Article

First vaginal delivery at an older age: Does it carry an extra risk for the development of stress urinary incontinence?

Tel Aviv University, Tell Afif, Tel Aviv, Israel
Neurourology and Urodynamics (Impact Factor: 2.87). 10/2007; 26(6):779-82. DOI: 10.1002/nau.20414
Source: PubMed
ABSTRACT
First delivery at an older age is not an uncommon event in modern obstetric practice. The present study was undertaken to compare the prevalence of postpartum stress urinary incontinence (SUI) according to maternal age and mode of delivery.
Fifty two consecutive elderly primiparae (mean age 40.0 +/- 1.8) who underwent spontaneous vaginal delivery, 42 consecutive elderly primiparae (mean age 40.7 +/- 3.6) who underwent elective cesarean section, and 92 consecutive young primiparae (mean age 26.2 +/- 2.5) who underwent spontaneous vaginal delivery were interviewed 1-2 years postpartum about the symptom of SUI. Women who had SUI before pregnancy were not enrolled. Obstetric data were collected from computerized hospital records.
The prevalence of SUI 1-2 years after spontaneous vaginal delivery was significantly higher in elderly compared with younger primiparae (38.5% vs. 9.8%, respectively). Elderly primiparae who underwent elective cesarean section had a significantly lower prevalence of postpartum SUI than those delivered vaginally (16.7% vs. 38.5%, respectively). Further comparison of stress-incontinent versus continent elderly primiparae failed to reveal significant demographic or obstetric differences, except for increased prevalence of SUI during pregnancy among incontinent patients (45% vs. 19%, respectively).
First vaginal delivery at an older age carries an increased risk for postpartum SUI. Stress-incontinent women also had higher prevalence of SUI during pregnancy. This finding implies that the pathophysiologic process of SUI begins during pregnancy, prior to active labor and delivery. Nonetheless, elective cesarean section in these women has a protective effect and lowers the risk of developing postpartum SUI.

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Available from: David Pauzner, Jul 20, 2014
Neurou rolog y and Urody na mics
First Vaginal Delivery at an Older Age: Does It Carry an
Extra Risk for the Development of Stress Urinary Incontinence?
Asnat Groutz,* Limor Helpman, Ronen Gold, David Pauzner,
Joseph B. Le ssing, and David Gordon
Urogynecology and Pelvic Floor Unit, Department of Obstetrics and Gynecology, Lis Maternity Hospital,
Tel Aviv Sourasky Medical Center, a⁄liated to the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
Aims: First delivery at an older age is not an uncommon event i n modern obstetric practice. The
present study was undertaken to compare the prevalence of postpartum stress urinary incontinence
(SUI) according to maternal age and mode of delivery. Methods: Fifty two consecutive
elderly prim iparae (mean age 40.0 1.8) who underwent spontaneous vagina l delivery, 42 consecu-
tive elderly primiparae (mean age 40.7 3.6) who un derwent elective cesa rean section, and 92 con-
secutive young primiparae (mean age 26.2 2.5) wh o underwe nt spontaneous vaginal delivery were
interviewed 1^2 years postpartum about the symptom of SUI. Women who had SUI before
preg nancy were not enrolled. Obst etric data were collected from computerized hospital
records. Re su lts: The prevalence of SUI 1^2 years after spontaneous vaginal delivery was signi¢-
cantly higher in elderly compared with younger primiparae (38.5% vs. 9.8%, respectively). Elderly
primiparae who underwe nt elective cesarean section had a signi¢cantly lower prevalence of post-
partum SUI than those delivered vaginally (16.7% vs. 38.5%, respectively). Further comparison of
stress-incontinent versus continent elder ly primiparae failed to reveal signi¢cant demographic or
obstetric di¡erences, except for increased prevalence of SUI during pregnan cy among incontinent
patients (45% vs. 19%, respectively). Co nclu sions: First vaginal de livery at an older age carries an
increased risk for postpartum SUI. Stress-incontinent women also had higher prevalence of
SUI during pregnancy. This ¢nding implies that the pathophysiologic process of SUI begins during
preg nancy, prior to active labor and delivery. Nonetheless, elective cesarean section in these women
has a protective e¡ect and lowers the risk of developing postpartum SUI. Neurourol. Urodynam.
ß 2007 Wiley-Liss, Inc.
Key words: childbirth; elderly primiparae; maternal age; pregnancy; stress urinary
incontinen ce
INTRODUCTION
Pregnancy and childbir th have lo ng been considered as risk
fact ors in the genesis of pelvic £oor disorders. Mechanical
and hormonal changes during pregnancy, as well as the
me chanical strain during labor and delivery, may all cause
partial denervation of the pel vic £oor, and direct injury to
pelvic mu scles and connective tissue. Thes e injuries may
further lead to the development of stress urinary incontinence
(SUI), anal incontinence, pelvic organ prolapse, and/or void-
ing dysfunction. Although ma ny studies have shown some
correlation between obstetric parameters and the develop-
me nt of these s ymptoms, there is no consensus regarding
the impact and relative contribution of the di¡erent risk
fact ors. Moreover, the etiology of pelvic £oor disorders is
multifactorial. Additional risk factors, other than pr egnancy
and child birth, include heredity, collagen abnormalities,
obesity and aging [Rortveit et al., 2001, 2003a,b; Grodstein
et al ., 20 03].
First delivery at an older age is not an u ncommon e vent in
modern obstetric practice, and the association between
advanced mate rnal age and various pregnancy complications
is well established. However, it is still unknown whether
eld erly primiparae are also at increased risk for childbirth-
associated pelvic £oor injury. The prese nt study was underta-
ken to compa re the prevalence of SUI among elderly versus
young er primiparae1^2 ye ars after spontaneous vaginal deliv-
ery and to a ssess the risk for postpartum SUI associated with
di¡erent mo des of delivery among elderly prim iparae.
METHODS
Elderly prim ipara e were de¢ned as being 3 7 years old and
over.Young primiparae were d e¢ned as being 20^29 years old.
No con£ict of interest reporte d by the author(s).
Abbreviations: SUI, stress urinary incontinence
Asnat Groutz and Limor Helpman made equal contribution to this paper.
*Correspondence to: Asnat Groutz, MD, Urogynecology, Lis Maternity
hospital, Tel Aviv Sourasky Medical Center, 6 Weizman St reet, Tel Aviv,
Israel. E-mail: agroutz@yahoo.com
Received 24 August 20 06; Accepted 17 January 2007
Published online i nWiley InterScience
(www.interscience.wiley.com)
DOI 10.1002/nau.20414
ß 2007Wiley-Liss,Inc.
Page 1
The study population comprised of 186 prim ipara e who
delivered in the obstetric ward of the Lis Maternity Hospital,
Tel Aviv Sourasky Medical Center. The stu dy populat ion was
divided into three subgroups ac cording to maternal age and
mode of delivery: 52 consecutive elderly p rimiparae who
underwent sp ontaneous vaginal delivery, 42 consecutive
elderly primiparae who underwent elective cesarean
section, and 92 consecutive young primiparae who underwent
spontaneous vaginal delivery. Pr e-term deliveries, multi fetal
pregnancie s, instrumental-assisted deliveries and non-elective
cesarean sections, were all excluded. Patie nts who underwent
elective cesarean section were not given a trial of labor.
One to two years postpart um, all women were interviewed
regarding the symptom o f SUI. We chose this time period
because a previous study showed that primiparous women
with SUI, 3 months postpartum, are at increased risk of long-
lasting symptoms [Viktrup and Lose , 2001]. Moreover, women
who had a second pregnancy and delivery within this time
period were excluded. The symptom of SUI was de¢ned as
an involuntary leakage of urine with coughing, laughing,
sneezing, or any other physical e¡ort. Women were asked
whe ther they had ever experienced SUI before pregnancy.
Those who had SUI before pregnancy were excluded . Thus,
only ca ses of de novo childbirth-associated SUI were a na-
lyzed . Furthermore, we considered only ‘‘regular’ u ri nar y
incontinence as d e¢ned by Thomas et al. [1980]: ‘‘involuntary
excretion or leakage of urine in inappropriate places or at
inappropriate times twice or more a month, regardless of
the quantity of urine lost.’’ Patients were also asked
whe ther they had consulted a physician regarding their urin-
ary incontinence, and whether the y desi red further evaluation
and treatment.
Obstetric data were collected from a computerized data-
base. Details of maternal, fetal, obstetric and anesthesiologic
parameters were obtained, a nd included: maternal a ge, weight
and height, gestational age at delivery, length of ¢rst and sec-
ond stages of labor, use and type of analgesia (epid ural, narco-
tics), p erineal trauma (posterolateral episiot omy, te ars), birth
weight and Apgar scores. Prevalence of SUI du rin g pregnancy
and at 1^2 years postpartum, as well as demographic and
obstetric parameters, were analyze d and compared among
the three study subgr oups.
Statistical analysis was performe d using Stu dent’s t-tes t
for continuous data or w
2
for categorical data. P < 0.05 was
considered statistically signi¢cant. Data ar e summa rized
as mean standard dev iation (M SD), or percentage
according to the variables.
RESULTS
Fifty-two consecutive eld erly pr imiparae (mean age
40.0 1.8) who underwent spontaneous vagi nal delivery,
42 consecutive elderly primiparae (mean age 40.7 3.6) who
underwent elective cesarean section, and 9 2 consecutive
young primiparae (mean a ge 26.2 2.5) who underwent
spontaneous vaginal delivery were enrolled. Demographic
and obstetric characteristics of the three stu dy subgroups are
presented in Table I. The thr ee subgroups were comparable
with respect to maternal height, gestational age at delivery,
use of epidural anesthesia, episiotomy (among parturients
delivering vaginally) and Apgar scores, as well as the pr eva-
lence of SUI dur ing pregnancy. Mean maternal body weight
was found to b e signi¢cantly higher among elderly primiparae
regardless of mo de of delivery. Among pa rturients delivering
vaginally, length of second stage of labor a nd newborn birth
weights were signi¢cantly higher in younger primiparae.
Among elderly primiparae, bir th weights were signi¢cantly
higher in patients undergoing elective cesarean section.
T he prevalence of SUI 1^2 years after spontaneous vaginal
delivery was signi¢cantly higher in elderly compar ed with
younger primipar a e (38.5 % vs. 9.8% , resp e c t i vel y; P < 0.0 01).
Elderly prim iparae who u nder went elective cesarean section
had a signi¢cantly lo wer prevalence of postpartum SUI than
those delivered vagi nally (16.7 % vs. 38.5 %, respectively,
P ¼ 0.02).
Comparison of stress-i ncontinent versus continent
eld erly prim ipara e 1^2 years afte r spontaneous vaginal
delivery is shown in Table II. The prevalence of SUI during
pregnancy was signi¢cantly higher among those who were
str ess-incontinent postpa rtum (45% vs. 18.8%, respectively;
P ¼ 0.04). All other demographic and obstetric parameters
were comparable among incontinent and continent women.
Most (80^ 90%) of the stress-incontinent women in
each age group had not consulted a physician regar ding their
s ymptoms. However, on dir ect questioning, half of these
s ymptomatic women expr ess ed their desire for further evalua-
tion and treatment.
Neurourology and Urodynamics DOI 10.1002/nau
TABLE I. Patient Characteristics
Mean SD or (%)
Elderl y
primiparae
VD
You n g e r
prim iparae
VD
Elderly
prim iparae
CS
No. of patients 52 92 42
Age (yr) 40.0 1.8 26.2 2.5 * 40.7 3.6
Weight (k g) 74 11.0 59 8.9* 76.1 19.1
Heig ht (cm) 165 6.3 163 6.7 165.4 6.4
Gestational age (wk) 39.1 1.7 39.7 1.3 38.6 1.3
First stage (min) 360 392 303 138 NR
Second stage (min) 89 64.5 106 53.9* NR
Episiotomy (%) 42 (80.1) 78 (84.8) NR
Epidural anesthesia (%) 46 (88.5) 86 (93.5) 42 (100)
Apgar 1 min 8.8 0.7 8.9 0.26 8.9 0.3
Apgar 5 min 9.8 0.6 9.9 0.2 9.8 0.8
Bir th weight (g ) 3037 438* 3240 405 3311 619
SUIduringpregnancy(%) 15(28.8) 26(28.3) 11(26.2)
Postpartum SUI (%) 20 (38.5)* 9 (9.8) 7 (16.7)
SUI, stress urina ry incontinence; VD, spontaneous vaginal delivery; CS,
elective cesarean section.
*Signi ¢cantly di¡erent from the corresponding ¢gures in the same line,
P < 0.05.
2Groutzetal.
Page 2
DISCUSSION
Labor and delivery have long been known as the major
causes of pelvic £oor injury. However, it is unknown whether
the insult begins during pregnancy, prior to the active process
of labor a nd delivery, and how important are other risk
fact ors, such as maternal age, weight, genetics, and l ife style.
Results of our study suggest that postpartum SUI is rel ated
to ad vanced maternal age at ¢rst d elivery and the pregna nt sta-
tus , and not onl y to obstetric trauma per se. Re sult s also sug-
gest that incontinence is not fully preventable by elective
cesarean section at term.
Data re ga rding the association between maternal age and
the development of SUI are scarce. Fritel et al. [2004] con-
ducted a retrospective cohort survey investigating SUI 4 years
after ¢rst delivery. Of 669 eligible women, 307 (46%) com-
pleted a mailed questionnaire. Of these, 36% underwent
assisted forceps delivery and 10% underwent cesarean section.
The main risk factors for SUI 4 years postpartum were mater-
nal age >30 years at ¢rst delivery, incontinence before and
during pr egnancy,vaginal delivery an d prolonged labor. How-
ever, these results sho uld be interpret ed cautiously because of
the heterogeneous study group, the inclusion of patients with
symptoms of SUI before pregnancy, possible recall bias asso-
ciated with a retrospective ques tionnaire remote from the
index event, and the partial response r ate.
In a recently reported large epidemiological study, all
women who delivered over the course of a year in th ree
maternity units were ask to complete a mailed questionnai re
3 months postpartum [Glazener et al., 2006]. Of 10,989 eligible
women, 7,879 (72%) completed the questionnaire, 3,405 of
whom were primiparae with singleton births. D e novo post-
partum incontinence was associated with older maternal age
and vaginal delivery. The likelihood increased most for the
oldest women (35 and over). Howe ver, incontinence ¢rst
occurring during pregnancy and still presented at 3 months
postpartum was not associated with maternal age. O f the
original cohort of 10,989 eligible women, 4,214 (38%)
completed a follow up questionnaire 6 years later [MacArthur
et al., 2006]. Older maternal age at ¢rst birth (>30 years),
parity and va ginal delivery were found to be signi¢cant risk
factors for persistent and long-term urinary incontinence.
DeL ancey et al. [2003] used m agnetic resonance imaging
(MRI) to explore the appearance of the levator a ni muscle
aft er vaginal delivery. The study population consisted of
80 stress-incontinent primiparae, 80 continent primiparae,
and 80 nul liparae controls. The primiparous women were
scanned 9^12 months after vag inal delivery. As many as 20%
of the primiparae were found to have levator ani
muscle defects on MRI. No similar defects were idented in
nulliparous women. Stress incontinent women were twice
more likely to have levator a ni defects than continent women.
In a recently publi shed report of the same cohort, obstetric
factors associated with levator an i injury were analyzed
[Kearney et al., 2006]. Levator ani muscle defects were found
to be associated with di⁄cult vaginal delivery (forceps, a nal
sphincter rupture, episiotomy and prolonged secon d stage of
labor) and with older maternal age. Primiparae with
levator ani defects were, on average, 3.5 years older than
those without identi¢able injury (32.8 5.9 vs. 29.3 4.7,
respectively, P ¼ 0.001).
Results of our study support t hese aforementioned reports.
T he prevalence of SUI 1^2 years after spontaneous vaginal
delivery was found to be four times higher in elderly com-
pared with younger primiparous women (38.5% vs. 9.8%,
respectively; P < 0.05). Importantly, eld erly primiparae
had shorter deliveries and smaller babies than younger primi-
parae. These ¢ndings re£ect narrower ‘‘safety margins’’ in
the obstetric management of elderly primiparae. The high pre-
valence of postpartum SUI, despite the lack of obs tetric
trauma in these women, hig hlights the importance of
other, non-obstetric risk factors, such as maternal age. It i s
also possible, that tiss ue r ecovery in elderly women is
impaired- although, to date, there is no scienti¢c e vidence to
support this sp eculation.
SUI is also an exceedingly common symptom during preg-
nancy, but in most women spontaneous resolution occurs
within several weeks after delivery [Viktrup et al., 1992]. It is
unknown, however, whether women with pregnancy-
associated SUI are at increased risk for incontinence in
later life. Results of our study reveal that stress-incontinent pri-
miparae 1^2 years postpartum also had higher prevalence of
SUI during pregnancy. Similarly, several other studies suggested
that regardless of the mode of ¢rst delivery, new onset of SUI
during pregnancy is associated with increased risk of long-last-
ing SUI [Wilson et al., 1996; Groutz et al., 1999, 2004; Thorp
et al. , 1999; Persson et al., 20 00; Pregazzi et al., 2002].These ¢nd-
ings i mply that the pathophysiologic process of SUI begins dur-
ing pregnancy, prior to active labor and delivery.
The iuence of mode of delivery on pelvic £oor trauma has
also been addressed i n several studies. It is especially interesting
Neurourology and Urodynamics DOI 10.1002/nau
TABLE II. Comparison of Elderly Primiparae With Versus
Without SUI 12 Years After Spontaneous Vaginal Delivery
Mean SD Continent Stress incontinent
No. of patients 32 20
Age (yr) 40.11.9 39.9 1.6
Wei ght (kg) 7211 7710
Height (cm) 1656.7 1665.3
Gestational age (wk) 39.21.4 391.9
First stage (min) 364431 353332
Second stage (min) 8561 9570
Episiotomy (%) 27 (84) 15 (75)
Epidura l anesthesia (%) 27 (84) 19 (95)
Apgar 1 min 8.70.5 8.90.9
Apgar 5 min 9.80.5 9.80.7
Birth weight (g) 3,012422 3,078471
SUI during pregnancy (%) 6 (18.8)* 9 (45)
SUI, stress urinary incontinence.
*Signi ¢cantly di¡erent from the corresponding ¢gures in the same line,
P < 0.05.
Childbir th-Associated Stress Urinar y Incontinence and Maternal A ge 3
Page 3
to compare primiparae undergoing elective cesarean delivery,
avoiding the trauma associated with labor, to those delivering
vaginally. Data on this issue is scarce and conclusions are incon-
sistent. Recently, Rortveit et al. [2003b] investigated the associa-
tion between childbirth and urinary incontinence in a large
community-based cohort of 15,307 women who were younger
than 65 years of age, and who were either nulliparous, or had
undergone only cesarean or only vaginal deliveries. The preva-
lence of SUI was 4.7% in the nulliparous group,6.9% in the cesar-
ean section group and 12.2% in the vaginal delivery group.
Further classi¢cation of cesarean sections into elective versus
non-elective, performed in a subgroup of 239 primiparae, failed
to reveal a statistically signi¢cant di¡erence. However, non-elec-
tive cesarean sections were analyzed as one group with no
further di¡erentiation between cesarean sections for obstructed
labor and other obstetric conditions (i.e., fetal distress, maternal
indications, etc). Grouping all cesarean section deliveries into
one category may be associated with an overestimation bias, as
it is possible that in cases of cesarean section performed for
obstructed labor, pelvic £oor injury is already too extensive to
be reversed by surgical intervention. A previous study by our
group [Groutz et al., 2004] was designed to include only primi-
parae, and categorized indications for cesarean section. Our data
demonstrated a similar prevalence of SUI 1 year postpartum
among primiparae after vaginal deliver y and after cesarean sec-
tion for obstructed labor (10.3% and 12%). Conversely, elective
cesarean section,with no trial of labor,was associated with a sig-
ni¢cantly lower prevalence of postpartum SUI (3.4%), suggest-
ing a protective ect. A similarly constructed study by Chin
et al. [2006] compared the prevalence of postpartum SUI among
women undergoing elective cesarean section, emergent cesarean
section and vaginal delivery. Elective cesarean section was found
to be associated with a lower prevalence of SUI 1 year postpar-
tum compared to both vagi nal delivery and emergent cesarean
section.
Results of our present investigation ¢nd a sign i¢cantly
lo wer prevalence of SUI 1^2 years postpartum among
primiparae who underwent elective cesarean sect ion com-
pared to those delivered vaginally within the elderly age group
(16.7 % and 38.5%, respectively; P ¼ 0.02). This suggests that
the mechanical strain of labor and deliver y makes a sign i¢cant
contribution to the devel opment of postpa rtum SUI, in addi-
tion to maternal age and to the hormonal and mechanical
e¡ects of pregnancy. Whether the prevention of pelvic £oor
injur y should be an indication for elective cesarean section
remains controversial becau se the issue is complex: how hi gh
would the rate of cesarean section have to be in order to
achieve a signi¢cant reduction in the prevalence of postpar-
tum SUI? What would be the price of the rise in cesarean
section rates in terms of mate rnal morbidity and e¡ect on
future pregna ncies and deliveries? And what would be the
long term bene ¢t of such a change in policy ?
In conclusion, ¢rst vaginal d elivery at an older age carries
an increased risk for SUI. Whether the p revention of further
pelvic £oor injury should be an indicat ion for elective cesarean
section in this age group rema ins to be establi shed. It should
be borne in mind that cesarean section may expose women
to greate r morbidity and mortality, and that the apparently
protective ect of cesarean section may vanish with aging,
or with further surgical interv entions. Better understanding
of path ophysiologic mechanisms associated wit h p elvic
£oor dysfunction, may provide the possibility to use appro-
priate preventive measures, or alternat ively to suggest elective
cesarean section in selected cases.
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4Groutzetal.
Page 4
  • Source
    • "The majority of studies examined risk factors for postpartum UI in women with either vaginal or cesarean delivery (considered together as one group). Various risk factors for UI were found: vaginal delivery [1, 5, 14–18], instrumental de- livery [1, 14], prolonged second stage of labor in women with operative vaginal delivery [19], perineal lesions [1] , episioto- my [14], UI during the pregnancy [5,16171819, increasing maternal age [15, 16], maternal age > 30 years [17], high BMI [15], labor >8 h [17], and macrosomia [15]. In contrast, Viktrup et al. [6], using a restrictive definition of UI, found a low incidence of SUI 1 year after delivery in primiparous women and no significant association with obstetric factors. "
    [Show abstract] [Hide abstract] ABSTRACT: The objective was to examine the relationship between maternal and perinatal factors and the occurrence of stress (SUI) or mixed (MUI) urinary incontinence (UI) 1 year after the first vaginal delivery in primiparous women. Participants in this prospective cohort were recruited consecutively from June 2003 to July 2005 from all eligible women who delivered in the department. A validated questionnaire, the International Consultation of Incontinence Questionnaire Short Form (ICIQ-SF) was completed by all participants 2-3 days after delivery, and a similar second questionnaire was filled out 1 year later. Additional data were obtained from the medical records. The first questionnaire was completed by 1,018 women (63 %) and the second by 859 women (84 %). The study group comprised the 575 women without any UI before the pregnancy and who had a vaginal delivery. The primary analysis comprised 117 women with either SUI or MUI 1 year after the vaginal delivery and 403 women without any UI. In univariate analyses, the following factors were associated with SUI or MUI: prepregnancy body mass index (BMI) ≥ 30 (p < 0.05), UI during the pregnancy (p < 0.05), perineal lesions (p < 0.05), and anal sphincter tears (p = 0.05). Logistic regression analysis showed that SUI or MUI was strongly associated with UI during the pregnancy [adjusted odds ratio (OR) 4.7, 95 % confidence interval (CI) 2.9-7.7) and inversely associated with oxytocin augmentation (adjusted OR 0.5, 95 % CI 0.3-0.9). SUI or MUI 1 year after the first vaginal delivery was strongly associated with UI during the pregnancy and inversely associated with oxytocin augmentation.
    Full-text · Article · Oct 2013 · International Urogynecology Journal
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    • "Many studies conducted in the area of etiopathogenesis of urinary incontinence have not provided an answer which would fully explain the causes of this disorder. Due to the fact that the mechanisms of urinary incontinence have not been finally explained, this scope of problem remains in the focus of interest of many scientific centres worldwide [3, 14]. Due to the considerable prevalence and character of symptoms of SUI, it is mentioned among ailments exerting a great effect on the psychological condition of the women who suffer from this disorder. "
    [Show abstract] [Hide abstract] ABSTRACT: Introduction: Stress urinary incontinence (SUI) is the most frequent type of urinary incontinence among adult women. Objective: The objective of the study was evaluation of the effect of environmental, systemic and obstetrical factors on the development of stress urinary incontinence, and diagnosing and determination of areas in which changes could be made. Material and method: The study covered 313 females aged 30-75 living in the Lublin Region. The respondents were divided into two groups according to the clinical diagnosis, occurrence of symptoms of SUI or lack thereof: Group I - women with SUI symptoms (119), Group II - women without SUI (194). A diagnostic survey was conducted with the use of a self-designed research instrument based on the Gaudenz questionnaire, data from relevant literature and the 'competent judges' test. The following statistical tests were used to compare two structure indicators (fraction, frequency); chi-square test and t-Student test. Statistical analysis was performed by means of STATISTICA 9 (StatSoft) software. Results and conclusions: Statistically significant differences were found between the group of patients with SUI and the control group, with respect to the number of deliveries and their duration. The study showed that there is a statistically higher probability of the development of SUI in the case of surgical delivery, or natural childbirth of a baby with a birth weight of 4000 g or more. The study showed that hard physical work and past gynaecological surgeries are risk factors of urinary incontinence. Barriers of a psychosocial nature were also found (feeling of shame and embarrassment accompanying disclosure of the SUI), which minimized the respondents' participation in urinary incontinence prophylactic actions.
    Full-text · Article · Mar 2013 · Annals of agricultural and environmental medicine: AAEM
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    • "Antenatal UI was also found to be a risk factor for postnatal UI, and the risk of UI was higher among women who had CS or VD than among nulliparous women [4, 7, 22, 26, 27]. These findings suggest that the pathophysiology of UI, SUI, or UUI begins during pregnancy, before the onset of labor or delivery [26]. Our findings only identified greater maternal age as being associated with both antenatal SUI and UUI. "
    [Show abstract] [Hide abstract] ABSTRACT: Introduction and hypothesis: This study evaluated factors and their prevalence associated with urinary (UI) and fecal (FI) incontinence during and after a woman's first pregnancy. Methods: Nulliparous Chinese women with no UI or FI before pregnancy were studied with a standardized questionnaire for UI and FI from early pregnancy until 12 months after childbirth. Maternal characteristics and obstetric data were analyzed using descriptive analysis, independent sample t test, chi-square test, and logistic regression. Results: Three hundred and twenty-eight (74.2 %) women completed the study. The prevalence of antenatal UI increased with gestation. Overall, 192 (58.5 %), 60 (18.3 %), and 76 (23.1 %) had normal vaginal delivery, instrumental delivery, and cesarean section, respectively. Twelve months after delivery, prevalence of stress urinary incontinence (SUI) and urge urinary incontinence (UUI) was 25.9 % [95 % confidence interval (CI) 21.5-30.6] and 8.2 % (95 % CI 5.2-11.2), respectively. In those who delivered vaginally, the prevalence was 29.7 % and 9.1 %, respectively. Prevalence of FI was 4.0 % (95 % CI 1.9-6.1). On logistic regression, vaginal delivery [odds ratio (OR) 3.6], antenatal SUI (OR 2.8), and UUI (OR 2.4) were associated with SUI. Antenatal UUI (OR 6.4) and increasing maternal body mass index (BMI) at the first trimester (OR 1.2) were associated with UUI. Antenatal FI was associated with FI (OR 6.1). Conclusions: The prevalence of SUI, UUI, and FI were 25.9 %, 8.2 %, and 4.0 %, respectively, 12 months after delivery. Vaginal delivery, antenatal SUI, and UUI were associated with SUI; antenatal UUI and increasing maternal BMI at the first trimester were associated with UUI. Antenatal FI was associated with FI. Pregnancy, regardless of route of delivery and obstetric practice, had an effect on UI and FI.
    Full-text · Article · Dec 2012 · International Urogynecology Journal
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