Postpartum Urinary Incontinence Research Articles

Rééducation pelvi-périnéale et troubles de la statique pelvienne de la femme

Our goal is to provide an update on the results of pelvic floor rehabilitation in the treatment of urinary incontinence and genital prolapse symptoms. Pelvic floor muscle training allows a reduction of urinary incontinence symptoms. Pelvic floor muscle contractions supervised by a healthcare professional allow cure in half cases of stress urinary incontinence. Viewing this contraction through biofeedback improves outcomes, but this effect could also be due by a more intensive and prolonged program with the physiotherapist. The place of electrostimulation remains unclear. The results obtained with vaginal cones are similar to pelvic floor muscle training with or without biofeedback or electrostimulation. It is not known whether pelvic floor muscle training has an effect after one year. In case of stress urinary incontinence, supervised pelvic floor muscle training avoids surgery in half of the cases at 1-year follow-up. Pelvic floor muscle training is the first-line treatment of post-partum urinary incontinence. Its preventive effect is uncertain. Pelvic floor muscle training may reduce the symptoms associated with genital prolapse. In conclusion, pelvic floor rehabilitation supervised by a physiotherapist is an effective short-term treatment to reduce the symptoms of urinary incontinence or pelvic organ prolapse.

Prevalence and predictors of urinary/anal incontinence after vaginal delivery: prospective study of Nigerian women.

Urinary and anal incontinence are major public health problems impacting on the quality of life of affected women, with resultant loss of self-esteem. Despite the anticipated magnitude of this public health problem in sub-Saharan Africa, there is paucity of data on the prevalence of urinary and/or anal incontinence after childbirth in the region. This study determined the prevalence and predictors of urinary and anal incontinence after vaginal delivery among women in Enugu, southeastern Nigeria. This was a longitudinal study of 230 consecutive parturients at the University of Nigeria Teaching Hospital, Enugu, Nigeria. Eligible women were followed up immediately, 6 weeks, and 3 months postpartum to assess the development of urinary and/or anal incontinence using validated questionnaires. Overall, 28 women had urinary incontinence, giving a cumulative prevalence rate of 12.2 %. The cumulative prevalence rate was 13.5 % for anal incontinence and 3 % for combined urinary and anal incontinence. Age, social class, parity, prolonged second stage of labor, and neonatal birth weight were significantly associated with postpartum urinary incontinence (P < 0.05). On the other hand, age, parity, prolonged second stage of labor, episiotomy, and instrumental vaginal delivery were significantly associated with postpartum anal incontinence (P < 0.05). Urinary and anal incontinence are common after vaginal delivery in Enugu, Nigeria. Modification of obstetric care and discouraging preventable predisposing factors for incontinence, such as prolonged second stage of labor and vaginal delivery of macrosomic babies, are measures that may reduce the prevalence of postpartum incontinence in our population.

Prediction Models for Postpartum Urinary and Fecal Incontinence in Primiparous Women

Prediction Models for Postpartum Urinary and Fecal Incontinence in Primiparous Women

Planned caesarean section or trial of vaginal delivery? A meta-analysis.

This systematic review with meta-analysis aims to determine whether maternal outcomes are better with antenatal choice to give birth by caesarean section compared to vaginal birth, in singleton pregnancies in low-risk women without a subsequent pregnancy. The main outcome measures used were as follows: postpartum haemorrhage, postnatal depression, urinary incontinence and maternal mortality. There were seven relevant studies (2 730 410 women) that were of high quality, identified for the purpose of this review. Randomized and observational evidence was synthesized, showing no real difference in maternal morbidity risk: maternal mortality (relative risk 0.19, 95% confidence interval 0.0013-27.27, P = 0.51); postpartum haemorrhage (relative risk 1.15, 95% confidence interval 0.40-3.31, P = 0.79) and blood transfusion (relative risk 0.91, 95% confidence interval 0.39-2.13, P = 0.84). On the basis of the current research and the findings of this review, planned caesarean section is associated with a lower risk of developing urinary incontinence symptoms postpartum or having a blood transfusion yet conversely results showed an increased risk of postpartum haemorrhage. The synthesized data are not applicable to clinical practice; however, they prompt much further investigation into planned delivery and its associated morbidity risk.

Effect of pregnancy and delivery on urinary incontinence after the midurethral sling procedure.

To evaluate the continence status and to reveal the optimal delivery mode of women who had an infant after application of a midurethral sling to treat stress urinary incontinence. Between January 2007 and January 2013, 12 women who delivered an infant after application of a midurethral sling were detected and demographic data, type of MUS, interval between MUS and delivery, mode of delivery, birth weight of the newborn, complications during pregnancy, and continence status after delivery were collected. Between 2000 and 2014, in 14 articles listed in Pubmed, the data of 54 patients who had delivered after successful midurethral sling application were included. Postpartum recurrence of urinary incontinence was evaluated according to delivery type in 54 patients. Mean age of 12 patients at the time of MUS was 33.1 ± 4.3 years old and the interval between MUS procedure and pregnancy was 30.2 ± 14.2 months. Four patients had a transvaginal tape (TVT; 33.3%) and 8 had transobturator tape (TOT) procedure (66.7%) and mean follow-up after MUS surgery was 52 ± 12.3 months. Seven women had cesarean section (CS; 58.3%) and 5 women delivered vaginally (41.7%). Nine women were continent during pregnancy (75%) and 10 were continent after delivery (83.3%). Among 54 women who were included in the review, 28 underwent CS (51.9%), 26 women delivered vaginally (48.1%), and 11 women had postpartum incontinence (20.3%). In the case of postpartum urinary incontinence, there was no statistically significant difference between the CS and vaginal delivery groups (14.3 vs 26.9% respectively, p = 0.32). In logistic regression, incontinence during pregnancy was a risk factor for postpartum incontinence (OR:5.5; 95% CI: 1.1-27.6, p = 0.036). Risk of postpartum SUI recurrence in women who underwent application of midurethral slings seems to be similar independent of delivery mode and incontinence during pregnancy may be a risk factor for postpartum incontinence.

Postpartum İdrar Retansi̇yonu (Postpartum Urinary Retention)

Postpartum urinary retention (PUR), defined as urinary retention after the delivery, is a common condition that can easily disappear spontaneously. Although this problem could cause stress to the women, PUR has not been clearly described and explored its causes and symptoms like postpartum urinary incontinence due to the self-limiting condition without treatment. There were not enough reports about this subject in the literature. In this report PUR is reviewed with the literature.

Risk factors for obstetric anal sphincter injuries and postpartum anal and urinary incontinence: a case-control trial.

Obstetric anal sphincter injuries (OASIS) cause serious maternal morbidity for mothers. A clearer understanding of aetiological factors is needed. We aimed to determine the risk factors for OASIS . Birth details of 222 primiparous women sustaining OASIS were compared with 174 women who did not sustain OASIS (controls) to determine the relevant risk factors. The data underwent univariate analysis and logistic regression analysis. Asian or Indian ethnicity, operative vaginal birth (p = 0.00), persistent occipito-posterior position (p = 0.038) and rapid uncontrolled delivery of the head were identified as risk factors for OASIS. Pushing time, use of epidural, episiotomy and head circumference were not predictors of OASIS. Women with Asian or Indian ethnicity, operative vaginal birth, persistent occipito-posterior position and rapid uncontrolled delivery of the fetal head were likely to sustain OASIS. Awareness of these factors may help to minimise the incidence of OASIS.

A case control study investigation risk factors of postpartum urinary incontinence

Objective To investigate the clinical associated risk factors which affect the postpartum urinary incontinence ,providing theoretical basis for early prevention and treatment of this disease . Methods The clinical data of 60 cases who diagnosed postpartum urinary incontinence were collected ,and established database ,and apply regression analysis method were used to analyze the clinical associated risk factors .Results The results showed that BMI（OR=2.534,95%CI：0.975 -6.489 ）,fetal weight （OR =2.342,95%CI：0.723 -6.575） second stage （OR=3.346,95%CI：0.635~6.673）.Conclusion high BMI,fetal weight is heavy,prolonged second stage was re-lated risk factors with postpartum urinary incontinence . Key words: Urinary incontinence; Postpartum period; Risk factors; Case-control studies

Study on neuromuscular stimulation combined with vaginal cones treatment in patients with postpartum stress urinary incontinence

Objective To study the clinical effect of neuromuscular stimulation combined with vaginal cones treatment in patients with postpartum stress urinary incontinence（SUI）. Methods 100 cases using random sampling method were divided into vaginal cones （ control group） in 50 cases and neuromuscular stimulation combined with vaginal cones training （ observation group） in 50 cases, by each treatment for 8 weeks, The treatment effect of SUI before and after of the two groups was evaluated. Results The change of pelvic floor muscle strength before treatment in the two groups was no statistically significant differences （ x^2 = 5.49, P 〉 0.05 ） ; The change of pelvic floor muscle strength after treatment in the observation group than the control group obviously improve （ x^2 = 23.11, P 〈 0.05 ） ; The of pelvic floor muscle strengthseore score （4.88 ±0.77 ）point after 12 week in the observation group were significantly higher than those control group （3.88 ± 0.69 ）/point （t = 3.55 ,P 〈 0.05 ） ;The incidence rate （10%） of urinary incontinence after 12 week in the observation group were significantly lower than those in the control group （18%） （x^2 =4.33 ,P 〈 0.05 ）;The muscles contraction strength[ （37.55±7.98）μV] after treatment in the observation group were markedly increased compared to the control group[ （37. 55 ± 7.98 ） μV] （ t = 5.13,P 〈0. 05）. Conclusion The incidence rate of urinary incontinence postpartum can reduce postpartum stress urinary incontinence, and pelvic floor muscle strength were increased by treatment in neuromuscular stimulation combined with vaginal cones. Key words: Urinary incontinence, stress ; Postpartum; Neuromuscular stimulation; Vaginal cones

Consultation about urinary and faecal incontinence in the year after childbirth: a cohort study.

To investigate the extent to which primary-care practitioners routinely inquire about postpartum urinary and faecal incontinence, and assess the proportion of women who disclose symptoms. Prospective pregnancy cohort study of nulliparous women. Melbourne, Australia. A total of 1507 nulliparous women recruited in early pregnancy. Women were recruited from six public maternity hospitals, with follow up at 3, 6, 9 and 12 months postpartum. Standardised measures of urinary and bowel symptoms, and measures of health service use. In the first 12 months postpartum, the period prevalence of urinary incontinence was 47%, and of faecal incontinence was 17%. In all, 86% of women visited a primary health-care practitioner at least once to discuss their own health in the first year after childbirth. However, only around a quarter were asked about urinary incontinence, and fewer than one in five women were asked about faecal incontinence. Discussion of symptoms with health professionals was most likely to occur in the first 3 months postpartum, and happened only rarely during the remainder of the first postnatal year. Over 70% of women reporting severe urinary incontinence and/or faecal incontinence had not discussed symptoms with a health professional. The findings provide robust evidence that many women experiencing postpartum urinary and faecal incontinence—including women with moderate and severe symptoms—do not receive adequate primary-care follow up in the first 12 months postpartum. Systems of maternal health surveillance need to include routine inquiry about urinary and faecal incontinence to overcome women's reluctance to seek help.

Factors associated with treatment-seeking behavior for postpartum urinary incontinence.

To identify the factors associated with treatment-seeking behavior for urinary incontinence (UI) among postpartum women. This is a cross-sectional study. A total of 142 women with postpartum UI responded a telephone interview between August of 2010 and March of 2011. The association between the treatment-seeking and the predicting variables were measured through odds ratio and 95% confidence interval. The treatment-seeking percentage was 37.3% and the treatment percentage was 27.5%. The result of multiple logistic regressions indicated that: counseling about UI in pregnancy, postpartum physical exercise, and Spanish nationality predicted 47.8% of the variance in treatment-seeking behavior The lack of counseling largely determines the low rates of treatment-seeking among Spanish mothers. Nursing counseling during pregnancy can contribute substantially to increasing the number of women treated for postpartum UI.

Kegel’s Exercise could Reduce the Incidence of Postpartum Urinary Stress Incontinence

Objective: To investigate the cause of postpartum urin ary incontinence in primi gravida women and to determin e the relationship between stress urinary incontinence and kegel's exercise.&#x0D; Method: This was an observational study with cross sectional method , perform ed in instituti onal hospitals in Makassar. Thirty primigravida women who performed kegel's exercise were compared with 30 primi gravida women who did not perform kegel's exercise. Data were analyzed with independent-t sta tistical analysis.&#x0D; Result: Urinary incontinence were significantly lower in primigravida women who performed kegel's exercise (P=O.OOO).&#x0D; Conclusion: Kegel's exercise may reduce the incidence of postpartum stress urinary incontinence.&#x0D; Keywords: kegel's exercise, primigravida, urinary Incontinence.

Perineal Body Stretch in the Second Stage of Labor does not Predict Obstetric Trauma or Postpartum Pelvic Floor Function

Short perineal body length (PBL) has been associated with an increased risk of severe perineal laceration at the time of delivery and postpartum functional disorders. Stretch damage to pelvic floor muscles is thought to occur during the second stage of labor. We aimed to describe changes in PBL during the second stage of labor and evaluate whether degree of PBL stretch predicted perineal lacerations or postpartum urinary incontinence (UI), fecal incontinence (FI) or sexual activity.

Postpartum Pelvic Floor Muscle Training and Urinary Incontinence: A Randomized Controlled Trial

Postpartum Pelvic Floor Muscle Training and Urinary Incontinence: A Randomized Controlled Trial

Postpartum Pelvic Floor Muscle Training and Urinary Incontinence

To evaluate whether postpartum pelvic floor muscle training decrease prevalence of any urinary incontinence (UI) in primiparous women with and without UI at inclusion (mixed population) and further to perform stratified analyses on women with and without major levator ani muscle defects. A two-armed assessor-blinded randomized controlled trial including primiparous women 6 weeks after vaginal delivery was conducted. Participants were stratified on major levator ani muscle defects, verified by transperineal ultrasonography, and thereafter randomly allocated to training or control. All participants were taught to contract the pelvic floor muscles. The control participants received no further intervention, whereas training participants attended a weekly supervised pelvic floor muscle training class and performed daily home exercise for 16 weeks. Primary outcome was self-reported UI analyzed by relative risk. We included 175 women, 55 with major levator ani muscle defects and 120 without. Prevalence of UI at baseline was 39.1% in the training group (n=87) and 50% among those in the control group (n=88). Fifteen women (8.6%) were lost to follow-up. At 6 months after delivery (postintervention), 34.5% and 38.6% reported UI in the training and control groups, respectively. Relative risk analysis of UI gave a nonsignificant effect size of 0.89 (95% confidence interval [CI] 0.60-1.32). Results were similar for the stratum with and without major levator ani muscle defects, 0.89 (95% CI 0.51-1.56) and 0.90 (95% CI 0.53-1.52), respectively. Postpartum pelvic floor training did not decrease UI prevalence 6 months after delivery in primiparous women. Stratified analysis on women with and without major levator ani muscle defects showed similar nonsignificant results. ClinicalTrials.gov, www.clinicaltrials.gov, NCT01069484. : I.

Urinary Incontinence in the 12-Month Postpartum Period

The etiology of postpartum urinary incontinence (UI) appears to be multifactorial. A large number of potential risk factors have been investigated. The aim of this study was to describe the prevalence and severity of UI in the 12-month postpartum period and determine the role of several potential risk factors in its development. Potential predisposing risk factors examined included body mass index, smoking, oral contraceptives, breast-feeding, and pelvic floor muscle exercise. The role of these and other potential factors associated with UI were studied over 4 time points within the postpartum year. Participants were a sample of 523 women at a mean age of 28.6 (range, 14–42 years) who had obstetrical deliveries between February 26, 1990, and March 1, 1991. Women were interviewed on postpartum day 2 or 3 in their rooms. Follow-up telephone interviews to assess outcomes were conducted at 6 weeks, 3 months, 6 months, and 12 months postpartum. Obstetrical data from the index delivery were obtained by chart review and abstracted. Generalized estimating equation (GEE) analysis was used to assess associations between UI and predictor variables. The proportion of women reporting incontinence at 6 weeks after the index delivery was 11.4% and did not change significantly over the postpartum period. Frequency of accidents decreased over the year from a mean 15.9 per week at 6 weeks to about half this amount at the 3- and 6-month follow-up and to about 5 per week at the 12-month follow-up. In the multivariable GEE model equation, postpartum incontinence over the 4 time points was significantly associated with the following 7 variables: baseline report of smoking (odds ratio [OR], 2.934; P = 0.002), incontinence during pregnancy (OR, 2.002; P = 0.007), length of breast-feeding (OR, 1.169; P = 0.023), 2 obstetrical factors (vaginal delivery [OR, 2.360; P = 0.002], and use of forceps [OR, 1.870; P = 0.024]), and 2 time varying covariates (frequency of urination [OR, 1.123; P < 0.001] and body mass index [OR, 1.055; P = 0.005]). Several potential risk factors were not associated with postpartum incontinence. These included educational level, episiotomy, number of vaginal deliveries, attendance at childbirth preparation classes, and performing pelvic floor muscle exercises during the postpartum period. This study identified a number of risk factors associated with incontinence in the postpartum period. Some of these factors are potentially modifiable, and others may help target at-risk women for early intervention.

URINARY INCONTINENCE THREE MONTHS AFTER DELIVERY;

Objective: The objective of this study was to investigate prevalence of urinary incontinence at 3 months postpartum andto study how continence status during pregnancy and different factors influence urinary incontinence at 3 months postpartum inprimiparous women. Setting: Pregnant women attending routine antenatal clinic at Ziauddin hospital and Kharader general hospitalKarachi were recruited to this study. Methods: Urinary incontinence before and during pregnancy was assessed at study enrolment earlyin the third trimester. Incontinence was re-assessed three months postpartum. Logistic regression analysis was used to assess the role ofmaternal and obstetric factors in causing postpartum urinary incontinence. Results: Urinary incontinence was reported in 15 women(10.6% ) out of 141 women, mode of delivery, onset of labor weight of the baby, episiotomy, and the length of the second stage of labor,were not predictive of urinary incontinence after delivery. Adjusted RR for incontinence after spontaneous vaginal delivery compared withelective caesarean section was 2.200(95% CI .6-7.28) among women who were continent during pregnancy. Conclusions: Urinaryincontinence was prevalent 3 months postpartum. The association between incontinence postpartum mode of delivery, onset of labor,perineal trauma and weight of baby was not statistically significant.

Prevalence of urinary incontinence and pelvic floor muscle dysfunction in primiparae two years after cesarean section: cross-sectional study.

There is uncertainty in the literature regarding the theory that obstetric events and pelvic floor injuries give rise to lower risk of subsequent urinary incontinence among women delivering via cesarean section than among women delivering vaginally. The objective of this study was to assess the two-year postpartum prevalence of urinary incontinence and pelvic floor muscle dysfunction and the factors responsible for them. Cross-sectional study, conducted in a public university. 220 women who had undergone elective cesarean section or vaginal childbirth two years earlier were selected. Their urinary incontinence symptoms were investigated, and their pelvic floor muscle dysfunction was assessed using digital palpation and a perineometer. The two-year urinary incontinence prevalences following vaginal childbirth and cesarean section were 17% and 18.9%, respectively. The only risk factor for pelvic floor muscle dysfunction was weight gain during pregnancy. Body mass index less than 25 kg/m 2 and normal pelvic floor muscle function protected against urinary incontinence. Gestational urinary incontinence increased the risk of two-year postpartum urinary incontinence. Gestational urinary incontinence was a crucial precursor of postpartum urinary incontinence. Weight gain during pregnancy increased the subsequent risk of pelvic floor muscle dysfunction, and elective cesarean section did not prevent urinary incontinence.

Prediction Models for Postpartum Urinary and Fecal Incontinence in Primiparous Women

This study aimed to develop and internally validate a nomogram that facilitates decision making between patient and physician by predicting a woman's individual probability of developing urinary (UI) or fecal incontinence (FI) after her first delivery. This study used Childbirth and Pelvic Symptoms Study data, which estimated the prevalence of postpartum UI and FI in primiparous women after vaginal or cesarean delivery. Two models were developed using antepartum variables, and 2 models were developed using antepartum plus labor and delivery variables. Urinary incontinence was defined by a response of leaking urine "sometimes" or "often" using the Medical, Epidemiological, and Social Aspects of Aging Questionnaire. Fecal incontinence was defined as any involuntary leakage of mucus, liquid, or solid stool using the Fecal Incontinence Severity Index. Logistic regression models allowing nonlinear effects were used and displayed as nomograms. Overall performance was assessed using the Brier score (zero equals perfect model) and concordance index (c-statistic). A total of 921 women enrolled in the Childbirth and Pelvic Symptoms Study, and 759 (82%) were interviewed by telephone 6 months postpartum. Two antepartum models were generated, which discriminated between women who will and will not develop UI (Brier score = 0.19, c-statistic = 0.69) and FI (Brier score = 0.10, c-statistic = 0.67) at 6 months and 2 models were generated (Brier score = 0.18, c-statistic= 0.68 and Brier score = 0.09, c-statistic = 0.68) for predicting UI and FI, respectively, for use after labor and delivery. These models yielded 4 nomograms that are accurate for generating individualized prognostic estimates of postpartum UI and FI and may facilitate decision making in the prevention of incontinence.

Urinary incontinence and weight changes during pregnancy and post partum: A pending challenge

Objectiveto analyse the association between urinary incontinence and maternal weight, and its variations in pregnancy and post partum. Designobservational study of a cohort of women from the start of pregnancy until six months post partum. SettingHospital San Pedro in La Rioja, Spain. Participants402 pregnant women without urinary incontinence at the start of pregnancy. Measurements and findingsthe dependent variable was urinary incontinence, assessed using the Urogenital Distress Inventory-Short Form questionnaire. The main independent variables were body mass index (BMI) at the first antenatal visit and six months post partum, weight gain during pregnancy, postpartum weight loss, and weight retained from the start of pregnancy to six months post partum. The association between urinary incontinence and the main independent variables was measured using Student's t-test. Three simple logistic regression models were used to assess the strength of this association, one for each of the independent variables that showed a significant association with urinary incontinence (p<0.05), and three multiple regression models that included the possible variable effect modifiers were also used. At the start of pregnancy, 20.1% of the women were overweight and 8.7% were obese. Six months post partum, 30.3% of the women were overweight and 11.4% were obese. The mean (±standard deviation) retained weight was 2 (±3.1)kg. Postpartum urinary incontinence was associated with BMI at six months post partum, postpartum weight loss and retained weight at six months post partum (p<0.05). The association of urinary incontinence with these variables was significant, and remained stable in both simple and multiple regression analyses with BMI at six months post partum [odds ratio (OR) 1.09 versus 1.08], weight loss from delivery to six months post partum (OR 0.88 versus 0.88), and retained weight from the beginning of pregnancy until six months post partum (OR 1.23 versus 1.19). Key conclusionshigh BMI and weight retention at six months post partum increase the risk of urinary incontinence, whereas postpartum weight loss decreases the risk of urinary incontinence, even if other urinary incontinence risk factors co-exist. Implications for practiceprimary care midwifes can make a major contribution towards the prevention and rehabilitation of urinary incontinence in women. It is important for the midwife and the woman to keep in contact in the first six months post partum. Individualised advice about eating and exercise habits to avoid weight retention after pregnancy may have a considerable impact on decreasing the risk of urinary incontinence.