Transactions of the 67th Annual Meeting of the South Atlantic Association of Obstetricians and Gynecologists
The effect of pregnancy and mode of delivery on the prevalence of urinary and fecal incontinence

https://doi.org/10.1016/j.ajog.2005.03.056Get rights and content

Objective

The purpose of this study was to determine the relative effects of pregnancy and mode of delivery on the prevalence of urinary and fecal incontinence.

Study design

This was a prospective, observational multicenter study of women presenting to 6 gynecology clinics. Demographic data collected included: height, weight, gravidity, parity, and number of vaginal deliveries. Patients were diagnosed with incontinence by questionnaire. Standard univariate logistic regression analyses' were performed to determine the contribution of pregnancy, mode of delivery, and BMI on the prevalence of urinary and fecal incontinence.

Results

One thousand and four women were enrolled over an 18-month period. Two hundred and thirty-seven and 128 subjects had urinary and fecal incontinence, respectively. Odds ratio (95% CI) calculated for the prevalence of urinary incontinence by pregnancy and mode of delivery were: any term pregnancy vs no term pregnancy was 2.46 (1.53-3.95), any term pregnancy but no vaginal deliveries (cesarean section only) vs no term pregnancy was 1.95 (0.99-3.80), any term pregnancy and at least 1 vaginal delivery vs no term pregnancy was 2.53 (1.57-4.07), and any term pregnancy but no vaginal delivery (cesarean section only) vs any term pregnancy, and at least 1 vaginal delivery was 1.30 (0.77-3.95). Odds ratio (95% CI) calculated for the prevalence of fecal incontinence by pregnancy and mode of delivery were: any term pregnancy vs no term pregnancy was 2.26 (1.22-4.19), any term pregnancy but no vaginal deliveries (cesarean section only) vs no term pregnancy was 1.13 (0.43-2.96), any term pregnancy and at least 1 vaginal delivery vs no term pregnancy was 2.41 (1.30-4.49), and any term pregnancy but no vaginal deliveries (cesarean section only) vs any term pregnancy, and at least 1 vaginal delivery was 2.15 (0.97-4.77). BMI and age did not impact these results.

Conclusion

Pregnancy increases the risk of urinary and fecal incontinence. Cesarean section does not decrease the risk of urinary or fecal incontinence compared to pregnancy with a vaginal delivery.

Section snippets

Material and methods

Data were collected from 1004 women enrolled over an 18-month period as part of the Pelvic Organ Support Study Project, a multicenter study involving 6 outpatient gynecology clinics in the US.8 The study was approved by local IRBs at each site, and before participation each subject signed an informed consent. Demographic data were collected and included; age, height, and weight. In addition, detailed information regarding the subjects' obstetric history was collected and included; gravity,

Results

The mean age of subjects was 42.7 ± 13.9 (± SD) years. Racial distribution was 43% Caucasian, 24% African American, 29% Hispanic, 2% Asian, 2% other. Of the 1004 subjects in the study, 978 had complete data on gravidity (G), parity (P), and normal spontaneous vaginal delivery (NSVD), and fully answered the questionnaire. They are the basis of this report. There were 174 nulliparous women (P = 0), 91 parous women with no vaginal deliveries (P ≥1 and vaginal delivery = 0), and 712 parous women with

Comment

There is a developing consensus of opinion in obstetrics and gynecology that pregnancy and a vaginal delivery contributes to the eventual development of urinary and fecal incontinence. This relationship has biologic plausibility and stems from research that established a relationship between vaginal delivery, pudendal neuropathy, and urinary and fecal incontinence. Also, there is a growing controversy that cesarean delivery protects against this injury, and should be offered to patients who are

References (15)

There are more references available in the full text version of this article.

Cited by (77)

  • Maternal risk factors of urinary incontinence during pregnancy and postpartum: A prospective cohort study

    2022, European Journal of Obstetrics and Gynecology and Reproductive Biology: X
    Citation Excerpt :

    In women in early adulthood, UI is a less common problem that nevertheless affects 25% of this population segment [1,2]. Aging aside, pregnancy and childbirth are also known risk factors of UI [3]. In nulliparous women, the most common risk factors are obesity, childhood enuresis and high-impact exercise [4].

  • Birthweight and urinary incontinence after childbirth: a systematic review and meta-analysis

    2020, European Journal of Obstetrics and Gynecology and Reproductive Biology: X
View all citing articles on Scopus

Presented at the Sixty-Seventh Annual Meeting of the South Atlantic Association of Obstetricians and Gynecologists, January 22-25, 2005, White Sulphur Springs, WVa.

View full text