Bothersome lower urinary tract symptoms 1 year after first delivery: prevalence and the effect of childbirth

Abstract

RESULTSOf the 344 women, 83 (24.2%) reported having a moderate to greatly bothersome frequency symptom at 36 weeks of gestation. After childbirth there was a statistically significant decline in the prevalence of bothersome frequency to 38 (9.6%) women ( P < 0.001).Bothersome SUI was present in 53 (15.4%) women at 36 weeks of gestation, and in 36 (10.5%) at 1 year after childbirth. Fifty-eight (16.9%) women reported having moderate to greatly bothersome urge UI (UUI) and at 1 year after childbirth, 51 (14.8%) were still bothered by it. After univariate and multivariate analysis, the predictive factors for the presence of bothersome SUI were greater maternal age (32.5 vs 30.3 years old at delivery) and the presence of bothersome SUI at 12 weeks of gestation. Bothersome UUI was significantly associated with a lower educational level (odds ratio 0.08, 95% confidence interval 0.02-0.36). Women after a Caesarean delivery had more bothersome UUI and women after a spontaneous vaginal delivery developed more bothersome SUI (neither statistically significant, possibly because there were too few samples). During pregnancy, all UDI subscale scores increased significantly and after childbirth all scores decreased significantly vs 36 weeks of gestation. However, the score on the UI subscale remained significantly higher at 1 year after birth than at 12 weeks of gestation, whereas the scores on the OAB and obstructive voiding subscales were lower at 1 year after birth than at 12 weeks of gestation. Nevertheless, the scores for UI and obstructive voiding were low, indicating little bother. CONCLUSIONMost women are not bothered by their LUTS after their first delivery. As the prevalence of bothersome symptoms was highest at 36 weeks of gestation, they are probably part of a normal pregnancy. However, OAB symptoms can be perceived as bothersome. Physiotherapy and bladder training can be offered to women with bothersome LUTS. Bothersome SUI in early pregnancy and a greater maternal age were predictive of bothersome SUI at 1 year after first childbirth. A Caesarean delivery seemed to be protective for bothersome SUI at 1 year after birth, but bothersome UUI was more prevalent after a Caesarean than a vaginal delivery. More research with a larger sample is needed to allow definite statements about the effect of the mode of delivery and bothersome UI symptoms.

Avaliação da Incontinência Urinária na Gravidez e no Pós-Parto: Estudo Observacional

“…À luz dos conhecimentos atuais, a episiotomia constitui um tema de debate; embora a maioria dos estudos demonstre resultados semelhantes aos apresentados. [30][31][32] Em relação aos restantes fatores peri-parto, alguns autores também não demonstraram qualquer associação entre a IU pós-parto e a ocorrência de laceração perineal ou o peso do recém-nascido superior a 4000 gr. [31][32][33][34] Chamou-nos também a atenção o facto de que uma percentagem significativa das mulheres entrevistadas não recebeu qualquer tipo de orientação sobre a IU durante a gestação, e a maioria daquelas com IU no pós parto não procurou aconselhamento médico.…”

The impact of fecal and urinary incontinence on quality of life 6 months after childbirth

“…In studies of fecal incontinence (FI) and urinary incontinence (UI) during the postpartum period, UI is reported by 10-50% of women, [1][2][3][4][5][6] whereas FI is present in up to 25%. 2,3,7 The Pelvic Floor Disorders Network (PFDN) has previously published findings of the Childbirth and Pelvic Symptoms (CAPS) study, 8 which examined the prevalence of FI and UI in 3 cohorts of primiparous women.…”

“…9 Although several case series report the impact of postpartum UI on QOL, 3,4,6 data are very limited on the impact of FI on QOL in the postpartum period. In a Canadian study, 3 FI was present in 20.6% of 1305 primiparous women 6 months postpartum, and QOL varied significantly with the severity of both FI and UI.…”

Effects of pregnancy on pelvic floor dysfunction and body image; a prospective study

“…Proposed mechanisms include anatomic disruption, denervation to the pelvic floor, or trauma by vaginal delivery [1][2][3][4][5][6][7][8]. However, while these conditions have been shown to impact quality of life in the postpartum period [9][10][11][12], impact during pregnancy is less clear. Additionally, although previous reports have suggested that impaired body image may occur with prolapse [13], the effect of urinary and fecal incontinence on body image has not been previously documented.…”