Stress incontinence and pelvic floor neurophysiology 15 years after the first delivery

Abstract

Headline This is a longitudinal study of a cohort of primigravidae recruited between 1985 and 1987 and followed up 7 and 15 years later. Pelvic floor neurophysiology was performed and questionnaires were administered to determine the natural history of stress incontinence and to establish whether pelvic floor denervation after the first delivery is associated with symptoms of stress urinary incontinence in the future. Objectives To study the natural history of stress urinary incontinence arising during the first pregnancy, to determine whether postnatal pelvic floor denervation progresses with time and whether it predisposes to stress urinary incontinence in the future. Design Prospective longitudinal cohort study.Setting Tertiary referral urogynaecology unit.Sample Cohort of 96 primigravidae studied prospectively between 1985 and 1987 and followed up 7 years (n ¼ 76) and 15 years (n ¼ 55) later. Methods Urinary incontinence symptoms were recorded and pelvic floor neurophysiology was performed antenatally and postnatally between 1985 and 1987. Repeat neurophysiological tests and questionnaires were completed by those relocated 7 and 15 years later. Main outcome measure Symptoms of stress urinary incontinence.Secondary outcomes Symptoms of urge urinary incontinence and anal incontinence; motor unit potential duration and pudendal nerve terminal latency; vaginal squeeze pressure measured by perineometry. Results Prevalence of stress incontinence was highest during pregnancy and had increased seven years after the first postnatal period ( P ¼ 0.0129). Two-thirds of women with antenatal stress incontinence had stress incontinence 15 years later. One-third of women with stress incontinence at any time appear to undergo resolution of symptoms. Motor unit potential duration increased at seven years ( P ¼ 0.036). Vaginal squeeze pressure improved during the same period ( P ¼ 0.0007). Conclusions When stress urinary incontinence arises during the first pregnancy, the risk of stress incontinence occurring 15 years later is doubled. Although pelvic floor reinnervation progressed after the postnatal period, the absence of an adequate marker for pelvic floor denervation makes it of uncertain clinical significance.

Post-partum urinary incontinence among Saudi women

“…In our study, most of the women reported a mild effect of UI on their quality of life. Some studies that have been conducted to evaluate the impact of UI in primiparous women reported a mild effect of UI in HRQL [27]. The impact on quality of life is considered to be mild, perhaps because most women consider urinary incontinence as a temporary difficulty that will resolve on its own.…”

Systematic review and economic modelling of the effectiveness and cost-effectiveness of non-surgical treatments for women with stress urinary incontinence

“…Having antenatal SUI doubles this risk. 28 Immediately after childbirth women may expect to have higher levels of incontinence, which can often resolve spontaneously over the first 6 months. As this natural resolution might confound the effect of any intervention, data from trials in women in the immediate postpartum period were not included in the main body of the systematic review or in the cost-effectiveness analysis (results are reported in Appendix 20).…”

Atendimento de puérperas pela fisioterapia em uma maternidade pública humanizada

“…Sabe-se que a gravidez, o trabalho de parto e o parto podem provocar efeitos negativos na função dessa musculatura 20 e favorecer o aparecimento de IU em cerca de 38% das puérperas, porcentagem que se eleva para 45% em multíparas 21,22 . Isso justifica a importância dessa avaliação e de intervenção fisioterapêutica precoce, já que é uma abordagem de baixo custo, sem efeitos colaterais e tem demonstrado bons resultados.…”

“…Morkeved e Bo 25 demonstraram, em um seguimento de um ano, melhora significativa da força muscular do assoalho pélvico e diminuição da IU (p<0,01) em puérperas submetidas a um treinamento específico dessa musculatura. Como alguns estudos apontam possíveis disfunções perineais, especialmente após o parto vaginal 21 (tipo de parto mais comum na amostra estudada), os exercícios do assoalho pélvico são realizados de rotina, como medida preventiva, conforme recomendado pela literatura 18,25 . Algumas puérperas não realizaram os exercícios por apresentar desconforto na região da episiorrafia.…”