Professional Documents
Culture Documents
134
PhD,
LEVEL OF EVIDENCE: II
RESULTS
A total of 15,787 women completed the survey, for a
response rate of 39%. Of these women, 5,841 were
primiparous, completed the survey in the desired
timeframe, and submitted information on their urinary continence. Two hundred forty-two women
were excluded because they reported urinary incontinence before pregnancy. The final analysis set included 5,599 women (Fig. 1). The average interval
between delivery and completion of the survey was
4.4 months (range 3 6 months) for all women.
The distribution of urinary incontinence in this
population is shown in Figure 2. Of the women who
experienced urinary incontinence during pregnancy,
Hamilton Boyles et al
135
Fecal Incontinence
Postpartum
Phase II survey
N=15,787
Excluded: survey
completed less than 11
weeks or more than 27
weeks after delivery
n=488
Survey completed
between 11 weeks and
27 weeks after delivery
n=15,299
Excluded: multiparous
n=9,147
Nulliparous
n=6,152
Excluded: invalid urinary
leakage survey
n=311
Valid urinary
leakage survey
n=5,841
Excluded: urinary
leakage before first
pregnancy
n=242
Analysis I
(urinary leakage after
first delivery)
No urinary leakage
before first pregnancy
n=5,599
136
Hamilton Boyles et al
Hamilton Boyles et al
137
Unknown
Age at pregnancy (y)
Average
Younger than 20
2024
2529
30 or older
BMI before pregnancy (kg/m2)
Average
Less than 20
20 to 24
25 to 29
30 or higher
Weight gain at pregnancy (lb)
Average
Less than 25
25 to 34
35 to 44
45 or higher
BMI (kg/m2)at this pregnancy
Average
Less than 25
25 to 29
30 to 34
35 or higher
Birth weight (lb)
Average
Less than 7
78
8 or more
Pushing time
Median
Less than 15 min
15 to 44.9 min
45 min to 1.99 h
2 h or more
Exercise during pregnancy
Aerobic dance
Jogging
Yoga
Conditions before or during pregnancy
Diabetes
Asthma
Constipation
No
Yes
4,644 (82.9)
955 (17.1)
4.40.7
4.40.7
.94
372 (8.0)
616 (13.3)
423 (9.1)
409 (8.8)
2,119 (45.6)
542 (11.7)
163 (3.5)
24 (2.5)
37 (3.9)
29 (3.0)
84 (8.8)
577 (60.4)
175 (18.3)
29 (3.0)
.001
27.05.7
463 (10.0)
1,202 (25.9)
1,381 (29.8)
1,589 (34.3)
27.75.8
84 (8.8)
204 (21.4)
282 (29.6)
384 (40.3)
.001
.001
24.35.3
744 (16.4)
2,287 (50.5)
933 (20.6)
564 (12.5)
24.75.2
123 (13.1)
473 (50.3)
226 (24.0)
119 (12.7)
.05
36.414.9
759 (17.0)
1,260 (28.2)
1,257 (28.1)
1,193 (26.7)
37.415.1
139 (15.0)
250 (27.0)
266 (28.7)
271 (29.3)
.06
.25
30.35.4
538 (12.3)
1,877 (42.8)
1,257 (28.7)
709 (16.2)
30.75.3
99 (10.8)
346 (37.9)
311 (34.0)
158 (17.3)
.04
.004
7.51.3
1,339 (29.4)
1,665 (36.6)
1,544 (34.0)
7.61.1
245 (26.0)
360 (38.2)
338 (35.8)
.12
.10
45 min
1,235 (27.3)
961 (21.2)
1,133 (25.1)
1,194 (26.4)
1h
124 (13.4)
233 (25.1)
304 (32.8)
266 (28.7)
.001
.001
451 (10.1)
786 (17.4)
1,036 (23.3)
79 (8.6)
194 (21.1)
240 (26.6)
.19
.008
.03
172 (3.7)
583 (12.8)
1,424 (30.7)
29 (3.2)
144 (15.8)
508 (53.2)
.41
.01
.001
One hundred fifty-six participants (2.8%) without delivery information and 36 participants who had vaginal delivery with unknown
laceration.
138
Hamilton Boyles et al
Incidence
Unadjusted
1
4.27 (3.405.35)
1
0.93 (0.551.58)
1.06 (0.611.86)
3.18 (1.985.12)
4.22 (2.776.44)
5.01 (3.207.82)
Adjusted*
.001
4.96 (3.826.44)
1
0.93 (0.521.67)
1.01 (0.531.94)
3.83 (2.226.63)
4.86 (3.007.87)
5.34 (3.229.16)
.001
.79
.83
.001
.001
.001
.82
.98
.001
.001
.001
Data are n (%, 95% confidence interval) or odds ratio (95% confidence interval) unless otherwise specified.
* Adjusted for potential predictors of urinary incontinence (P.05) in Table 1 and birth weight.
during pregnancy, and active constipation were independently associated with postpartum urinary incontinence in women who delivered vaginally. For
women who delivered by cesarean, maternal BMI of
30 or higher and active constipation were independently associated with postpartum urinary incontinence (Table 3).
DISCUSSION
The risk of urinary incontinence in the 3 6 months
after a primiparous delivery is greater in women who
deliver vaginally than in women who deliver by
cesarean, regardless of whether the cesarean was
performed before, during, or after labor. Labor and
pushing alone, without vaginal delivery, do not seem
Table 3. Factors Associated with Urinary Incontinence
Vaginal
Predictor
Demographics
Age 30 y or older
BMI (kg/m2) 30 or higher
Labor/delivery experience
Birth weight 8 lb or heavier
Pushed 2 h or longer
Device use
Laceration/tear
Exercise during pregnancy
Jogging
Yoga
Condition before delivery
Asthma
Constipation
Cesarean
Unadjusted
Adjusted
Unadjusted
Adjusted
1.54* (1.321.81)
1.44* (1.231.68)
1.48* (1.241.75)
1.52* (1.281.79)
1.16 (0.751.77)
1.83 (1.142.94)
1.88 (1.173.01)
1.29 (1.101.52)
1.06 (0.901.26)
1.23 (1.021.48)
1.36 (1.071.73)
1.22 (1.031.45)
0.84 (0.531.35)
1.01 (0.591.73)
NA
NA
1.23 (1.021.49)
1.22 (1.021.46)
1.32* (1.081.62)
0.86 (0.461.60)
1.09 (0.661.79)
1.29 (1.041.60)
2.65 (2.273.10)
2.53* (2.152.99)
1.41 (0.802.48)
2.41* (1.573.71)
2.35* (1.513.65)
P.05.
P.01.
Hamilton Boyles et al
139
140
Hamilton Boyles et al
3. Rortveit G, Daltveit AK, Hannestad YS, Hunskaar S; Norwegian EPINCONT Study. Urinary incontinence after vaginal
delivery or cesarean section. N Engl J Med 2003;348:9007.
4. Handa VL, Harvey L, Fox HE, Kjerulff KH. Parity and route
of delivery: does cesarean delivery reduce bladder symptoms
later in life? Am J Obstet Gynecol 2004;191:4639.
5. Farrell SA, Allen VM, Baskett TF. Parturition and urinary
incontinence in primiparas. Obstet Gynecol 2001;97:3506.
6. Fritel X, Fauconnier A, Levet C, Benifla JL. Stress urinary
incontinence 4 years after the first delivery: a retrospective
cohort survey. Acta Obstet Gynecol Scand 2004;83:9415.
7. Persson J, Wolner-Hanssen P, Rydhstroem H. Obstetric risk
factors for stress urinary incontinence: a population-based
study. Obstet Gynecol 2000;96:4405.
8. Altman D, Ekstrom A, Forsgren C, Nordenstam J, Zetterstrom J.
Symptoms of anal and urinary incontinence following cesarean
section or spontaneous vaginal delivery. Am J Obstet Gynecol
2007;197:512.e17.
9. Burgio KL, Borello-France D, Richter HE, Fitzgerald MP,
Whitehead W, Handa VL, et al. Risk factors for fecal and
urinary incontinence after childbirth: the childbirth and pelvic
symptoms study. Am J Gastroenterol 2007;102:19982004.
10. Connolly TJ, Litman HJ, Tennstedt SL, Link CL, McKinlay JB.
The effect of mode of delivery, parity, and birth weight on risk
of urinary incontinence. Int Urogynecol J Pelvic Floor Dysfunct 2007;18:103342.
11. Schytt E, Lindmark G, Waldenstrom U. Symptoms of stress
incontinence 1 year after childbirth: prevalence and predictors
in a national Swedish sample. Acta Obstet Gynecol Scand
2004;83:92836.
Hamilton Boyles et al
141