Author(s): Wilson PD, Herbison RM, Herbison GP
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Abstract 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 0.2 (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\%) in comparison with those women who delivered vaginally (37.7\%). Other significant independent odds rations were found for daily antenatal pelvic floor exercises (PFE) (0.6, 95\% CI 0.4-0.9), parity > or = 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 (> or = 5). Caesarean section and daily antenatal PFE appear to be protective, although not completely so.
This article was published in Br J Obstet Gynaecol
and referenced in Journal of Cell Science & Therapy