress incontinence prior to pregnancy in connection with puberty: 8.5% of the total number of stress incontinents (2% of th entire material). -- Permanent stress incontinence with onset during pregnancy; 23% of all stress incontinents (5% of the entire material). --Temporary, mild, "physiological" stress incontinence, manifest only during the second part of the pregnancy and disappearing approximately 3 months after delivery. This type of incontinence represents 50% of all stress incontinence (11% of the entire material). --Stress incontinence arising in conjunction with or following parturition; 19% of all cases of stress incontinence (4% of the entire material). Of the patients in this group 8% were temporarily incontinent. Eleven percent (2.3% of the entire material), represents women suffering from constant incontinence which first appeared in connection with childbirth. It is more often the case that stress incontinence begins during the first pregnancy rather than during subsequent pregnancies (statistical significance P less than or equal to 0.05). The results indicate that the pregnancy itself and hereditary factors predispose more readily than the parturition trauma to the occurrence of stress incontinence.
71 women delivered at St Bartholomew's Hospital, London, were studied by electrophysiological tests of the innervation of the external anal sphincter muscle and by manometry. The investigations were done 2-3 days after delivery and again, in 70% of these women, 2 months later. Faecal and urinary incontinence developing after vaginal delivery has been thought to be due to direct sphincter division, or muscle stretching, but the results of the study suggest that in most cases this incontinence results from damage to the innervation of the pelvic floor muscles.
One thousand and sixty women aged 18 or over, randomly selected from a defined geographical area in South Wales, were interviewed at home about their urinary symptoms. Ninety-five per cent co-operated, of whom 45% admitted to some degree of incontinence. "Stress' incontinence was reported by 22% of women, "urge' incontinence by 10%, and both types combined--"complex'--by 14%. In most women urinary loss was both small and infrequent but 5% of all women experienced a loss sufficient to necessitate a change of clothes; in 2.6% such loss occurred daily. Over 3% of all women reported that incontinence interfered with their social or domestic life but only half of these had sought medical advice.
We questioned 181 healthy pregnant women about their urological symptoms during pregnancy; frequency and stress incontinence were commonest. The incidences of stress incontinence and urge incontinence were increased and that of hesitancy was decreased by pregnancy. Descent of the presenting part did not affect any of these symptoms.
The prevalence of urinary incontinence was investigated by determining the number of incontinent patients under the care of various health and social service agencies in two London boroughs and by a postal survey of the 22 430 people aged 5 years and over on the practice lists of 12 general practitioners in different parts of the country. The prevalence of incontinence known to the health and social service agencies was 0.2% in women and 0.1% in men aged 15-64 and 2.5% in women and 1.3% in men aged 65 and over. The postal survey, to which 89% of the people whose correct address was known replied, showed a prevalence of urinary incontinence of 8.5% in women and 1.6% in men aged 15-64 and 11.6% in women and 6.9% in men aged 65 and over. Nulliparous women had a lower prevalence than those who had had one, two, or three babies, but within the parity range of one to three there were no differences in prevalence. The prevalence was appreciably increased in women who had had four or more babies. Incontinence was moderate or severe in a fifth of those who reported it in the postal survey, of whom less than a third were receiving health or social services for the condition. Incontinence is a common symptom, and many unrecognised cases appear to exist. There may be considerable scope for improving its management.
This study was undertaken to evaluate the risk of permanent flatus or urinary incontinence after repeated vaginal deliveries.
In 1989 a questionnaire on obstetric history and urinary and fecal incontinence was sent to a sample of 304 women selected from the birth records from 1976 to 1988; 242 responded (80 percent).
Participants had one, two, or three vaginal deliveries, all without an obstetric tear of the anal sphincter. After the first, second, and third deliveries, 1.2, 1.5, and 8.3 percent developed permanent flatus incontinence. The risk was significantly increased after the third delivery compared with the first and second deliveries (odds ratio, 6.6; confidence interval, 2.4-18.3). Permanent urinary incontinence after the first, second, and third delivery developed in 3.3, 1.0, and 6.8 percent. The risk was significantly increased after the third delivery compared with the first and second (odds ratio, 3.2; confidence interval, 1.1-9.1).
These results indicate that repeated vaginal deliveries increase the risk of minor anal and urinary incontinence, which were found to be a common problem in premenopausal women.
The aim of the present investigation was to study the possible role of obesity in the etiology of adult female urinary incontinence (UI). A random population sample of 3,114 women aged 30-59 years were mailed a questionnaire concerning UI and, among other things, body weight and height. The overall rate of response was 85%, and the present analysis comprises 2,589 women who supplied information about their body weight and height. The period prevalence of all UI, stress UI, urge UI, and mixed stress and urge UI was 17%, 15%, 9%, and 7%, respectively. The mean body mass index (BMI) was 22.7 kg/m2. Irrespective of other risk indicators, BMI was positively associated with UI prevalence (OR, 1.07/BMI unit; P < 0.0001). BMI interacted with childbirth in predicting stress UI prevalence, with cystitis in predicting urge UI, and with both in predicting mixed UI. Stress UI proved to be the UI type most closely associated with BMI.
The aim of this case-control study was to examine differences in risk factors and determinants of genuine stress incontinence between smokers and nonsmokers.
Seventy one smokers and 118 nonsmokers with pure genuine stress incontinence underwent a complete urogynecologic evaluation. Differences in risk factors and determinants of genuine stress incontinence were analyzed by means of chi 2 and nonparametric techniques.
Smokers had stronger urethral sphincters and generated greater increases in bladder pressure with coughing but had equivalent urethral mobility and pressure transmission ratios compared with nonsmokers. Smokers were significantly younger than nonsmokers, tended to be less often hypoestrogenic, but were of equivalent vaginal parity and weight.
Genuine stress incontinence develops in smokers in spite of their stronger urethral sphincter and lower risk profile than nonsmokers. More violent coughing by smokers likely promotes the earlier development of the anatomic and pressure transmission defects that allow genuine stress incontinence and overcomes any protective advantage of a stronger urethral sphincter.
In a cross-sectional study, 85% of 3114 women responded to a questionnaire on urinary incontinence and a history of abdominal, gynaecological and urological surgery. In 1987 the prevalence of urinary incontinence was 17%; 63% had undergone surgery, mainly gynaecological, and almost one-third of the respondents had had more than one operation. Bivariate and multivariate analysis showed stress urinary incontinence to be associated with previous exposure to surgery.
To evaluate the influence of mediolateral episiotomy on the perineal state after spontaneous, singleton vaginal deliveries with fetus in the occiput anterior position.
The study was a population based, observational study. Two approaches were used in the analyses. Initially, we considered the parturients as quasi-randomised to one of three equally sized groups of midwives with different attitudes towards episiotomy. Secondly, we studied the effect of episiotomy on the state of the anal sphincter, controlling for birthweight, parity, and duration of second stage of labour.
2188 pregnant women delivering consecutively.
Perineal lacerations and tear of the anal sphincter.
Women allocated to the group of midwives with the lowest rate of episiotomy were more likely to have intact perineum after delivery (OR = 1.8 (1.4-2.2)), had a slight tendency towards more perineal lacerations (OR = 1.3 (1.0-1.5)), but no increase risk of having tear of the anal sphincter, compared with the women allocated to the two groups of midwives with higher frequencies of episiotomy. The second approach showed that episiotomy was related to an increased risk of tear of the anal sphincter (OR = 2.3 (1.2-4.6)). However, this relation was not found among the group of parturients delivered by the midwives with the lowest rate of episiotomy (22%).
Our results encourage a conservative approach to the use of mediolateral episiotomy, and in the light of previous findings, it seems reasonable to suggest that episiotomy should ideally be used in about one in five spontaneous vaginal deliveries.
To investigate the prevalence of urinary incontinence among people living at home, their responses to it, and its emotional and social effects.
Random sample of 4007 adults interviewed in their own homes.
Random sample of 178 constituency sampling points throughout Great Britain.
1883 men, 2124 women aged 30 and over.
Responses to questionnaire.
6.6% (125) men and 14.0% (297) women had been incontinent of urine at some time--2.8% (52) men and 7.5% (159) women in the previous two months and 61% (124) of these for more than four years. 52% (108) had consulted their general practitioner at the onset of incontinence and a further 31% (65) later. Doctors commonly took a urine sample (163, 54%), referred the patient to a specialist (127, 42%), and prescribed tablets (109, 36%); only 22% (66) carried out an abdominal, rectal, or vaginal examination. Patients were not embarrassed in seeing their doctor and most thought they were treated sympathetically. 60% (265) of all those affected were concerned or worried about their incontinence, and in almost half incontinence limited their daily social activities.
More people with incontinence seem to be consulting their doctors about it than has been found in previous studies, but the procedures carried out by general practitioners still seem to be suboptimal. Urinary incontinence has a profound effect on the day to day lives of most of those who suffer from it.
The influence of age, parity, duration of previous oral contraceptive use, hysterectomy and menopause on the prevalence of urinary incontinence was evaluated by means of a postal questionnaire in women 46 to 86 years old who resided in the city of Göteborg, Sweden. A sample of 10,000 women from the 7 birth cohorts of 1900 to 1940 was obtained at random from the population register. The overall response rate was 74.6%. The prevalence of urinary incontinence increased (p < 0.001) in a linear fashion from 12.1% in the 1940 birth cohort to 24.6% in the 1900 birth cohort. The prevalence of urinary incontinence in nulliparous women was 7.7% in the 1930 birth cohort and 5.5% in the 1940 birth cohort. The corresponding figures for women who had experienced 1 delivery were 11.1% and 10.6%, compared to 14.0% and 16.4% among women who had had 3 or more deliveries. Urinary incontinence was more prevalent in women who had undergone hysterectomy (p < 0.05). The prevalence of urinary incontinence was unaffected by the duration of previous oral contraceptive use and there was no evidence to suggest that the prevalence of urinary incontinence increased at the time of the last menstrual period.
The purpose of this study was to explore the symptoms of urinary incontinence among primiparous women.
This descriptive study used a paper and pencil mail survey. A sample of 300 primigravida mothers (aged 16 to 45 years; 10 weeks to 8 months postpartum) was garnered from a university-affiliated city-county hospital.
Most respondents (53%, n = 65/122) reported urinary incontinence (UI) symptoms sometime before, during, or after pregnancy. Few respondents (6.2%, n = 4) had UI symptoms continuously across all time periods surveyed. Age did not contribute to UI when a comparison was made among mothers who were very young (aged 16 to 19 years), young (aged 20 to 29 years), and mature (aged 30 to 36 years). None of the respondents with persistent or current UI had reported the symptoms to a health care provider. Of those who had reported their symptoms (n = 11), only four mothers received any recommendations for treatment.
However common UI may be during pregnancy, it is commonly overlooked as a problem amenable to simple and effective behavioral treatments. This study shows that UI is equally problematic for very young mothers and more mature mothers. Additional studies are indicated among very young mothers to document factors related to prevalence and incidence.
To investigate the relationship between pre-pregnancy obesity, and urinary symptoms, especially urinary incontinence, before, during, and 6-18 months after delivery.
Body Mass Index extracted from obstetric records. Postal questionnaire. MATERIAL AND SETTING: One hundred and eight women with Body Mass Index of at least 30 kg/m2 delivered at the Obstetric Department, Herning Central Hospital, October 1994 to September 1995. As control served 108 matched, normal weight women delivering during the same period.
Response rate was 83%. Stress incontinence, urgency and the feeling of having a hygienic problem was significantly more common after delivery in both groups, but at any time significantly more common among obese women. Urge incontinence was a numerically small problem after delivery.
Obesity is a potent risk factor for several urinary symptoms after pregnancy and delivery, and a substantial number of women still have problems 6-18 months postpartum.
To investigate the effect of applying a problem assessment versus a pure symptom urinary incontinence (UI) caseness definition in etiologic research.
A random population sample of 2613 women aged 30-59 years, who responded to a postal questionnaire. MAIN PARAMETERS: One-year period prevalence of the symptom of stress UI; UI assessed by the woman to be a social and/or hygienic problem; childbirth and history of abdominal, gynecological, obstetric or urologic surgery.
Among the 388 women (14.8% of the population sample) who reported stress UI, 62.6% considered it a social or hygienic problem, and 21.9% had ever abstained socially because of UI. Applying a problem assessment caseness definition caused under-estimation of the role of childbirth, as compared with analyses including a pure symptom caseness definition.
The International Continence Society (ICS) incontinence definition presents intrinsic logical problems that invalidates its use in biomedical, if not in sociomedical, research. As definition and medical decision are different concepts, this does not necessarily affect the potential utility of the problem assessment aspect when used in everyday clinical practice as a basis for the decision whether to treat women with UI or not.
To assess specific parturition and reproductive variables as potential risk factors for urinary incontinence in later life.
A mail survey was conducted with a random sample of 1922 women members of a large health maintenance organization. Multivariate analysis was used to estimate the independent association between parturition factors, hysterectomy, hormone use, and incontinence.
Completed surveys were returned by 939 women (49%), 682 of whom reported at least one episode of incontinence in the past 12 months or ever having been treated for incontinence. On univariate analysis, women with incontinence were more likely to be white and heavier and to have had a hysterectomy before age 45, at least one live birth, a postdate (at least 42 weeks' gestation) birth, a labor lasting longer than 24 hours, and exposure to oxytocin. The risk of incontinence increased significantly with the number of exposures to oxytocin. In a multivariate model including age, there was a significant association between incontinence and white race (odds ratio [OR] 1.8, 95% confidence interval [CI] 1.2, 2.8), body mass (OR for fourth quartile 3.0, 95% CI 1.8, 5.0), estrogen replacement (OR 1.9, 95% CI 1.3, 2.8) and oxytocin (OR 1.9, 95% CI 1.0, 3.6). Parity was also associated with incontinence (P < .05).
This study supports previous findings of a positive association between urinary incontinence and body mass, parity, and use of estrogen. In addition, we found a significant independent association between exposure to oxytocin during labor and incontinence in later life.
Validation of a questionnaire about incontinence in pregnancy. Diploma report, English summary
- Winslew NA
- Winslew NA
Validation of a questionnaire about incontinence in pregnancy. Diploma report, English summary. Faculty of Health Sciences
- N A Winslew