Findings Confirm Increased Incontinence Risk With Vaginal Delivery

By Anne Harding

February 24, 2014

NEW YORK (Reuters Health) - Women who deliver vaginally are at greater risk of urinary incontinence (UI) during their first year postpartum compared to women who have cesarean sections, new findings confirm.

But when researchers looked only at the prevalence of moderate to serious UI, however, the rates were similar in the two groups at one year, Dr. Shiow-Ru Chang of National Taiwan University in Taipei and colleagues found.

"Doctors must be aware that the normal delivery is a substantial burden for the pelvic floor," Dr. Guri Rortveit, who reviewed the story for Reuters Health, said in an interview. "Other studies have not been able to single out women at particular risk, who might have been offered specific advice. As it is, we clinicians should be conscious about these facts and encourage pelvic floor exercises as a means of prevention as well as treatment for urinary incontinence."

Fear of UI is a leading reason why many women opt for cesarean delivery, Dr. Chang and colleagues note in their report in the March issue of Obstetrics & Gynecology. To better understand the associations between vaginal delivery or C-section and UI risk, and to look at how UI changed over time, the researchers studied 330 women, 189 of whom delivered vaginally and 141 who had cesarean sections.

All of the women completed the Incontinence Questionnaire-UI Short Form five times over the course of their first year postpartum.

At most time points, the women who delivered vaginally were more likely to have any UI, stress UI, and moderate to severe UI. They also reported a greater degree of interference with their daily life due to UI at three to five days and four to six weeks after delivery.

At one year, 40.2% of women who delivered vaginally reported having any incontinence, vs 25.4% of the women who delivered by cesarean. However, the percentage of women in both groups who had moderate to severe UI at one year was similar, at about 8%.

"Our findings give health professionals a better understanding of postpartum UI and will help with maternal decision-making to select the most appropriate childbirth and intervention strategy," Dr. Chang and colleagues write.

Although women's UI risk may be lower with C-sections, Dr. Rortveit said, "cesarean section is not the way to solve the problem, since it has many other, negative effects--and most women who undergo vaginal delivery still do not become incontinent. Also, it is important to notice that moderate and severe incontinence were not more prevalent among women with vaginal delivery after one year, which has also been shown by others."

She added, "I think the data on interference with daily life are difficult to interpret. The authors don't explain much about how the data were obtained and analyzed in the methods section. Considering the low number of participants, I think it wise not to emphasize these findings too much."

Dr. Rortveit concluded: "Generally, the paper describes a small study confirming results from previous studies. What they add is a very detailed description of how incontinence evolves over the first year postpartum in a cohort followed prospectively."

Dr. Chang did not respond to a request for an interview.


Obstet Gynecol 2014.


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