Failure to void in labour: postnatal urinary and anal incontinence

Abstract

The objectives was to identify the impact of intrapartum voiding on postnatal urinary and anal incontinence. A longitudinal, prospective, repeated measures, cohort study design was used. The study was set in one of the biggest and busiest acute NHS university teaching hospitals in the North West of England, which provides maternity care to over 4000 women each year. Primiparous women with no pre-existing disease (n=516) participated and were recruited after a normal 20-week gestation obstetric ultrasound scan. Data was collected using validated questionnaires during the last trimester of pregnancy and postnatally at six weeks, six months and finally at one year. Obstetric and demographic data was extracted from case notes. This included age, body mass index, gestation, duration of labour, analgesia, birth weight, mode of delivery and perineal trauma. Statistical analysis was undertaken using Statistics Package for Social Sciences (SPSS version 13.0). The main outcome measures were urinary incontinence symptoms and anal incontinence symptoms. Prolonged periods of time in labour without emptying the bladder was associated with increased rates of postnatal urinary incontinence (OR 2.36) and may also contribute to anal incontinence. Postnatal urinary incontinence may be reduced if intrapartum bladder care policies reflect frequent emptying. This preliminary data supports large-scale exploration of the association between postnatal anal incontinence and bladder emptying in labour.