Factors involved in the persistence of stress urinary incontinence from postpartum to 12 years after first delivery

Abstract

Aims The aim of this study was to investigate constitutional‐, pregnancy‐, labor‐, and delivery‐related factors involved in the long‐term persistence of stress urinary incontinence (SUI) from 6 months postpartum to 12 years after first delivery. We also evaluated severity and impact on quality of life of persistent SUI. Methods This was a longitudinal study including primigravid women who gave birth at our Public Health Hospital during 2007. Urinary symptoms were investigated at inclusion, 6 months and 12 years after delivery. Persistent SUI was defined as SUI reported both at 6 months postpartum and 12 years after first delivery. The International Consultation on Incontinence‐Urinary Incontinence‐Short Form (ICIQ‐UI‐SF) and the Incontinence Severity Index (ISI) were used to evaluate SUI. Results During the inclusion period, 479 pregnant women were interviewed, 381 attended the 6‐month follow‐up visit, and 315 formed the study group. SUI persisted in 36 out of 44 (81.8%) women. With the ISI, 52.8% of these women were categorized as having slight, 41.7% moderate, and 5.6% severe incontinence. The mean ICIQ‐UI‐SF score was 7.13 (SD 3.51). Pregnancy SUI (odds ratio [OR], 4.54; 95% confidence interval [CI], 2.10‐9.80) and active second stage of labor more than or equal to 1 hour (OR, 3.68; 95% CI, 1.21‐11.14) were independently associated with persistent SUI. Conclusions Women who reported SUI during pregnancy, and those who had pushed for more than or equal to 1 hour in the second stage of labor were at greater risk of SUI persisting from 6 months postpartum to long after delivery. We found this independent association after controlling for several constitutional‐, pregnancy‐, labor‐, and delivery‐related variables.

Urinary incontinence 6 weeks to 1 year post-partum: prevalence, experience of bother, beliefs, and help-seeking behavior

“…The total score ranges from 0 (no UI) to 21 (very severe problem). The total score is divided into four categories: slight (1-5), moderate (6)(7)(8)(9)(10)(11)(12), severe (13)(14)(15)(16)(17)(18), and very severe (19)(20)(21) [12]. A fourth question on the occurrence of symptoms of UI was used to indicate SUI, UUI and MUI [13].…”

“…However, up to 91% of women with SUI after their first delivery still report SUI 12 years later [21]. Although UI is not life threatening, women in the general population with UI report lower health-related quality of life and mental wellbeing and 45% of women report a moderately to totally (19)(20)(21) 0 (0) 0 (0) 0 (0) 0 (0) N = number, % = percentage, SD = standard deviation, CI = confidence interval, UI = urinary incontinence, SUI = stress urinary incontinence, UUI = urgency urinary incontinence, MUI = mixed urinary incontinence, ICIQ-UI-SF = International Consultation on Incontinence Questionnaire Urinary Incontinence Short Form limiting effect on exercise [22]. Women with UI in this study reported significant bother of UI regarding physical activities like in the study of Monz et al [22].…”

Current Resources for Evidence‐Based Practice, July/August 2021

“…Prolonged second stage of labor among 4 studies with over 5800 participants had a nonsignificant increased odds of UI (OR, 1.19; 95% CI, 0.94‐1.52). However, by 12 years after birth in the above‐mentioned cohort study, active pushing longer than one hour was associated an OR of 3.68 (95% CI, 1.21‐11.14), although this was not identified as a factor at 12 months postpartum 7,8 . In a separate meta‐analysis of 7 studies, Smeets et al calculated no association between avulsion of the pubic portion of the levator ani during birth and UI (adjusted OR [aOR], 0.72; 95% CI, 0.40‐1.30) among 22 studies with nearly 11,500 particpants 9 …”

“…UI persists during the postpartum for about 30% of people, decreasing with time to 11% reporting symptoms by one year after birth 7 . A cohort study following over 300 people with UI at 6 months postpartum found 80% still had symptoms at 12 years 8 . The largest risk factor for UI postpartum identified in the meta‐analysis by Hage‐Fransen et al was its presence during pregnancy.…”

“…The short‐term odds ratio (OR) for pregnancy UI to be persistent postpartum is 5.32 (95% CI, 4.13‐6.86) based on over 2000 participants in 3 studies 1 . A single study at 12 years after birth estimated pregnancy UI increased the adjusted odds of persistent UI over 4 times 8 . In the meta‐analysis for short‐term risks, there were small increased ORs for factors known to be associated with UI in middle‐aged and older women such as constipation (OR, 1.55) and obesity (OR, 1.33).…”