The effect of vaginal and cesarean delivery on lower urinary tract symptoms: what makes the difference?

Abstract

A prospective cohort study was undertaken to evaluate the effect of pregnancy and childbirth in nulliparous pregnant women. The focus of this paper is on the difference in the prevalences and risk factors for lower urinary tract symptoms (LUTS) between woman who delivered vaginally or by cesarean and secondly the effect of LUTS on the quality of life between these two groups was analyzed. Included were 344 nulliparous pregnant women who completed four questionnaires with the Urogenital Distress Inventory and the Incontinence Impact Questionnaire (IIQ). Two groups were formed: vaginal delivery group (VD), which included spontaneous vaginal delivery and an instrumental vaginal delivery and cesarean delivery group (CD). No statistical significant differences were found in the prevalences of LUTS during pregnancy between the two groups. Three months after childbirth, urgency and urge urinary incontinence (UUI) are less prevalent in the CD group, but no statistical difference was found 1 year postpartum. Stress incontinence was significantly more prevalent in the VD group at 3 and 12 months postpartum. The presence of stress urinary incontinence (SUI) in early pregnancy is predictive for SUI both in the VD as in CD group. A woman who underwent a CD and had SUI in early pregnancy had an 18 times higher risk of having SUI in year postpartum. Women were more embarrassed by urinary frequency after a VD. After a CD, 9% experienced urge urinary incontinence. Urge incontinence affected the emotional functioning more after a cesarean, but the domain scores on the IIQ were low, indicating a minor restriction in lifestyle. In conclusion, after childbirth, SUI was significantly more prevalent in the group who delivered vaginally. Besides a vaginal delivery, we found both in the VD and in the CD group that the presence of SUI in early pregnancy increased the risk for SUI 1 year after childbirth. Further research is necessary to evaluate the effect of SUI in early pregnancy on SUI later in life. Women were more embarrassed by urinary frequency after a vaginal delivery. UUI after a CD compared to a vaginal birth limited the women more emotionally; no difference was found for the effect of SUI on the quality of life between the two groups.

Incontinência urinária de esforço em mulheres pertencentes ao Programa de Saúde da Família de Dourados (MS)

“…52 Some studies have shown a low impact on the quality of life of women with UI; however, they were conducted during pregnancy or in the first year postpartum. 53,54 This difference in results might be associated with the fact that the women in these situations see UI as an expected disorder for such situations instead of considering it a disease. Córcoles et al, studying 126 women with SUI, demonstrated impairment in their quality of life with gradual deterioration as they got older.…”

Incontinência urinária na gestação: implicações na qualidade de vida

“…24 Fritel et al 25 concluíram que mulheres acima de 35 anos possuem maior risco de desenvolver disfunções do assoalho pélvico. Isso ocorre porque o envelhecimento fisiológico é acompanhado pelo aumento na densidade das fibras de desnervação da musculatura do assoalho pélvico (MAP), de modo que quanto maior a densidade, menor a velocidade da condução nervosa.…”

“…24 No presente estudo, entre as gestantes com perda urinária, a maior proporção foi de secundigestas de parto vaginal anterior. No entanto, há evidências de que esses sintomas também ocorram em primigestas.…”

Sintomas urinários irritativos após parto vaginal ou cesárea

“…Além da via de parto vaginal, alterações anatômicas e fisiológicas que ocorrem no trato urinário inferior ao longo da gestação predispõem o desencadeamento de SUI. Os SUI, decorrentes da gestação ou do trauma obstétrico, podem persistir após o parto 7,8 e gestações subseqüentes parecem atribuir risco adicional à disfunção do trato urinário inferior, aumentando a severidade dos sintomas urinários 9 . Scarpa et al 10 observaram que a paridade (multíparas ≥ 4) foi associada ao aumento de SUI, particularmente da noctúria e freqüência miccional, durante o último trimestre da gestação.…”

“…Primíparas, que tiveram parto via vaginal, apresentaram maior ocorrência da urgência e da urge-incontinência no puerpério, comparado às mulheres submetidas à cesariana. Entretanto, um ano depois do parto, esta diferença não se manteve significativa 8 . Assim como Chaliha et al 20 , neste estudo, não foi observada associação significativa entre a presença dos sintomas urinários irritativos após o parto e a via exclusiva de parto (vaginal ou cesárea).…”