Postpartum Urinary Incontinence Research Articles

Development and validation of a risk prediction model for postpartum urinary incontinence in primiparas with singleton pregnancies: a multicenter clinical investigation.

Postpartum urinary incontinence (UI) is a serious condition that significantly affects the quality of life. Several studies have demonstrated that it is associated with pelvic floor dysfunction. This study aimed to develop and validate a UI risk prediction model to identify primiparas with singleton pregnancies at high risk. A multistage stratified random sampling process was used. UI was measured using the International Standard Consultation on Incontinence Questionnaire Form (a modified Bristol questionnaire, ICIQ-FLUTS). Records of 1,340 primiparas with singleton pregnancies were reviewed, and data were collected from January 2014 to December 2014 in multiple centers. A univariate logistic regression analysis was performed, followed by a multivariable logistic regression analysis of the data. Using bootstrap resampling, we constructed a nomogram to assess postpartum UI risk. A total of 1,340 patients were enrolled, including 345 with postpartum UI and 995 with non-postpartum UI. The occurrence of postpartum UI was significantly related to the mode of delivery, family history of UI, coffee or tea consumption, antenatal UI, and frequent cough. The nomogram exhibited good discriminatory ability with a C-index of 0.718 (95% confidence interval: 0.684-0.752) and a bootstrap-corrected C-index of 0.716. Additionally, the calibration curve demonstrated that the predicted outcomes aligned well with the actual observations. Ultimately, the decision curve analysis indicated that the nomogram exhibited favorable clinical applicability. The decision curve analysis suggests that the nomogram could provide clinical value. The clinician will then feel more confident about making clinical recommendations regarding postpartum UI screening for primiparous women with singleton pregnancies.

Obstetric Perineal Tears, Birth Characteristics and the Association with Urinary Incontinence Among Primiparous Women 12 Months Postpartum: A Prospective Cohort Study.

Postpartumurinary incontinence (UI)is common and aconcern for many women, as UI leads to a lower quality of life and self-esteem. Perineal tears may be a risk factor for UI, yet few studies have investigated the association between the degree of perineal tear and risk of developing UI postpartum. The objective was to examine how the degree of perineal tear and selected obstetric risk factors were associated with any UI and stress ultrasound (SUI) 12 months postpartum among primiparous women. A prospective cohort study was conducted at four Danish hospitals. Baseline data were obtained at a clinical examination 2 weeks postpartum. Symptoms of UI were evaluated 12 months postpartum by the International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form questionnaire (web-based). Multivariate regression analyses were performed to investigate the risk factors for UI. A total of 603 primiparous women (203 with none/labia/first-degree tears, 200 with second-degree tears and 200 with third-/fourth-degree tears) were included between July 2015 and January 2018. Women with tears involving the perineal muscles reported any UI more often than women with no/labia or first-degree tears (spontaneous second-degree tear: RR 2.04, 95% CI 0.92-4.50; episiotomy: RR 2.22, 95% CI 0.99-4.96; third- or fourth-degree tear: RR 2.73, 95% CI 1.18-6.28). The same was found for SUI, but with wider confidence intervals. A higher prevalence of any UI and SUI was found among women with perineal tears involving any perineal muscles, compared with women with no, labia, or first-degree tears.

Effect of pelvic floor muscle exercise combined with infrared physiotherapy on postpartum urinary incontinence

BACKGROUND: Scientific treatments for postpartum urinary incontinence, including pelvic floor muscle exercises (such as Kegel exercises) and infrared therapy, can effectively improve pelvic floor and urethral function, thus enhancing quality of life. However, clinical research on the combined use of these interventions for postpartum urinary incontinence is limited. OBJECTIVE: To investigate the combining efficacy of pelvic floor muscle exercises with infrared physiotherapy on postpartum urinary incontinence. METHODS: Clinical information of 102 patients with postpartum urinary incontinence (June 2021–June 2022) were collected and analyzed. Patients were randomly divided into control (conventional intervention) and observation (pelvic floor muscle exercises combined with infrared physiotherapy) groups, with 52 and 50 cases respectively. We compared pelvic floor muscle strength, urodynamic indicators, leakage volume, quality of life, and overall clinical efficacy between the two groups. RESULTS: Before intervention, both groups had similar pelvic floor function scores and urodynamic indicators. Post-intervention, the pelvic floor function scores in the observation group were significantly lower than control. The urodynamic indicator levels of the observation group were markedly higher than control after 2 months of intervention. Leakage volume was similar before intervention, while the observation group had significantly lower volumes after 1 and 2 months of intervention. Quality of life scores were similar initially, but after 2 months, the observation group scored higher. The observation group showed notably better pelvic floor rehabilitation at 2 months post-intervention. CONCLUSION: Combining pelvic floor muscle exercise with infrared physiotherapy has been shown to be a highly effective approach in enhancing pelvic floor muscle strength and improving the quality of life for postpartum women experiencing urinary incontinence. This combined therapy also demonstrates positive effects on urodynamic indicators, reducing leakage volume, and facilitating pelvic floor rehabilitation.

Gestational and Postpartum Urinary Incontinence at Mansoura University Hospital

Gestational and Postpartum Urinary Incontinence at Mansoura University Hospital

De novo urethral hypermobility at 6 months after first delivery as a risk factor for stress urinary incontinence 12 years postpartum.

The aim of the study was to analyze the association between de novo urethral hypermobility 6 months postpartum and stress urinary incontinence (SUI) symptoms at 6 months and 12 years after first delivery. Risk factors associated with the development of postnatal urethral hypermobility were also examined. A longitudinal cohort study was conducted on primigravid women, after excluding those with UI before pregnancy and/or urethral hypermobility (rotational angle ≥30°) at term. At 6 months postpartum, SUI was assessed based on symptoms and introital ultrasound performed to measure rotational angle (difference between urethro-pelvic angle at rest and at maximum Valsalva). Twelve years after delivery, women were sent a questionnaire including SUI assessment and questions on parity, current age, and body mass index. Continuous variables were compared using student's t-test and qualitative variables using chi-squared tests. A logistic regression model was constructed including variables that reached statistical significance (P < 0.05) in the univariate analysis. Of the 314 women who completed the 6-month follow-up, 265 (84.4%) were successfully contacted and completed the questionnaire at 12 years and these formed the study group. In 127 women (47.9%), de novo urethral hypermobility had developed by 6 months postpartum. There was no association between urethral hypermobility and SUI symptoms 6 months postpartum (OR: 1.17; 95% CI: 0.59-2.33). Twelve years after delivery, however, SUI was reported by 110 women overall (41.5%) and nearly half of the women who developed postnatal urethral hypermobility (61/127, 48.0%). De novo urethral hypermobility 6 months postpartum constitutes a risk factor for SUI 12 years later.

Risk factors for postpartum stress urinary incontinence: An updated systematic review and meta-analysis

&lt;b&gt;Background:&lt;/b&gt; The objective of this meta-analysis was to identify and quantify postpartum stress urinary incontinence (SUI) risk factors.&lt;br /&gt; &lt;b&gt;Methods:&lt;/b&gt; We systemically searched three electronic databases (PubMed, Scopus, and Web of Science). The evaluated variables as risk factors were pooled as odds ratio (OR) with the corresponding 95% confidence intervals (CI).&lt;br /&gt; &lt;b&gt;Results:&lt;/b&gt; 63 studies were included. The analysis found a significant positive association between SUI and vaginal delivery (OR=2.15), age (OR=1.44), BMI (OR=1.19), parity (OR=1.43), and fetal-birth weight (OR=1.08).&lt;br /&gt; &lt;b&gt;Conclusions:&lt;/b&gt; Age, parity, delivery with forceps, birth weight, maternal body mass index, induction of labor, length of the second stage of labor, history of prenatal SUI, and vaginal delivery were all risk factors for postpartum SUI.&lt;br /&gt; &lt;b&gt;Scientific novelty:&lt;/b&gt; This systematic review and meta-analysis provides the most comprehensive and updated evidence to date.&lt;br /&gt; &lt;b&gt;Practical significance of the results:&lt;/b&gt; Healthcare personnel should be taught to recognize and treat postpartum SUI risk factors.

Self-efficacy with Pelvic floor muscle training mediates the effect of an App-based intervention on improving postpartum urinary incontinence severity among pregnant women: A causal mediation analysis from a randomised controlled trial

BackgroundA pragmatic randomised controlled trial has confirmed the effectiveness of Urinary Incontinence for Women (UIW) app-based intervention in improving postpartum urinary incontinence (UI) severity among pregnant women. However, the causal mechanisms underlying this intervention effect remain unclear. ObjectiveTo examine the mediating role of self-efficacy with pelvic floor muscle training (PFMT) on the effect of the UIW app-based intervention in improving postpartum UI severity. MethodsThis was a secondary causal mediation analysis of a single-center, 2-arm, unblinded pragmatic randomised controlled trial. Singleton pregnant women without UI before pregnancy aged ≥18 years and between 24 and 28 weeks of gestation were recruited from a tertiary public hospital in China and randomised to receive the UIW app intervention plus oral PFMT instructions (n = 63) or oral PFMT instructions alone (n = 63). The primary outcome was postpartum changes in UI severity at 6 weeks. Changes in self-efficacy with PFMT 2 months after randomisation were a hypothesised mediator. Causal mediation analysis was used to estimate the average causal mediation effect (ACME), average direct effect (ADE), average total effect (ATE), and proportion mediated. A sensitivity analysis was conducted to examine the robustness of the ACME in relation to potential unmeasured confounding. ResultsData from 103 participants were analyzed. The ATE of UIW app-based intervention on postpartum UI severity was 2.91 points (95 % confidence intervals [CI] 1.69 to 4.12), with ADE of 1.97 points (95 % CI 0.63 to 3.41) and the ACME 0.94 points (95 % CI 0.27 to 1.72). The proportion of ATE mediated by self-efficacy with PFMT was 0.32 (95 % CI 0.08 to 0.67). Sensitivity analysis revealed the robust ACME with respect to the potential effects of unmeasured confounding. ConclusionAn increase in self-efficacy with PFMT partially mediated the effect of the UIW app intervention on improvements in postpartum UI severity. Trial registrationThe original trial was prospectively registered in the Chinese Clinical Trial Registry under the reference number ChiCTR1800016171 on 16/05/2018. Further details can be accessed at: http://www.chictr.org.cn/showproj.aspx?proj=27455.

Comparison of Vaginal Pessaries to Standard Care or Pelvic Floor Muscle Training for Treating Postpartum Urinary Incontinence: a Pragmatic Randomized Controlled Trial.

To compare three conservative treatment options, standard care, pelvic floor muscle training (PFMT), and vaginal pessaries, for postpartum urinary incontinence (UI) that are accessible to most patients and practitioners in a generalizable cohort. A multicenter, open-label, parallel group, pragmatic randomized controlled clinical trial comparing standard care, PFMT, and vaginal cube pessary for postpartum urinary incontinence was conducted in six outpatient clinics. Sample size was based on large treatment effects (Cramers' V>0.35) with a power of 80% and an alpha of 0.05 for a 3×3 contingency table, 44 patients needed to be included in the trial. Outcomes were analyzed according to the intention-to-treat principle. Group comparisons were made using analysis of variance (ANOVA), Kruskal-Wallis, and chi-square test as appropriate. P<0.05 was considered statistically significant. Of the 516 women screened, 111 presented with postpartum UI. Of these, 52 were randomized to one of three treatment groups: standard care (n=17), pelvic floor muscle training (n=17), or vaginal cube pessary (n=18). After 12 weeks of treatment, treatment success, as measured by patient satisfaction, was significantly higher in the vaginal pessary group (77.8%, n=14/18), compared to the standard care group (41.2%, n=7/17), and the PFMT (23.5%, n=4/17; χ 2 2,n=52 =14.55; p=0.006, Cramer-V=0.374). No adverse events were reported. SUI and MUI accounted for 88.4% of postpartum UI. Vaginal pessaries were superior to standard care or PFMT to satisfyingly reduce postpartum UI symptoms. No complications were found.

Postpartum Pelvic Floor Muscle Training for Reducing Urinary Incontinence: A Systematic Review of Randomized Control Trials

Postpartum urinary incontinence is an increasingly prevalent problem for women, as it affects about one-third of women. The clinical significance of urine incontinence in relation to deficiencies in the active and passive pelvic floor structures is well recognized. Hence, pelvic floor muscle training (PMFT) treatment for urine incontinence is recommended. Several research studies suggest that PFMT prevents and treats pregnancy- and delivery-related urine incontinence. This study aimed to determine the effectiveness of postpartum PFMT for the treatment of urinary incontinence. Randomized control trials reporting the efficiency of PFMT among postpartum women from 2003–2023 were included. Studies including pregnant women or women who underwent any surgical intervention, along with studies describing pharmacological interventions and others apart from PFMT or PFMT with electrostimulation or biofeedback, were excluded. Additionally, studies with insufficient or unclear data regarding pregnancy outcomes were excluded. A Cochrane bias risk assessment tool was utilized to assess the quality of the studies. Final inclusion resulted in 7 studies that recruited 1398 patients. Four of the included trials assessed the endurance and strength of PFMT, and various rates of strength and endurance were observed among participants in both the intervention and control groups. The prevalence of urinary incontinence in comparison to the control group was observed to be lower in the intervention group, which demonstrates the beneficial role of PFMT in the management of urinary incontinence postpartum. There is strong evidence to suggest the effectiveness of PFMT in the management of postpartum urinary incontinence. However, this beneficial role of PFMT is often overlooked or under-described in clinical practice, for which awareness among clinicians and patients is vital. Additionally, awareness and planning for PFMT execution during antenatal visits can also help prevent urinary incontinence postpartum.

Prevalence and Risk Factors of Postpartum Urinary Incontinence in Southern Saudi Arabia: A Cross-sectional Study

Abstract Background: Besides knowing the prevalence of urinary incontinence (UI), it is also vital to know its risk factors and how many patients will seek treatment. UI affects women’s quality of life considerably, but the severity and impact on quality of life differ significantly. Postpartum urinary incontinence (p-UI) reported a wide range ranging from 3% to 40%. It is essential to estimate the prevalence of postpartum incontinence accurately. Methods: We conducted a cross-sectional study of consented females of childbearing age with previous delivery and complaints of p-UI from August to December 2022. Experts developed a questionnaire form after a literature review of similar articles. Data have been collected from attendants of obstetrics and gynecology departments at three leading hospitals in the region after obtaining consent for direct interviews and answering the questionnaire. Results: One hundred and seventy-six females with UI agreed to be included in the study. Participants age ranged from 18 to 50 years old, with a mean of 32.1 ± 6.8 years. Of 103 (58.5%) had previous 1–3 deliveries and 33 (18.8%) had previous deliveries of 6 times or more. The most reported type of delivery was normal vaginal delivery (NVD) among 115 (65.3%), whereas 24 (13.6%) had both NVD and cesarean section. Exact 44.3% of the females complained of urinary frequency. Furthermore, 37.5% felt an urgent need to empty the bladder, and 35.2% had frequent lower abdomen pain. Urgency was reported by 34.1% of the females, and 26.7% complained of experiencing a minimal amount of urinary incontinence (urine drops). Conclusions: The prevalence of p-UI about one-third of the participants in southern Saudi Arabia with mixed UI was the most common type. Moreover, old age, multiparity, and high BMI were significant risk factors.

Effect of home-based core exercises on postpartum stress urinary incontinence during COVID-19 pandemic in Jeddah city: a randomised control trial

IntroductionIntroduction. Postpartum stress urinary incontinence affects many women worldwide; it may exist during pregnancy or postpartum with a risk of permanence increasing five years later. This study aimed to determine the effect of home-based core exercises on postpartum stress urinary incontinence during the COVID-19 pandemic, in Jeddah city.MethodsRandomised control trial was conducted on 26 postpartum women aged 25–40 years with mild or moderate grade stress urinary incontinence and a body mass index (BMI) less than 30 kg/m2. Participants were randomly divided into two equal groups (A &amp; B). Group A performed home-based core exercises and pelvic floor muscle training for twenty-four sessions three times weekly for eight weeks; each session lasted 30 minutes. Group B performed home-based PFMT only. The assessment of pelvic floor muscles (PFMs) was measured with the Modified Oxford Grading Scale, while the 1-hour pad test and International Consolation on Incontinence questionnaire-short form (ICIQ UI- SF) total score served to assess incontinence severity before and after treatment.ResultsThe results showed a significant improvement in PFMs strength and endurance in both groups and there was a highly significant difference between groups, favouring the study group (A). There was a highly significant difference between the groups in the 1-hour pad test and ICIQ-SF total score, favouring the study group (A).ConclusionsHome-based core exercises for postpartum SUI women were an effective method to improve PFMs strength and endurance and minimise SUI symptoms.

Evidence Based Management of Labor.

Induction of labor (IOL) is a common obstetric intervention. Augmentation of labor and active management of the second stage is frequently required in obstetric practice. However, techniques around labor and induction management vary widely. Evidence-based practice regarding induction and labor management can reduce birth complications such as infection and hemorrhage and decrease rates of cesarean delivery. To review existing evidence on IOL and labor management strategies with respect to preparing for induction, cervical ripening, induction and augmentation, and second stage of labor techniques. Review of recent original research, review articles, and guidelines on IOL using PubMed (2000-2022). Preinduction, pelvic floor training and perineal massage reduce postpartum urinary incontinence and perineal trauma, respectively. Timely membrane sweeping (38 weeks) can promote spontaneous labor and prevent postterm inductions. Outpatient Foley bulb placement in low-risk nulliparous patients with planned IOL reduces time to delivery. Inpatient Foley bulb use beyond 6 to 12 hours shows no benefit. When synthetic prostaglandins are indicated, vaginal misoprostol should be preferred. For nulliparous patients and those with obesity, oxytocin should be titrated using a high-dose protocol. Once cervical dilation is complete, pushing should begin immediately. Warm compresses and perineal massage decrease risk of perineal trauma. Several strategies exist to assist in successful IOL and promote vaginal delivery. Evidence-based strategies should be used to improve outcomes and decrease risk of complications and cesarean delivery. Recommendations should be shared across interdisciplinary team members, creating a model that promotes safe patient care.

Effectiveness of exercise interventions on urinary incontinence and pelvic organ prolapse in pregnant and postpartum women: umbrella review and clinical guideline development.

Dysfunction related to pelvic floor muscles (PFM) is common among pregnant and postpartum women and can cause symptoms such as urinary incontinence or pelvic organ prolapse (POP). As part of developing a nationwide clinical practice guideline for nursing in Finland, the aim of this umbrella review is to summarize the existing evidence about the effectiveness of exercise interventions on urinary incontinence and POP in pregnant and postpartum women. To promote knowledge translation, recommendations for health care professionals are presented. We conducted an umbrella review to summarize the existing evidence. The JBI methodology for umbrella reviews was used to guide the review. The level of evidence was evaluated using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach, and recommendations based on the evidence were formulated by a clinical guideline working group. Altogether, 9 systematic reviews, reporting findings from 89 original studies, were included. The methodological quality of the reviews was evaluated using JBI's checklist. The highest level of evidence was found for preventing the symptoms of postpartum urinary incontinence through exercise and pelvic floor muscle training (PFMT) during pregnancy. Moderate-level evidence showed that exercise and PFMT are likely to reduce the symptoms and severity of urinary incontinence, but the level of evidence was low on PFMT reducing the symptoms of POP. We recommend encouraging and guiding pregnant and postpartum women to exercise and train PFM. We also recommend identifying pregnant and postpartum women with symptoms of PFM dysfunction and directing them to a physiotherapist or other health care professional specializing in pelvic floor function.

Pelvic floor muscle training with biofeedback or feedback from a physiotherapist for urinary and anal incontinence after childbirth - a systematic review

BackgroundChildbirth is one of the biggest risk factors for incontinence. Urinary and anal incontinence can cause pain and social limitations that affect social life, cohabitation, and work. There is currently no up-to-date literature study on the effect of pelvic floor muscle training with feedback from a physiotherapist, which involves verbal instructions based on vaginal and anal digital palpation, compared to treatment without feedback (e.g., recommendations for pelvic floor muscle training).AimThe objective of this systematic review was to examine the scientific evidence regarding the impact of pelvic floor muscle training (PFMT) with feedback from a physiotherapist and/or biofeedback on urinary and anal incontinence in women during the first six months following vaginal delivery, compared to treatment without feedback.MethodsThe literature search was conducted in the databases PubMed, Cochrane, and CINAHL. In addition, a manual search was conducted. The search terms consisted of MeSH terms and synonyms in the respective search block including population, intervention, and study design, as well as the terms pelvic floor and postpartum. An evaluation of each included study was conducted for methodological quality, evidence value, and clinical relevance.ResultsEight studies were included, three of which showed a significant difference between groups, in favor of the intervention group that received pelvic floor muscle training with feedback from a physiotherapist and/or biofeedback. Due to the varying results and insufficient quality for the majority of the studies, the scientific basis was considered insufficient.ConclusionThe scientific evidence for pelvic floor muscle training with feedback from a physiotherapist or biofeedback on postpartum urinary and anal incontinence compared to treatment without feedback is considered insufficient. Further research on the subject is needed. The study is registered in PROSPERO CRD42022361296.

Prevalence and factors of urinary incontinence among postpartum: systematic review and meta-analysis

BackgroundPostpartum urinary incontinence substantially impacts the psychophysical well-being of women. The influencing factors contributing to postpartum urinary incontinence remain a subject of contention in clinical investigation. By elucidating the factors contributing to postpartum urinary incontinence, more efficacious interventions for laboring women can be devised. Consequently, this review endeavored to scrutinize the repercussions of maternal postpartum urinary incontinence to furnish empirical references for the clinical advancement of preventive strategies.MethodThe investigation employed bibliographic databases: Embase, PubMed, Web of Science, Cochrane Library, CBM, VIP, CNKI, and Wan Fang Data for article retrieval. A comprehensive consideration of all study designs was undertaken during the examination of the effects of postpartum urinary incontinence. The temporal limitation was set at all articles prior to February 2023. Studies incorporated laboring mothers experiencing normative labor and parturition. A total of 28,303 women were encompassed in the reviewed investigations.ResultsA total of 5,915 putative citations were identified, from which 32 articles were selected for evaluating the effects of postpartum urinary incontinence. Meta-analyses revealed that the incidence of postpartum urinary incontinence was 26% [95%CI: (21% ~ 30%)]. Twelve pivotal variables were identified to influence postpartum urinary incontinence: cesarean delivery, vaginal delivery, age ≥ 35 years, multiparty (number of deliveries ≥ 2), neonatal weight > 4 kg, perineal dystonia, antecedents of urological incontinence-related pathology, maternal pre-conception BMI ≥ 24 kg/m^2, perineal laceration, instrumental parturition, historical pelvic surgical procedures, and protracted second stage of labor. Among these, cesarean delivery was identified as a protective factor against postpartum urinary incontinence.ConclusionThe study corroborated that anamnestic factors pertinent to urinary incontinence, vaginal parturitions, and neonates with a weight exceeding 4 kg serve as significant risk factors for postpartum urinary incontinence. Cesarean delivery emerged as a protective factor against postpartum urinary incontinence. Based on the prevalence of postpartum urinary incontinence, proactive intervention is requisite to mitigate the risk of postpartum urinary incontinence in postpartum women possessing these risk factors.Trial registrationCRD42023412096.

Effect of different interventions on the efficacy of postpartum urinary incontinence in China: A systematic review and network meta-analysis.

Currently, numerous treatment measures exist for postpartum stress urinary incontinence (PSUI); however, the study results are inconsistent. Computer searches of PubMed, Embase, Web of Science, CKNI, and Wanfang databases were conducted to search the literature on 13 different intervention modalities for PSUI from the date of establishment to January 2023 for analysis. The literature was independently screened, and the information was extracted by 2 researchers. A reticulated meta-analysis was conducted using Stata software. The findings of the reticulated meta-analysis revealed that, in terms of the effectiveness of the 13 interventions for treating PSUI from highest to lowest, the most effective was acupressure + pelvic floor muscle training (94.6%). Following this, the interventions ranked from best to worst were electroacupuncture + trans moxibustion (79.1%), pelvic floor muscle training + acupuncture (64.3%), pelvic floor muscle training + pelvic floor electrical stimulation (60.3%), biofeedback electrical stimulation + acupuncture (60.0%), pelvic floor muscle training + biofeedback electrical stimulation (59.8%), biofeedback electrical stimulation + acupuncture + herbal hot compresses (56.6%), moxibustion + pelvic floor muscle training (56.6%), pelvic floor muscle training + pelvic floor electrical stimulation + acupuncture (53.1%), biofeedback electrical stimulation + moxibustion (52.1%), pelvic floor muscle training (17.6%), biofeedback electrical stimulation (16.1%), and health coaching (0.2%). The evidence indicates that acupressure + pelvic floor muscle training may be the most effective intervention for treating PSUI occurrence. Improvement in 13 clinical indicators was observed in patients with PSUI, and significant enhancement was achieved through acupressure + pelvic floor muscle training.

Predisposisi Inkontenensia Urin pada Postpartum; Studi Retrospektif

Background : Urinary incontinence as a condition of unconscious urine output and is a social problem or a hygiene problem. The incidence of urinary incontinence at RSUD dr. Abdul Rivai Berau, in 2020 there were 36 people (0.02%), in 2021 there were 52 people (0.04%) and January-November 2022 there were 21 people (0.03%). Objective: to retrospectively determine the causes of postpartum urinary incontinence. Methods: This type of research was a quantitative study with an retrospective design. The sample is postpartum patients who experience urinary incontinence in 2022 as many as 21 people. Data analysis was descriptive univariate. Results: Description of the causes of urinary incontinence in postpartum mostly types of vaginal delivery (66.7%), multiparous parity (85.7%), labor complications in the form of prolonged labor (76.2%) and there was perineal tear (57.1%).

Pelvic floor parameters predict postpartum stress urinary incontinence: a prospective MRI study

ObjectiveTo investigate the pelvic floor changes in primiparas with postpartum stress urinary incontinence (SUI) after vaginal delivery using pelvic floor MRI.Materials and methodsFifty-two women were enrolled in the primiparous stress urinary incontinent (PSUI) group and 51 in the primiparous continent (PC) group. Thirty nulliparas were also recruited as the nulliparous control (NC) group. Levator ani muscle (LAM) injury, levator hiatus area (LHA), H-line, M-line, the distance from the bladder neck and cervix to the pubococcygeal line (B-PCL and U-PCL), levator plate angle, the anterior angle of the urethra, bladder neck descent, retrovesicourethral angle, functional urethral length, and a bladder neck funnel were evaluated on MRI images. Univariate and multivariate logistic regression analyses were used to explore anatomical predictors for SUI.ResultsThe primiparas in the PSUI group showed more obvious LAM injuries than in the PC groups (p = 0.001). LAM function assessment: the PSUI group had larger LHA and shorter B-PCL and U-PCL than the other groups during straining. Assessment of urethral mobility and function: the PSUI group had larger anterior angle of the urethra, bladder neck descent, retrovesicourethral angle, and shorter functional urethral length than the other two groups (all p < 0.05). Up to 88.5% of primiparas in the PSUI group showed bladder funnel (p < 0.001). The logistic regression analysis showed that retrovesicourethral angle, functional urethral length, and the presence of bladder funnel were significantly associated with postpartum SUI (p < 0.05).ConclusionsIncreased retrovesicourethral angle, shortened functional urethral length, and the presence of bladder funnel may be anatomical predictors for SUI in the early postpartum period. Urethral sphincter dysfunction plays an essential role in developing postpartum SUI.Critical relevance statementThis study used several measurements to reflect the anatomical structure and functional changes of the pelvic floor to identify the best anatomical predictors associated with postpartum stress urinary incontinence (SUI), aiming to provide new insights into treatment strategies for postpartum SUI.Key points• Increased retrovesicourethral angle, shortened functional urethral length, and the presence of bladder funnel are more commonly seen in primiparas with SUI.• The combination of retrovesicourethral angle, functional urethral length, and bladder funnel had the highest diagnostic performance in predicting postpartum SUI (AUC=0.947).• Urethral sphincter dysfunction may be the main pathophysiological foundation in SUI development.Graphical

Antenatal, Intrapartum and Postpartum Interventions for Preventing Postpartum Urinary and Faecal Incontinence: An Umbrella Overview of Cochrane Systematic Reviews.

Post-partum, women can suffer from urinary and faecal incontinence. It is important to assess interventions to prevent this problem. Cochrane systematic reviews summarize the data available from systematic reviews of randomized trials assessing interventions. We conducted an umbrella overview of Cochrane systematic reviews encompassing antenatal, intrapartum and postpartum interventions for preventing postpartum urinary and faecal incontinence. We searched the Cochrane Database of Systematic Reviews on the 9 May 2023. Results: Our search identified nine Cochrane reviews providing results. Data for urinary and faecal incontinence were available from 77 (72%) trials and included 51,113 women. The reviews assessed antenatal digital perineal massage, pelvic floor muscle training, techniques for repairing anal sphincter tears, routine use of episiotomy, use of endoanal ultrasound prior to repairing perineal tears, caesarean versus vaginal delivery (overall, for breech and for twins), and vaginal delivery with forceps or vacuum. Only the use of a vacuum instead of forceps if an assisted vaginal delivery is needed, the use of an endo-anal ultrasound prior to repairing perineal tears and postpartum pelvic floor muscle training suggest a reduction in postpartum incontinence. Due to the small number of relevant reviews, a consequence of the relatively small number of primary studies, the effect of almost all the tested interventions was found to be imprecise.

Association of epidural analgesia during labor and early postpartum urinary incontinence among women delivered vaginally: a propensity score matched retrospective cohort study

BackgroundAlthough epidural analgesia is considered the gold standard for pain relief during labor and is safe for maternity and fetus, the association between the epidural analgesia and pelvic floor disorders remains unclear. Thus we estimate the association between epidural analgesia and early postpartum urinary incontinence (UI).MethodsA propensity score-matched retrospective cohort study was conducted at a university-affiliated hospital in Shanghai, China. Primiparous women with term, singleton, and vaginal delivery between December 2020 and February 2022 were included. UI was self-reported by maternity at 42 to 60 days postpartum and was classified by International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form (ICIQ-UI SF). Using logistic regression models, the associations between epidural analgesia and early postpartum UI were assessed.ResultsAmong 5190 participants, 3709 (71.5%) choose epidural anesthesia during labor. Analysis of the propensity-matched cohort (including 1447 maternal pairs) showed epidural anesthesia during labor was independently associated with UI in early postpartum period (aOR 1.50, 95% CI 1.24–1.81). This association was mainly contributed to stress UI (aOR 1.38, 95% CI 1.12–1.71) rather than urge UI (aOR 1.45, 95% CI 0.99–2.15) and mixed UI (aOR 1.52, 95% CI 0.95–2.45). Furthermore, we observed that the association between epidural anesthesia and UI was more pronounced among older women (≥ 35 y) and women with macrosomia (infant weight ≥ 4000 g), compared with their counterparts (both P for interaction < 0.01). After further analysis excluding the women with UI during pregnancy, the results remained largely consistent with the main analysis.ConclusionsThe findings support that epidural anesthesia was associated with SUI in the early postpartum period.