Patient‐reported outcome measures for pregnancy‐related urinary and fecal incontinence: A prospective cohort study in a large Italian population

Abstract

Objective: To investigate prevalence and risk factors of pregnancy-related urinary/ fecal incontinence (UI/FI) in a large Italian population. Methods: This is a prospective cohort study analyzing patient-reported outcome (PRO) measures obtained from the systematic longitudinal survey on the maternity pathway of Tuscany from March 2019 to April 2021. Four questionnaires were completed by 6023 women from the beginning of pregnancy until 6 months postpartum, each including two PRO measures-Wexner scale for FI and ICIQ-SF for UI-, and questions investigating sociodemographic/clinical factors. After assessing UI/FI prevalence at each time-point, we run panel regressions to explore the related risk factors.Results: Women reporting UI and FI were, respectively, 24.3% and 6.2% in the third trimester, and 12.6% and 4.2% 6 months postpartum. UI occurrence and severity were higher in highly educated, aged >30, and overweight/obese women. Spontaneous tears or episiotomy were risk factors for postpartum UI, while receiving cesareansection and performing pelvic-floor-muscle-training during pregnancy were protective, mainly in specific groups. Finally, higher FI prevalence and severity emerged in overweight, aged >40, highly educated, non-Italian women and in those undergoing tears. Conclusion:We employed PRO measures to investigate the epidemiology of pregnancy-related UI/FI and detect the main risk groups. Pelvic-floor-muscle-training may be recommended in women with peculiar sociodemographic/clinical features.

Influence of the COVID‐19 pandemic on self‐reported urinary incontinence during pregnancy and postpartum: A prospective study

“…First, we confirmed the results of our previous study 11 on the main risk factors for developing pregnancy-related UI and more severe symptoms, such as advanced age, obesity, spontaneous tears or episiotomy, and experiencing a natural delivery rather than receiving a cesarean section. 17,18 Women with higher education more frequently reported UI symptoms, probably thanks to their greater awareness of their condition.…”

“…It provides a 0-to-21 score with greater values corresponding to higher symptom intensity. 13,14 Particularly, we obtained two independent study cohorts composed of women who experienced pregnancy just before or after the COVID-19 outbreak, regardless of having COVID-19: (1) the pre-pandemic group, including all women that gave birth before As previously explained, 11,15 this patient-reported outcome collection did not require informed consent and ethics approval according to the 2011 Italian guidelines of the Italian Data Protection Authority on processing personal data to perform customer satisfaction surveys in the healthcare sector. Indeed, it was conducted within a systematic survey monitoring women's experiences, outcomes, and satisfaction across the maternity care pathways of Tuscany.…”

“…16 We performed bivariate analyses to detect pre-post differences in UI occurrence and symptom severity. Then, we ran panel regression models including as covariates all those women's attributes and features that were used in our previous work 11 as well as the dichotomous variable for pre-/post-pandemic groups. We performed panel logistic regressions for the dichotomous variable "Presence of UI", and panel linear regressions for the ICIQ-SF scores.…”

“…As explained in our previous paper, 11 The ICIQ-SF is a three-item validated patient-reported outcome measure evaluating frequency and volume of urine leakage and the overall UI impact. It provides a 0-to-21 score with greater values corresponding to higher symptom intensity.…”

Risk factors of pelvic floor muscle strength in south Chinese women: a retrospective study

“…Both pregnancy and subsequent vaginal delivery may lead to levator plate relaxation and thus increase the risk of developing pelvic floor dysfunctions (PFDs), especially UI [5][6][7][8]. The prevalence of UI in adult women was approximately 22.1% in China, 16.7% in Japan, 53% in the United States, 35.3% in Australia, and 36.3% in Saudi countries, and the prevalence of fecal incontinence (FI) was 8.39% in America, 3.6% in the United Kingdom, and 4.2% in Italy based on large population-studies [9][10][11][12][13][14][15]. PFDs are serious problems that can decrease participation in sports and social functions, and that have an indisputable impact on quality of life [16,17].…”