Monday, March 1, 2010

Stress Urinary Incontinence 1 year after Childbirth: Can anything predict it?

It is well known that just being pregnant, is an established risk factor for stress incontinence in women, whether young or middle-aged. Common theories include pelvic floor damage during pregnancy, labor and delivery, as well as chronic stress conditions like coughing, straining, hysterectomy, and genetic linkage.

An interesting question is whether urinary incontinence itself during pregnancy is a risk factor for urinary incontinence after pregnancy, whether immediate or long term. Persistence of urinary incontinence after pregnancy is linked to higher maternal BMI, and those who delivered heavier babies. Most of the studies that look at these risks include women with multiple births, and concluded, rightly, that these variables are causal in the development of urinary incontinence after birth. But what about new-onset stress incontinence during pregnancy- is this linked to higher rates of it after a woman’s first birth?

A study from Spain observed woman during and after their first birth. Questionnaires and exams were performed. Pelvic floor strength was also measured at 6 months post partum. Nearly 400 women were seen in follow up after one year and assessed. The average age of the women was 31 years. Stress incontinence affected 40 (11.4%) of women 1 year after their first delivery. That is a huge number. Out of the total number of women, 4.3% had new onset stress incontinence, while 7.1% reported stress incontinence during pregnancy. When asked to break it down according to severity, 62.5% had “slight”, 32.5% had “moderate”, and 2.5% had severe.
Analysis revealed that women who had stress incontinence during pregnancy and who had vaginal delivery were more at risk for developing stress incontinence 1 year after first childbirth. This factor increased the risk more than 5 times. In addition, the strength of their pelvic floor was also lower on average at 6 months after delivery.

Taken altogether, this is just one more piece of evidence that suggests that women may want to adopt preventative strategies to lessen the risk of stress incontinence, or other consequences of pelvic floor damage by performing pelvic floor muscle training during pregnancy, before pregnancy, as well as perineal massage towards the end of term to prevent tearing during delivery. C-section after obstructed labor is not considered protective against urinary incontinence at 1 year post partum in other studies, and so the data suggest that merely being pregnant can be contributory to development of incontinence, not necessarily mode of delivery.

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