Urinary Incontinence after Vaginal Delivery or Cesarean Section

Rørtveit, Guri; Daltveit, Anne Kjersti; Hannestad, Yngvild S.; Hunskaar, Steinar

doi:10.1056/nejmoa021788

Cited by 684 publications

(380 citation statements)

References 18 publications

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“…17 There may also be an increased risk of urinary incontinence, although this may be more closely associated with a longer second stage of labour; 18,19 however, women who have a caesarean section have a lower risk of symptoms. 20,21 Other bowel problems such as haemorrhoids 19,22,23 and constipation 24 are more common after IVD, as are perineal pain and dyspareunia. 24,25 Caesarean section has many adverse sequelae, but, with the exception of faecal incontinence, most of these symptoms are less likely to occur in association with this delivery mode.…”

Section: Scientific Backgroundmentioning

confidence: 99%

“…However, urinary and faecal incontinence are important outcomes following birth and may be related to the mode of delivery, and can have long-lasting effects on HRQoL and additional visits to primary care. 17,21 Therefore, it was decided that, if necessary, primary care visits related to these adverse events would be estimated using recent data from the literature if significant differences between treatment arms were observed. Nevertheless, this was not the case (see Table 14), and such visits were not incorporated as part of the categories of resource use in the cost analysis and are presented as part of the health outcomes in the cost-consequences analysis.…”

Section: Nhs Health-care Resource Usementioning

confidence: 99%

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A multicentre, randomised controlled trial of position during the late stages of labour in nulliparous women with an epidural: clinical effectiveness and an economic evaluation (BUMPES)

Bick

Briley

Brocklehurst

et al. 2017

Health Technol Assess

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BackgroundEpidural analgesia leads to increased risk of instrumental vaginal delivery (IVD). There is debate about whether or not posture in second-stage labour influences the incidence of spontaneous vaginal birth (SVB).ObjectivesIn nulliparous women with epidural analgesia, does a policy of adopting an ‘upright position’ throughout second-stage labour increase the incidence of SVB compared with a policy of adopting a ‘lying-down’ position?DesignTwo-arm randomised controlled trial.SettingMaternity units in England and Wales.ParticipantsNulliparous women aged ≥ 16 years, at ≥ 37 weeks’ gestation with singleton cephalic presentation and intended SVB, in second-stage labour with an epidural providing effective pain relief.Interventions(1) Upright position to maintain the pelvis in as vertical a plane as possible; and (2) lying-down position to maintain the pelvis in as horizontal a plane as possible.Main outcome measuresThe primary outcome measure was incidence of SVB. Secondary outcomes included augmentation, interventions to maintain blood pressure, duration of labour, episiotomy, genital tract trauma, post-partum haemorrhage, maternal satisfaction, neonatal metabolic acidosis, 5-minute Apgar score of < 4, resuscitation at birth and admission to neonatal unit. At 1 year for (1) women: urinary or faecal incontinence, dyspareunia and health-related quality of life; (2) for infants: major morbidity. A cost–consequences analysis with a time horizon of 1 year after the birth from a NHS perspective.ResultsBetween October 2010 and January 2014, 3236 women were randomised from 41 centres in England and Wales. There was a statistically significant difference in the incidence of SVB between groups, with 35.2% of women achieving a SVB in the upright group, compared with 41.1% in the lying-down group (adjusted risk ratio 0.86, 95% confidence interval 0.78 to 0.94). There was no evidence of differences in most of the secondary maternal or neonatal outcomes, or in long-term outcomes at the 12-month follow-up. No significant overall cost differences were observed between upright and lying-down positions for mothers or their babies.LimitationsMeasurement of adherence was challenging in this unmasked trial, and adherence could be influenced by midwives’ beliefs about the allocated positions. If adherence was poor, this would have diluted the difference between the two groups.ConclusionsThere is clear evidence of the benefit of adopting a lying-down position in second-stage labour in nulliparous women with epidural analgesia, with no apparent disadvantages in either short- or long-term outcomes for mother or baby, and this is cost neutral for the NHS.Future workQuestions remain about whether or not other positions could increase the incidence of SVB further in this group of women. The results also raise questions about the role of maternal position in second-stage labour in women without an epidural.Trial registrationCurrent Controlled Trials ISRCTN35706297.FundingThis project was funded by the National Institute for Health Research Health Technology Assessment programme and will be published inHealth Technology Assessment, Vol 21, No. 65. See the NIHR Journals Library website for further project information.

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Section: Scientific Backgroundmentioning

confidence: 99%

Section: Nhs Health-care Resource Usementioning

confidence: 99%

A multicentre, randomised controlled trial of position during the late stages of labour in nulliparous women with an epidural: clinical effectiveness and an economic evaluation (BUMPES)

Bick

Briley

Brocklehurst

et al. 2017

Health Technol Assess

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“…PFD is a complex disease that involves many factors, and the majority of research suggests that the total collagen content is decreased in pelvic connective tissue and that the pelvic support tissues (the ligament, muscle and fascia) are relaxed because of reduced collagen fibers, which eventually leads to PFD [4,5]. Although PFD is not a lifethreating disease, it causes urinary and fecal incontinence, dysuria, obstructed defecation, abdominal straining, and sexual dysfunction, which may affect a patient's physical and mental wellbeing as well as their health and quality of life.…”

Section: Introductionmentioning

confidence: 99%

Mechanical stretching promotes the differentiation of BMSC into pelvic floor ligament fibroblasts

Zhao¹,

Wang²,

Ren³

et al. 2018

Oncotarget

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Pelvic floor dysfunction (PFD) is a prevalent and debilitating condition in agingwomen that is associated with weakened pelvic connective tissue. Fibroblasts are the main component of pelvic connective tissue and play a vital role in the maintenance of the pelvic organ. Mechanical stretching is a known modulator leading to the proliferation and differentiation of bone marrow mesenchymal stem cells (BMSCs). In this paper, we measured the lysyl oxidase (LOX), elastin and KDM4B expression in cultured BMSCs under different cyclic mechanical stretch (CMS) conditions via Western blot assays. Our findings indicated that the expression of these proteins was significantly higher in the CMS group than in the normal control group, and 10% CMS at a 0.5 Hz frequency had the best stimulatory effect. We further evaluated the influence of KDM4B on LOX and elastin expression via knockdown and overexpression of KDM4B in BMSCs. Chromatin immunoprecipitation (ChIP)-PCR analysis was performed to determine how H3K9me3 and KDM4B affect the regulatory regions of LOX and elastin in BMSCs subjected to 10% CMS combined with KDM4B knockdown. Finally, we verified the expression of KDM4B under CMS in vivo by subcutaneously transplanting KDM4B-overexpressing BMSCs into mice via immunofluorescence assays. The results showed that activating KDM4B by mechanical stretching increased the protein and gene expression levels of LOX and elastin and induced more LOX-positive cells in the BMSCs. These data suggest that CMS contributes to the differentiation of mesenchymal stem cells (MSCs) into fibroblasts, which indicates its potential use as a cell-based therapy for PFD.

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“…Some problems, especially like incontinence, are considered as a normal phenomena with increasing age by some females. Prevalence of lower urinary tract symptoms including incontinence is higher in females than in males [1,2]. One reason is the anatomical difference; female pelvis has wider outlet which predisposes for subsequent pelvic floor weakness [3].…”

Section: Introductionmentioning

confidence: 99%

“…Another utmost important and modifiable factor is the silent trauma to the pelvic supports-the utmost important structure for proper functioning of lower urinary tract, in the form of multiple vaginal deliveries (specially unattended home deliveries) and various obstetric and gynaecological surgeries (caesarean section, hysterectomy etc.) [1,2]. male patients with urinary problems, who attended the surgery and gynecology OPD in our institution, which is a tertiary referral centre in central India.…”

Section: Introductionmentioning

confidence: 99%

Study of Common Urinary Problems of Females at a Government Hospital in Central India

Pradhan¹,

Mathur²,

Mathur³

et al. 2012

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Aim: The aim of this study is to identify the common urinary problems in Indian females, their etiology and symtomatology. Material and Methods: This is a prospective epidemiological study of 703 female patients with urinary problems, who attended the surgery and gynecology OPD (outpatient department) in our institution which is a tertiary referral centre in central India. Result: 58% of patients were middle age (31 -55) yrs. Burning micturition was the most common urinary complain (607 patients) followed by increased frequency of micturition (309 patients). 68% females took months or even years to take first consultation after appearance of their symptoms. 14% percent of patients suffered from urinary incontinence (stress, urge and mixed). 86% of women had education level below fifth standard. About 58% of females gave birth to 3 or more than 3 issues. About 254 (36%) patients had one or more unassisted delivery at home. Thirty eight percent of patients still remained undiagnosed. More than 50% of undiagnosed females lie in middle age group. 68% of undiagnosed patients took consultation months or years after their symptoms first appeared. Irritative symptoms are the most common presenting complains of these undiagnosed patients followed by pain in abdomen. Around 60% of patients had history of either mental distress, domestic violence or any neuropschiatric disease. This study only gives us an idea about the urinary problems faced by females and their probable causative factors. Many more studies need to be done involving multidisciplinary approach in order to benefit this section of our society.

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Urinary Incontinence after Vaginal Delivery or Cesarean Section

Abstract: The risk of urinary incontinence is higher among women who have had cesarean sections than among nulliparous women and is even higher among women who have had vaginal deliveries. However, these findings should not be used to justify an increase in the use of cesarean sections.

Cited by 684 publications

References 18 publications

A multicentre, randomised controlled trial of position during the late stages of labour in nulliparous women with an epidural: clinical effectiveness and an economic evaluation (BUMPES)

A multicentre, randomised controlled trial of position during the late stages of labour in nulliparous women with an epidural: clinical effectiveness and an economic evaluation (BUMPES)

Mechanical stretching promotes the differentiation of BMSC into pelvic floor ligament fibroblasts

Study of Common Urinary Problems of Females at a Government Hospital in Central India

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