Factors Lead to Persistent Stress Urinary Incontinence After Childbirth

GOTHENBURG, Sweden -- September 9, 2019 -- Women who are incontinent during pregnancy and those who push for more than 1 hour during the second stage of labour appear to be at high risk of having long-term, persistent stress urinary incontinence (SUI), according to a study presented here at the 2019 Annual Meeting of the International Continence Society (ICS).

“Parity is an established risk factor for stress urinary incontinence, but the underlying etiology is not completely understood,” explained Irene Diez-Itza, MD, Hospital Universitario Donostia, Gipuzkoa, Spain, and colleagues. [This study’s] hypothesis was that both pregnancy and delivery factors may play a role in the long-term persistence of SUI.”

For the study, the researchers analysed data from 315 women aged 30 to 55 years who gave birth at their hospital from April 2007 to October 2007 and went on to develop SUI. Women with any kind of urinary incontinence before pregnancy were excluded from the study.

Mode of first delivery was vaginal in 275 (83.3%) women and caesarean in 40 (12.7%). Of those who had had a caesarean, 16 had a subsequent vaginal delivery.

Six months after birth, only 14% of women reported having SUI. However, 12 years after birth, 38.7% (n = 125) reported persistent SUI. Thirty-six women had SUI from right after birth to 12 years postpartum.

On univariate analysis, women who had been pushing more than 60 minutes in the second stage of labour had a significantly higher risk of having persistent SUI after birth compared with women who did not push for more than 60 minutes (odds ratio [OR] = 3.28; 95% confidence interval [CI], 1.19-9.03).

Women who had SUI during pregnancy also had a significantly higher risk of having persistent SUI after birth compared with women who did not have SUI in pregnancy (OR = 4.69; 95% CI, 0.51-6.27).

Multivariate analysis showed that having SUI during pregnancy (OR = 4.54; 95% CI, 2.10-9.80) and pushing for more than 1 hour during the second stage of labour (OR = 3.68; 95% CI, 1.21-11.14) were both independently associated with having persistent SUI 12 years after delivery.

“We were able to demonstrate this independent association taking into account different constitutional, pregnancy, labour, and delivery variables,” the authors wrote in their presentation.

These variables included age at first delivery, body mass index, SUI during pregnancy, mode of delivery, pushing time during second stage of labour, augmentation with oxytocin, epidural, episiotomy, birth weight, and head circumference.

“These results provide new information about the mechanism by which parity is linked to SUI and give us the opportunity of prevention,” the authors concluded.