Urinary incontinence during pregnancy – of predictive value?

Abstract

Objective: Primary objective was to find the prevalence of urinary incontinence during pregnancy by its type and see how predicative it was of urinary incontinence in the long term. Associated risk factors were identified as secondary objectives. Method: Antenatal clinics provide opportunistic screening for diseases of the breast, the heart or even the mind. Preventive gynaecological issues could also be addressed likewise. It was felt worth investigating the prevalence of urinary incontinence during pregnancy without undue harassment to the patients by way of a few routinely directed questions about urinary incontinence.This information is rarely volunteered due to embarrassment. 867 women attending antenatal clinics led by the author at teaching hospital Peradeniya, in 2007 and 2008 were interviewed during pregnancy and those incontinent were followed up post-partum at 6 weeks,one and two years till 2010. Patients were inquired regarding the predominant type of incontinence, when the symptoms were mixed(stress and urge both). Results: Of the 867 women analysed, 209 (24%) had some form of urinary incontinence. 110 (52%) of those affected had pure or predominant stress, and 15 (7%) pure or predominantly urge incontinence. The rest 41% had a mixed picture. 154 were still incontinent at 6 weeks post-partum. The proportion of the type of incontinence had changed. 97 (63%) had pure or predominantly stress incontinence, 6 (3.9%) had pure or predominantly urgency and the 33.1% had a mixed picture. 47 of them still complained of some degree of incontinence at the end of one year despite interventions of pelvic floor exercise (PFE),for urodynamic stress incontinence or mixed symptoms. The patterns were even more stress predominant. 33(70%). 2 patients (4.2%) had pure urgency and the rest 12 (25.5%) had a mixed pattern. End of 2 years only 43 patients of those incontinent at 1year were traceable at least over the telephone. Only 23 complained of persistence of the problems. Of the 23 with symptoms at 2 years, 2 were pregnant again. 18 (78%) had pure SI and the rest 5 (22%) had a mixed picture. This indicated that pure stress incontinence tended to persist more than urge incontinence probably indicating some form of permanent damage to the pelvic floor. Older and women of higher parity were found to be more affected again indicating possibility of such injury. Conclusions: The finding that of the initial 209 women who leaked urine during pregnancy 23 remained incontinent at the end of 2 years (11%), is evidence that incontinence during pregnancy is of some predictive value in finding those likely to have long term incontinence.The symptoms of stress incontinence persisted despite PFE. This places doubts on benign physiological and hormonal change theories which is discussed alongside these findings. Incontinence during pregnancy maybe a useful indicator of injury sustained to the pelvic floor providing early warning for trouble ahead with the sphincter mechanism. Questions about urinary incontinence as a routine during antenatal consultations may be a worthwhile exercise. This would take only a very short time and should be encouraged as a higher percentage would have remained incontinent had PFE not been initiated as an ethical intervention.