Wednesday, November 2, 2011

Is Advanced Maternal Age a Risk Factor for Stress Urinary Incontinence- What is the Medical Evidence?

It is well known that birth trauma ( pregnancy and vaginal birth) and age are two of the well known and common risk factors for developing stress urinary incontinence (SUI) (leaking urine with coughing, sneezing, laughing, lifting, exercise and sex). But, is delivering a child when a woman is “older” an additional risk factor for developing SUI? And, what is considered “older”? Is it 30, 35, 40, or over 45?

The injury that occurs during pregnancy and birth is both stretch and compression injury to the supportive ligaments of the bladder and urethra and the nerves that control the urethra. A prolonged labor or large baby head can worsen the birth trauma that occurs, but bear in mind that not all women who deliver ultimately develop SUI. In fact most don’t, but if a woman does deliver when older, are the tissues of the pelvis “less resilient” and more subject to long term changes that lead to SUI?

Further, if a woman develops SUI during pregnancy, the majority will recover within a few months to a year after delivery. Partial recovery or no recovery is a predictor for development of SUI within the next decade.
Though common sense would dictate “yes” to the question of “advanced maternal age”, some researchers recently looked at the medical literature to glean the answer from papers that review risk factors for SUI.

The results were mixed, but skewed heavily towards older age. In fact, of the papers, 15 showed that advance age was a risk, while 3 papers did not. Most of the papers did show a risk for women older than 35 yrs old, while some showed a risk from women older than 40-45 yrs. Interestingly, there were a few that showed risks for SUI for mothers of young age, less than 22.

Other risk factors noted include high BMI (>30), incontinence early on in pregnancy, and pre-pregnancy SUI. As the studies mount, further weight to the existing evidence will confirm our current theories and even uncover further risks. For women planning pregnancy, reducing risk factors such as high BMI and family planning for the best age to deliver can be very relevant issues.