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Cohort study
Persistent long-term urinary incontinence post parturition
  1. Ian K Walsh
  1. Queen's University Belfast, Belfast, UK
  1. Correspondence to: Dr Ian K Walsh, Centre for Medical Education, Mulhouse Building, Royal Victoria Hospital, Grosvenor Road, Belfast BT12 6DP, UK; i.walsh{at}qub.ac.uk

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Implications for practice and research

  • There is a high incidence of long-term postpartum urinary incontinence associated with spontaneous vaginal delivery, with maternal factors such as excessive weight and increased age as additional risk factors.

  • Delivery exclusively by caesarean section confers an advantage against developing postpartum urinary incontinence in the early, intermediate and long term.

  • Therapeutic interventions should be studied to ascertain efficacy in reducing the incidence and severity of such incontinence.

Context

Whist postpartum urinary incontinence is a well-documented phenomenon, long-term incontinence has not been studied and reported particularly well. This study follows on from the authors' previous work, which identified and examined a high incidence of urinary incontinence as late as 6 years after childbirth.1 This high incidence was noted to be related to increased maternal weight and age, in addition to increased incidence with vaginal delivery.1 ,2

Methods

Validated questionnaires were distributed to women in three separate maternity units in the UK and New Zealand at 3 months, 6 years and 12 years postpartum. Incontinence was classified in terms of type and stratified as to severity and impact on quality of life. Multiple logistic regression was deployed to identify potential correlations between urinary incontinence type/severity with obstetric, demographic and ethnographic factors.

Findings

Response rates were 48% at 12 years (3763 participants), with an incontinence incidence of 38%. If incontinence was reported at 3 months, it was likely to persist at 12 years (76%). De novo incontinence developed in 33% of participants at 6 years and 25% at 12 years. Stress incontinence was commonest, followed by mixed, and then urgency. Urinary loss was significant in most participants, requiring pad use and high levels of interference with quality of life. Despite this, most women had not received therapeutic intervention. Incontinence was less prevalent if deliveries were exclusively by caesarean section, but more common with advancing maternal age and obesity.

Commentary

This study provides valuable results in early and long-term postpartum urinary incontinence. The incidence rates are high and the extent of incontinence sufficiently severe to impact negatively on the quality of life of the participants. These high rates and impacts persist in the long term and the authors also highlight the development of de novo incontinence in the follow-up period.

The authors comment that the response rates are low at longer term follow-up, yet half of the initial participants remained within the study at 12 years, indicating a relatively low attrition rate compared with previous studies in the literature.2

The study highlights the protective effect of caesarean section against developing urinary incontinence, but only if this has been the exclusive mode of delivery. The study also confirms the already known effects of obesity and advancing maternal age as negative influences on continence rates following childbirth.

A surprising finding was that despite high incontinence rates, significant symptom severity and negative impact on quality of life, the majority of women had not received therapeutic intervention for their incontinence. Whether this reflected patient avoidance of seeking treatment or prevention, or an absence of such being offered remains unclear and may warrant further study.

References

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Footnotes

  • Competing interests None declared.

  • Provenance and peer review Commissioned; internally peer reviewed.

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