Frequency, severity and risk factors for urinary and faecal incontinence at 4years postpartum: a prospective cohort.

Abstract

To investigate frequency, severity and risk factors for urinary incontinence and faecal incontinence 4years after a first birth. Prospective pregnancy cohort study. Melbourne, Australia. A total of 1011 nulliparous women recruited in early pregnancy. Participants were followed up at 32weeks of gestation; then at 3, 6, 9 and 12months and 4years postpartum. Frequency and severity of urinary and faecal incontinence. At 4years, 29.6% of women reported urinary incontinence and 7.1% reported faecal incontinence. Compared with women having only spontaneous vaginal births, women who delivered exclusively by caesarean section were less likely to have urinary incontinence at 4years postpartum (adjusted odds ratio 0.4, 95% confidence interval 0.3-0.6). Women who reported urinary incontinence before or during the index pregnancy, and those experiencing symptoms in the first year postpartum had increased odds of incontinence at 4years, with the highest odds (6-12 times higher) among women who had previously reported moderate or severe symptoms. The odds of reporting faecal incontinence at 4years were two to six times higher for women experiencing symptoms in pregnancy, and around four to eight times higher for those with symptoms in the first year postpartum. Urinary and faecal incontinence are prevalent conditions 4years after a first birth. Women reporting urinary or faecal incontinence during pregnancy had markedly higher odds of reporting symptoms at 4years postpartum, suggesting a need for further investigation and elucidation of aetiological pathways involving nonbirth-related risk factors. Moderate/severe incontinence prevalent 4years after first birth in population cohort. Prior symptoms are biggest predictor.