Abstract
The increase of the intensity of urinary symptoms in late pregnancy and postpartum has been well documented by several authors, but their causes remain uncertain, partly because of its probable multifactor origin. There are also controversies whether the etiology of lower urinary tract symptoms during pregnancy is the same as postpartum and whether the method of delivery could influence the risk of onset of urinary symptoms. This study aimed to evaluate the urinary symptoms triggered during pregnancy and its evolution in the late puerperium, correlating them with the delivery method. A longitudinal study was conducted, which included 75 primigravidae women, classified according to method of delivery as: (VD) vaginal delivery with right mediolateral episiotomy (n = 28); (CS) elective caesarean section (n = 26); and (EC) emergency caesarean section (n = 21). Urinary symptoms were assessed in the last trimester of pregnancy and at 45 days (± 10) of puerperium with validated versions for Portuguese language of the following questionnaires: International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form (ICIQ-UI SF) and the International Consultation on Incontinence Questionnaire Overactive Bladder (ICIQ-OAB). It was observed that frequency, urgency, nocturia and urge incontinence, triggered during pregnancy, decreased significantly in the postpartum period, regardless of the delivery method (p = 0.0001). However, symptoms related to urinary loss due to stress persisted after vaginal delivery (p = 0.0001). Urgency, frequency and nocturia triggered during pregnancy tend to disappear in the late postpartum period, regardless of the delivery method, but the symptoms related to urinary loss due to stress tend to persist in late postpartum period after vaginal delivery.
Highlights
Introduction and ObjectivesThe increase of the intensity of urinary symptoms in late pregnancy and postpartum has been well documented by several authors, but their causes remain uncertain, partly because of its probable multifactor origin
Patients were evaluated during the last trimester of pregnancy and reassessed 45 days (± 10 days) after delivery, through culturally adapted and validated versions of the questionnaires: International Consultation on Incontinence Questionnaire - Urinary Incontinence Short Form (ICIQ-Urinary incontinence (UI) SF) and the International Consultation on Incontinence Overactive Bladder Questionnaire (ICIQ-OAB) [19,20]
It was shown that frequency, urgency, nocturia and urge incontinence, which have been observed during pregnancy, decreased significantly in the postpartum period, regardless of the delivery method (p = 0.0001)
Summary
The increase of the intensity of urinary symptoms in late pregnancy and postpartum has been well documented by several authors, but their causes remain uncertain, partly because of its probable multifactor origin. Results: It was observed that frequency, urgency, nocturia and urge incontinence, triggered during pregnancy, decreased significantly in the postpartum period, regardless of the delivery method (p = 0.0001). Conclusions: Urgency, frequency and nocturia triggered during pregnancy tend to disappear in the late postpartum period, regardless of the delivery method, but the symptoms related to urinary loss due to stress tend to persist in late postpartum period after vaginal delivery. The pathophysiological effects of pregnancy and method of delivery on the lower urinary tract in general and the pelvic floor in particular remain uncertain, despite frequent references in obstetric literature [2,16]
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