Multiple vaginal deliveries increase the risk of permanent incontinence of flatus and urine in normal premenopausal women

Ryhammer, Allan Maltha; Bek, Karl Møller; Laurberg, Søren

doi:10.1007/bf02048338

Cited by 129 publications

(64 citation statements)

References 13 publications

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“…We have already discussed pudendal neuropathy in relation to urinary incontinence; the neurogenic basis of fecal incontinence is even better established (Snooks et al, , 1985Sultan et al, 1994;Ryhammer et al, 1995;Kafka et al, 1997;Jackson, 1998). Pudendal nerve injury and traumatic anal sphincter disruption subsequent to vaginal delivery are the two primary causes of fecal incontinence (Jackson, 1998).…”

Section: Maintains Fecal Continencementioning

confidence: 97%

“…This suggests a double neuromuscular pathology: direct compression, stretch, and devascularization of the pudendal nerve resulting in levator ani atrophy and loss of urethral and bladder support. Ryhammer et al (1995) reported on the relationship between urinary incontinence symptomatology and the number of repeated vaginal deliveries. The risk for urinary incontinence was additive: 3.3%, 1.0%, and 6.8% after one, two, and three deliveries, respectively.…”

Section: Maintains Urinary Continencementioning

confidence: 98%

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Anatomy and physiology of the female perineal body with relevance to obstetrical injury and repair

Woodman

Graney

2002

Clinical Anatomy

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The female perineal body is a mass of interlocking muscular, fascial, and fibrous components lying between the vagina and anorectum. The perineal body is also an integral attachment point for components of the urinary and fecal continence mechanisms, which are commonly damaged during vaginal childbirth. Repair of injuries to the perineal body caused by spontaneous tears or episiotomy are topics too often neglected in medical education. This review presents the anatomy and physiology of the female perineal body, as well as clinical considerations for pelvic reconstructive surgery.

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Section: Maintains Fecal Continencementioning

confidence: 97%

Section: Maintains Urinary Continencementioning

confidence: 98%

Anatomy and physiology of the female perineal body with relevance to obstetrical injury and repair

Woodman

Graney

2002

Clinical Anatomy

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“…The first symptoms of urinary incontinence can arise after the first pregnancy and the risk of incontinence increases with multiple deliveries [584]. However, the sensitivity of the rat detrusor muscle to ATP was not modified by multiple pregnancies, while there was increased sensitivity to adrenergic and cholinergic stimulation [273].…”

Section: Changes Occurring During Pregnancy or Hormone Therapiesmentioning

confidence: 99%

Purinergic signalling in the urinary tract in health and disease

Burnstock

2013

Purinergic Signalling

143

149

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Purinergic signalling is involved in a number of physiological and pathophysiological activities in the lower urinary tract. In the bladder of laboratory animals there is parasympathetic excitatory cotransmission with the purinergic and cholinergic components being approximately equal, acting via P2X1 and muscarinic receptors, respectively. Purinergic mechanosensory transduction occurs where ATP, released from urothelial cells during distension of bladder and ureter, acts on P2X3 and P2X2/3 receptors on suburothelial sensory nerves to initiate the voiding reflex, via low threshold fibres, and nociception, via high threshold fibres. In human bladder t h e p u r i n e rg i c c o m p o n e n t o f p a r a s y m p a t h e t i c cotransmission is less than 3 %, but in pathological conditions, such as interstitial cystitis, obstructed and neuropathic bladder, the purinergic component is increased to 40 %. Other pathological conditions of the bladder have been shown to involve purinoceptor-mediated activities, including multiple sclerosis, ischaemia, diabetes, cancer and bacterial infections. In the ureter, P2X7 receptors have been implicated in inflammation and fibrosis. Purinergic therapeutic strategies are being explored that hopefully will be developed and bring benefit and relief to many patients with urinary tract disorders.

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“…In 1995, Ryhammer et a1. 19 reported that multiple vaginal deliveries increased the risk of permanent incontinence.…”

Section: Introductionmentioning

confidence: 99%

Anal incontinence after vaginal delivery: a prospective study in primiparous women

Zetterström

López

Anzén

et al. 1999

BJOG

153

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Objective To investigate the incidence and degree of anal incontinence after vaginal delivery among Design Prospective observational study.Setting Karolinska Institutet, Danderyd Hospital, Sweden, a university hospital.Participants Three hundred and forty-nine primiparous women.Methods Questionnaires distributed within the first days after delivery and re-distributed five and nine months postpartum. Analysis of delivery records.Results Eighty percent of the women answered all questionnaires. At five months postpartum, 2% of the women had symptoms of faecal incontinence and 25% had symptoms of involuntary flatus. At nine months postpartum, 1 % of the women had symptoms of faecal incontinence and 26% had symptoms of involuntary flatus. The majority of the women had infrequent symptoms and a decrease in severity was noted at nine months. Symptoms of incontinence were more common in women who sustained a sphincter tear at delivery. Risk factors for incontinence at five months included maternal age, duration of the second stage of labour, instrumental vaginal delivery, and clinically diagnosed sphincter tear at delivery. Development of incontinence at nine months was associated with maternal age and clinically diagnosed sphincter tear at delivery. ConclusionsThe present study demonstrates that infrequent involuntary flatus is a common symptom after vaginal delivery in primiparous women. These symptoms of involuntary flatus frequently improved and only a few women suffered from frank faecal incontinence. Factors associated with an increased risk of anal incontinence and sphincter tears should be considered during delivery.primiparous women and to define associated risk factors.

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Multiple vaginal deliveries increase the risk of permanent incontinence of flatus and urine in normal premenopausal women

Abstract: These results indicate that repeated vaginal deliveries increase the risk of minor anal and urinary incontinence, which were found to be a common problem in premenopausal women.

Cited by 129 publications

References 13 publications

Anatomy and physiology of the female perineal body with relevance to obstetrical injury and repair

Anatomy and physiology of the female perineal body with relevance to obstetrical injury and repair

Purinergic signalling in the urinary tract in health and disease

Anal incontinence after vaginal delivery: a prospective study in primiparous women

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