Urinary incontinence after uncomplicated spontaneous vaginal birth in primiparous women during the first year after birth

Susanne Åhlund, Emilia Rothstein, Ingela Rådestad, Sofia Zwedberg, Helena Lindgren, Susanne Åhlund, Emilia Rothstein, Ingela Rådestad, Sofia Zwedberg, Helena Lindgren

Abstract

Introduction and hypothesis: Urinary incontinence (UI) is associated with pregnancy and parity and can cause health problems for women. Our objective was to explore risk factors for UI and its effect on women's daily activities, psychological health and wellbeing 9-12 months postpartum in a low-risk primiparous population.

Methods: In this prospective cohort study, first-time mothers in a low-risk population with a spontaneous vaginal birth reported the occurrence of UI and its effect on daily activities and on their psychological health and wellbeing in a questionnaire completed 1 year after birth. Descriptive and comparative statistics were employed for the analysis.

Results: A total of 410 women (75.7%) completed the questionnaire. The self-reported rates of stress urinary incontinence, urge urinary incontinence and mixed urinary incontinence were 45.4%, 38.0% and 27.0% respectively. Neither the duration of the second stage of labour, the baby's head circumference or its birth weight were associated with the incidence of UI. There was an association between reported negative impact on daily activities and more negative psychological wellbeing (p < 0.001).

Conclusions: Urinary incontinence was common among primiparous women at 9-12 months postpartum. Women whose symptoms had a negative impact on their daily activities reported more psychological suffering.

Keywords: Birth; Postpartum; Primiparous; Urinary incontinence; Vaginal.

Conflict of interest statement

None.

References

    1. Thom DH, Rortveit G. Prevalence of postpartum urinary incontinence: a systematic review. Acta Obstet Gynecol Scand. 2010;89(12):1511–1522. doi: 10.3109/00016349.2010.526188.
    1. Gyhagen M, Bullarbo M, Nielsen TF, Milsom I. A comparison of the long-term consequences of vaginal delivery versus caesarean section on the prevalence, severity and bothersomeness of urinary incontinence subtypes: a national cohort study in primiparous women. BJOG. 2013;120(12):1548–1555. doi: 10.1111/1471-0528.12367.
    1. Handa VL, Pierce CB, Munoz A, Blomquist JL. Longitudinal changes in overactive bladder and stress incontinence among parous women. Neurourol Urodyn. 2015;34(4):356–361. doi: 10.1002/nau.22583.
    1. Hallock JL, Handa VL. The epidemiology of pelvic floor disorders and childbirth: an update. Obstet Gynecol Clin N Am. 2016;43(1):1–13. doi: 10.1016/j.ogc.2015.10.008.
    1. Haylen BT, de Ridder D, Freeman RM, Swift SE, Berghmans B, Lee J, et al. An International Urogynecological Association (IUGA)/International Continence Society (ICS) joint report on the terminology for female pelvic floor dysfunction. Int Urogynecol J. 2010;21(1):5–26. doi: 10.1007/s00192-009-0976-9.
    1. Tahtinen RM, Cartwright R, Tsui JF, Aaltonen RL, Aoki Y, Cardenas JL, et al. Long-term impact of mode of delivery on stress urinary incontinence and urgency urinary incontinence: a systematic review and meta-analysis. Eur Urol. 2016;70(1):148–158. doi: 10.1016/j.eururo.2016.01.037.
    1. Mannion CA, Vinturache AE, McDonald SW, Tough SC. The influence of back pain and urinary incontinence on daily tasks of mothers at 12 months postpartum. PLoS One. 2015;10(6):e0129615. doi: 10.1371/journal.pone.0129615.
    1. Wagg AR, Kendall S, Bunn F. Women’s experiences, beliefs and knowledge of urinary symptoms in the postpartum period and the perceptions of health professionals: a grounded theory study. Prim Health Care Res Dev. 2017;18(5):448–462. doi: 10.1017/S1463423617000366.
    1. Teleman P, Stenzelius K, Iorizzo L, Jakobsson U. Validation of the Swedish short forms of the Pelvic Floor Impact Questionnaire (PFIQ-7), Pelvic Floor Distress Inventory (PFDI-20) and Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire (PISQ-12) Acta Obstet Gynecol Scand. 2011;90(5):483–487. doi: 10.1111/j.1600-0412.2011.01085.x.
    1. Edqvist M, Hildingsson I, Mollberg M, Lundgren I, Lindgren H. Midwives’ management during the second stage of labor in relation to second-degree tears—an experimental study. Birth. 2017;44(1):86–94. doi: 10.1111/birt.12267.
    1. Delgado Nunes V, Gholitabar M, Sims JM, Bewley S. Intrapartum care of healthy women and their babies: summary of updated NICE guidance. BMJ. 2014;349:g6886. doi: 10.1136/bmj.g6886.
    1. Kemp E, Kingswood CJ, Kibuka M, Thornton JG. Position in the second stage of labour for women with epidural anaesthesia. Cochrane Database Syst Rev. 2013;(1):CD008070.
    1. American College of Obstetrics and Gynecology Committee on Practice Bulletins-Obstetrics ACOG practice bulletin number 49, December 2003: dystocia and augmentation of labor. Obstet Gynecol. 2003;102(6):1445–1454.
    1. Olsson A. Perineal trauma and suturing. In: Lindgren H, Christensson KD, Dykes A-K, editors. Reproductive health: the midwife’s core competencies. Lund: Studentlitteratur; 2016. p. 512.
    1. Svare JA, Hansen BB, Lose G. Risk factors for urinary incontinence 1 year after the first vaginal delivery in a cohort of primiparous Danish women. Int Urogynecol J. 2014;25(1):47–51. doi: 10.1007/s00192-013-2233-5.
    1. Chan SS, Cheung RY, Yiu KW, Lee LL, Chung TK. Prevalence of urinary and fecal incontinence in Chinese women during and after their first pregnancy. Int Urogynecol J. 2013;24(9):1473–1479. doi: 10.1007/s00192-012-2004-8.
    1. Brown S, Gartland D, Perlen S, McDonald E, MacArthur C. Consultation about urinary and faecal incontinence in the year after childbirth: a cohort study. BJOG. 2015;122(7):954–962. doi: 10.1111/1471-0528.12963.
    1. Press JZ, Klein MC, Kaczorowski J, Liston RM, von Dadelszen P. Does cesarean section reduce postpartum urinary incontinence? A systematic review. Birth. 2007;34(3):228–237. doi: 10.1111/j.1523-536X.2007.00175.x.
    1. Johannessen HH, Stafne SN, Falk RS, Stordahl A, Wibe A, Morkved S. Prevalence and predictors of double incontinence 1 year after first delivery. Int Urogynecol J. 2018;29(10):1529–1535. doi: 10.1007/s00192-018-3577-7.
    1. Daly D, Clarke M, Begley C. Urinary incontinence in nulliparous women before and during pregnancy: prevalence, incidence, type, and risk factors. Int Urogynecol J. 2018;29(3):353–362. doi: 10.1007/s00192-018-3554-1.
    1. Gartland D, Donath S, MacArthur C, Brown SJ. The onset, recurrence and associated obstetric risk factors for urinary incontinence in the first 18 months after a first birth: an Australian nulliparous cohort study. BJOG. 2012;119(11):1361–1369. doi: 10.1111/j.1471-0528.2012.03437.x.
    1. Sangsawang B, Sangsawang N. Stress urinary incontinence in pregnant women: a review of prevalence, pathophysiology, and treatment. Int Urogynecol J. 2013;24(6):901–912. doi: 10.1007/s00192-013-2061-7.
    1. Van Brummen HJ, Bruinse HW, van de Pol G, Heintz AP, van der Vaart CH. The effect of vaginal and cesarean delivery on lower urinary tract symptoms: what makes the difference? Int Urogynecol J Pelvic Floor Dysfunct. 2007;18(2):133–139. doi: 10.1007/s00192-006-0119-5.
    1. Durnea CM, Khashan AS, Kenny LC, Durnea UA, Dornan JC, O’Sullivan SM, et al. What is to blame for postnatal pelvic floor dysfunction in primiparous women—pre-pregnancy or intrapartum risk factors? Eur J Obstet Gynecol Reprod Biol. 2017;214:36–43. doi: 10.1016/j.ejogrb.2017.04.036.
    1. Burgio KL, Zyczynski H, Locher JL, Richter HE, Redden DT, Wright KC. Urinary incontinence in the 12-month postpartum period. Obstet Gynecol. 2003;102(6):1291–1298.
    1. Leeman L, Rogers R, Borders N, Teaf D, Qualls C. The effect of perineal lacerations on pelvic floor function and anatomy at 6 months postpartum in a prospective cohort of nulliparous women. Birth. 2016;43(4):293–302. doi: 10.1111/birt.12258.
    1. Wesnes SL, Hannestad Y, Rortveit G. Delivery parameters, neonatal parameters and incidence of urinary incontinence six months postpartum: a cohort study. Acta Obstet Gynecol Scand. 2017;96(10):1214–1222. doi: 10.1111/aogs.13183.
    1. Wei JT, Dunn R, Nygaard I, Burgio K, Lukacz ES, Markland A, et al. Development and validation of a quantitative measure of adaptive behaviors in women with pelvic floor disorders. Female Pelvic Med Reconstr Surg. 2017;23(4):232–237.
    1. Buurman MB, Lagro-Janssen AL. Women’s perception of postpartum pelvic floor dysfunction and their help-seeking behaviour: a qualitative interview study. Scand J Caring Sci. 2013;27(2):406–413. doi: 10.1111/j.1471-6712.2012.01044.x.
    1. Ragins AI, Shan J, Thom DH, Subak LL, Brown JS, Van Den Eeden SK. Effects of urinary incontinence, comorbidity and race on quality of life outcomes in women. J Urol. 2008;179(2):651–655. doi: 10.1016/j.juro.2007.09.074.
    1. Fritel X, Tsegan YE, Pierre F, Saurel-Cubizolles MJ. Association of postpartum depressive symptoms and urinary incontinence. A cohort study. Eur J Obstet Gynecol Reprod Biol. 2016;198:62–67. doi: 10.1016/j.ejogrb.2015.12.028.

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