Vaginal delivery increases incontinence risk-up to 20 years later

Compared with cesarean delivery, vaginal delivery increases both the likelihood of incontinence and the probability that the condition will be of long duration.

BMI and maternal age strongly influence the likelihood of urinary incontinence in women who deliver vaginally.

Compared with women who deliver via cesarean, women who deliver vaginally are 67% more likely to experience urinary incontinence (UI) up to 20 years after the birth and are almost 3 times or 275% as likely to be incontinent for more than 10 years, according to the findings of a Swedish study.

Researchers conducted a registry-based national cohort study involving more than 5,000 primigravidas who delivered a single infant between 1985 and 1988 and had no subsequent births.

Published online March 14 in BJOG, the results revealed that 40.3% of the women who delivered vaginally versus 28.8% of those who delivered surgically experienced UI (odds ratio [OR], 1.67; 95% CI, 1.45-1.92). In addition, 10.1% of those who delivered vaginally versus 3.9% of women who delivered surgically were incontinent for more than 10 years (OR, 2.75; 95% CI, 2.02-3.75).

No differences existed with regard to UI between women who had an acute cesarean delivery and those who had the procedure electively, indicating that the fetus passing through the pelvic floor in the late stage of delivery increases the risk of UI later, the authors write.

Two additional risk factors for UI were identified The first was increased maternal body mass index (BMI) The risk of UI in obese women was more than twice that of normal-weight women after vaginal delivery and more than triple that of normal-weight counterparts after cesarean delivery. Overall, there was an 8% increase in the risk of UI per BMI unit increase.

The second risk factor was maternal age. The prevalence of UI was 10% higher in women aged ≥35 years at delivery compared with women aged <23 years who delivered surgically and was 7% higher in women of the same ages who delivered vaginally.

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