Prevalence and correlates of stress urinary incontinence during pregnancy: a survey at UNICAMP Medical School, São Paulo, Brazil

Association between vaginal or cesarean delivery and later development of stress urinary incontinence or pelvic organ prolapse: A retrospective population-based cohort study

INTRODUCTION AND HYPOTHESIS

Child delivery mode may be associated with pelvic floor disorders. We explored the association between different delivery modes and later development of stress urinary incontinence (SUI) and pelvic organ prolapse (POP) in Taiwanese women.

METHODS

This was a retrospective population-based cohort study. Women who delivered babies between January 1, 2000, and December 31, 2018, were selected for this study. The study used Taiwan's National Health Insurance (NHI) Research Database. After propensity score matching, 51,587 women who underwent cesarean section (C/S) and 51,587 women who underwent vaginal delivery (VD) were recruited. Primary outcomes were the presence of SUI and POP after delivery.

RESULTS

The incidence of SUI (1.6/1000 person-years) and POP (1.5/1000 person-years) was higher in the VD group than in the C/S group (0.8 and 0.6 in 1000 person-years). VD was associated with an increased risk of SUI [hazard ratio (HR): 2.79, 95% confidence interval (CI): 2.45-3.17] and POP (HR: 1.96, 95% CI: 1.75-2.19) compared to C/S. We also found that age (HR: 1.06, 95% CI: 1.05-1.08 in SUI, HR: 1.08, 95% CI: 1.07-1.09 in POP) and Charlson Comorbidity Index (CCI) (HR: 1.28, 95% CI: 1.12-1.46 in SUI, HR: 1.27, 95% CI: 1.13-1.43 in POP) were associated with an increased risk of SUI and POP. The cumulative incidence of SUI and POP was higher in the VD group than in the C/S group (log-rank test, P < 0.05).

CONCLUSIONS

The current study was the largest retrospective cohort study regarding the influence of delivery mode on SUI and POP so far. VD was found to be associated with an increased risk of SUI and POP compared with C/S. Postpartum care for pelvic physical therapy should be provided particularly to women undergoing VD.

Prevalence of Stress Urinary Incontinence and Risk Factors among Saudi Females

Background and Objectives: Stress urinary incontinence (SUI) is involuntary urine leakage upon effort or physical exertion, sneezing, or coughing, and it is the most prevalent type of urinary incontinence (UI) in women. We aimed to estimate the prevalence of SUI and its risk factors among Saudi females. Materials and Methods: A descriptive cross-sectional study was conducted in the Kingdom of Saudi Arabia between March 2022 and July 2022, with a total of 842 respondents. We included Saudi females over the age of 20 years. Data were collected through an online questionnaire distributed to the target group and analyzed using SPSS software. Results: The prevalence of SUI was found to be 3.3% among Saudi women. Moreover, only 41.8% of the participants had at least one pregnancy; the majority had five or more pregnancies (29%). According to our findings, the majority of the participants diagnosed with SUI had the following risk factors: increased age, widowhood, a family history of SUI, and a history of pregnancy. The results revealed that the odds of SUI increased among Saudi females with a family history of SUI by 19.68-fold compared with those who had no family history of SUI, and this was statistically significant (p < 0.001). Conclusion: The prevalence of SUI among Saudi females was found to be relatively low. The above-listed associated factors should be considered in future research and interventions.

Association between pelvic floor muscle function and stress urinary incontinence in the third gestational trimester: A cross-sectional observational study

OBJECTIVE

Investigate the association between pelvic floor muscle function and stress urinary incontinence (SUI) in women in the third trimester of pregnancy.

METHODS

Cross-sectional observational study. Urinary symptoms were collected through a questionnaire. The physical examination of the pelvic floor muscle was performed by vaginal palpation and manometry. Multivariate logistic regression analyses were performed to investigate the factors associated with SUI.

RESULTS

Analysis of the data collected from nulliparous and multiparous women identified an association between decreased pelvic floor muscle function (i.e. Power, Repetition, and Maximal Voluntary Contraction (MVC)) and the presence of SUI. There were also associations noted between power and SUI [AOR (95% CI) = 1.41 (1.01-1.97)], repetition and SUI [AOR (95% CI) = 1.31 (1.06-1.63)], and MVC and SUI [AOR (95% CI) = 1.02 (1.00-1.03)]. In the analysis of nulliparous women, there was also an association between low resting vaginal pressure (manometry) and SUI [AOR (95% CI) = 1.03 (1.01-1.06)].

CONCLUSIONS

Low pelvic floor muscle strength, low MVC, and decreased ability to repeat sustained pelvic floor muscle contractions were associated with SUI in the third gestational trimester. In nulliparous women, there was an association between low resting vaginal pressure and SUI; however, none these associations were identified in multiparous women.

Is there an association between parity and urinary incontinence in women during pregnancy and the first year postpartum?: A systematic review and meta-analysis

AIMS

To systematically review the literature on possible associations between parity and urinary incontinence (UI) during pregnancy and in the first year postpartum.

METHODS

We searched the databases Pubmed, CINAHL, Embase, the Cochrane Library, PsycINFO, MIDIRS, ClinicalTrials.gov (inception-18 April 2020). One reviewer screened all titles. Two reviewers independently selected studies by abstract and full text. Risk of bias was assessed using the Quality In Prognosis Studies tool. Findings were synthesised in meta-analysis or narratively. We assessed the certainty of evidence using the Grading of Recommendations, Assessment, Development and Evaluation Working Group approach adopted for prognostic studies.

RESULTS

We identified 16 643 records and 39 were included. Thirty studies examined UI during pregnancy and 12 examined UI postpartum. Multiparity was associated with UI at any point in the last pregnancy (odds ratio [OR]: 1.59 [1.26-2.00], 5 studies, 1565 participants) and in the third trimester when measured by ICIQ-SF (OR: 2.67 [1.53-4.67], 4 studies, 1150 participants), but not when studies measured the UI point prevalence (OR: 2.48 [0.91-6.79], 4 studies, 52 976 participants), or if they measured the prevalence at one point in any trimester (OR: 1.09 (0.60-1.95), 3 studies, 872 participants). At 3 months postpartum, UI was associated with multiparity (OR: 2.03 [1.35-3.06], 4 studies, 6781 participants).

CONCLUSIONS

Increased parity was associated with UI in the first year postpartum, but studies on UI during pregnancy had conflicting results. The evidence was (very) uncertain. Future studies should use comparable definitions and further explore UI sub-types.

Natural history of urinary incontinence from first childbirth to 30-months postpartum

PURPOSE

The objectives of this study were to determine the incidence of UI in a large cohort of primiparous women before and during pregnancy and over the course of 30-months postpartum, and to identify risk factors for UI during and after pregnancy.

METHODS

Nulliparous women aged 18-35 years with singleton pregnancies were interviewed in their third trimester and asked about urinary incontinence before and during pregnancy (n = 3001). After delivery these women were interviewed at 1, 6, 12, 18, 24 and 30-months postpartum and asked about urinary incontinence occurring in the month prior to each interview. Multivariable logistic regression models identified risk factors for UI during pregnancy and during the follow-up period.

RESULTS

Overall, 4% reported having urinary incontinence before pregnancy and 36.8% during pregnancy. The strongest predictor of urinary incontinence during pregnancy was urinary incontinence before pregnancy (adjusted OR 13.11, 95% CI 7.43-23.13). Among the women with no subsequent pregnancies, the rate of urinary incontinence increased from 12.5% at 6-months postpartum to 27.4% at 30-months postpartum, 52.1% reported UI at one or more postpartum data collection stages, and the strongest predictors of postpartum UI were UI before pregnancy (adjusted OR 3.95 (95% CI 1.60-9.75) and during pregnancy (adjusted OR 4.36, 95% CI 3.24-5.87).

CONCLUSION

Our findings suggest that primiparous women who report UI before and during pregnancy should be monitored for the continuation or worsening of UI over the course of the first 2-3 years postpartum, and treatment options discussed.

Urinary symptoms in pregnant women in their third trimester-a cross-sectional study

INTRODUCTION AND HYPOTHESIS

Urinary symptoms are common in pregnancy. Our study aims to understand the extent of these symptoms in a cohort of pregnant women in the third trimester and their impact on quality of life (QOL) from the women's perspective.

METHODS

A single-centre cross-sectional study of self-reported urinary symptoms of pregnant women in the third trimester conducted from August 2018 at the Diana Princess of Wales Hospital, Northern Lincolnshire, and Goole NHS Foundation Trust, Grimsby, UK. We used an international validated questionnaire (ICIQ-FLUTS questionnaire) (Brookes et al. Am J Obstet Gynecol. 191(1):73-82, 2004).

RESULTS

A total of 302 women were included in this study. Nocturia was the most common symptom, reported by 97%, affecting QOL in 80%. Urgency of micturition was the second most common, present in 83%, adversely affecting QOL in 75%. Our study showed a startling finding of bladder pain in 47% (95% CI 41.1%, 52.3%) of these women. There was a high prevalence of nocturnal enuresis in 9.9% (95% CI 7.05%, 13.8%). Straining during micturition is not a well-known symptom in pregnancy, however reported by 18.2% (95% CI 14.2%, 23.0%).

CONCLUSION

The high prevalences of bladder pain, nocturnal enuresis and straining in the third trimester of pregnancy are novel findings. Our study also confirms that the prevalence of all voiding, filling and incontinence symptoms in pregnancy is significantly higher than in the non-pregnant population, having a negative impact on QOL, and yet is not discussed as part of routine antenatal care.

Urinary incontinence among pregnant women in Southern Brazil: A population-based cross-sectional survey

Urinary incontinence (UI) is a common condition that causes significant harm to the well-being and quality of life of pregnant women. This cross-sectional population-based study aimed to estimate the prevalence and identify factors associated with the occurrence of UI during pregnancy in women living in the municipality of Rio Grande (RS), Southern Brazil, between January 1 and December 31 of 2016, and included all puerperae living in this municipality that had a child in one of the two local maternity hospitals. The previously trained interviewers used a single standardized questionnaire, within 48 hours after delivery to retrieve information on maternal demographic, behavioral and reproductive/obstetric history, as well as socioeconomic status of the household and care received during pregnancy and childbirth. The multivariate analysis followed a previously defined hierarchical model using Poisson regression with robust variance adjustment and prevalence ratio (PR) as a measure of effect. As a result, 2,716 puerperae were identified, of which 2,694 (99.2%) participated in this study. The prevalence of urinary incontinence in the gestational period was 14.7% (95%CI: 13.4%-16.1%). After adjusted analysis, the likelihood of UI occurring varied significantly as per women's characteristics. For example, the PR for the occurrence of UI among women over 30 years of age was 2.05 (95% CI: 1.39-3.01) compared to adolescents. In two other groups of women who had their first pregnancy before the age of 20 or after the age of 30, the PR for UI was 1.36 (95% CI: 1.04-1.76) and 1.59 (95% CI: 1.01-2.51), respectively, when compared to those who became pregnant for the first time between 20 and 29 years of age. Finally, in two other groups of women, namely, those who reached 90 kg and over at the end of pregnancy and those who performed regular physical exercise and reported frequent urinary urgency, the PR was 2.49 (95% CI: 1.74-3.57), and 2.90 (95% CI: 2.10-4.00) compared to those who did not exercise and did not report urinary urgency, respectively. The authors concluded that UI showed a high prevalence in the study population. The identified risk factors can be well administered at primary health care level. The recommendation of regular physical exercise in pregnancy must be reviewed and better investigated with more robust designs because of possible facilitators for the occurrence of UI in this period.

Differences in urinary incontinence symptoms and pelvic floor structure changes during pregnancy between nulliparous and multiparous women

Background

This study was performed to compare changes in urinary incontinence (UI) symptoms and pelvic floor structure during pregnancy between nulliparous and multiparous women.

Methods

A cross-sectional survey was performed among pregnant women from July 2016 to January 2017. In total, 358 pregnant women from two hospitals underwent an interview and pelvic floor transperineal ultrasound assessment. A questionnaire regarding sociodemographic, gynecological, obstetric features and the International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF) were used for the interview. Imaging data sets were analyzed offline to assess the bladder neck vertical position (BNVP), urethral angles (α, β, and γ angles), and hiatal area (HA) at rest and at maximal Valsalva maneuver (VM).

Results

After excluding 16 women with invalid data, 342 women were included. The prevalence (χ² = 9.15, P = 0.002), frequency (t = 2.52, P = 0.014), usual amount of UI (t = 2.23, P = 0.029) and scores of interference with daily life (t = 2.03, P = 0.045) during pregnancy were higher in multiparous than nulliparous women. A larger bladder neck descent (BND) (F = 4.398, P < 0.001), HA (F = 6.977, P < 0.001), α angle (F = 2.178, P = 0.030), β angle (F = 4.404, P < 0.001), and γ angle (F = 2.54, P = 0.011) at VM were discovered in pregnant women with UI than without UI. Multiparous women had a significantly higher BND (t = 2.269, P = 0.024) and a larger α angle (F = 2.894, P = 0.004), β angle (F = 2.473, P = 0.014), and γ angle (F = 3.255, P = 0.001) at VM than did nulliparous women.

Conclusion

Multiparous women experienced more obvious UI symptoms and pelvic floor structure changes during pregnancy than did nulliparous women.

Prevalence and factors associated with urinary incontinence in climacteric

OBJECTIVE

To estimate the prevalence and identify associated factors to urinary incontinence (UI) in climacteric women.

METHOD

In a cross-sectional study with a stratified random sample, 1,200 women aged between 35 and 72 years were studied, enrolled in the Family Health Strategy in the city of Pindamonhangaba, São Paulo. Urinary incontinence was investigated using the International Consultation of Incontinence Questionnaire - Short Form, while associated factors were assessed based on a self-reported questionnaire with socio-demographic, obstetric and gynecological history, morbidities and drug use. The prevalence of urinary incontinence was estimated with a 95% confidence interval (95CI) and the associated factors were identified through multiple logistic regression model performed using Stata software, version 11.0.

RESULTS

Women had a mean age of 51.9 years, most were in menopause (59.4%), married (87.5%), Catholic (48.9%), and declared themselves black or brown (47.2%). The mean age of menopause of women with UI was 47.3 years. The prevalence of UI was 20.4% (95CI: 17.8-23.1%). The factors associated with UI were urinary loss during pregnancy (p=0.000) and after delivery (p=0.000), genital prolapse (p=0.000), stress (p=0.001), depression (p=0.002), and obesity (p=0.006).

CONCLUSION

The prevalence of UI was lower but similar to that found in most similar studies. Factors associated with the genesis of UI were urinary loss during pregnancy and after delivery, genital prolapse and obesity.

What are the probable predictors of urinary incontinence during pregnancy?

Objectives. The frequency, predisposing factors and impact of urinary incontinence (UI) on quality of life (QoL) during pregnancy were investigated.

Materials and Method. A preliminary cross-sectional survey was studied among pregnant women between January and July of 2014. A total of 132 pregnant women were recruited using a questionnaire form for sociodemographic features, the Turkish version of the International Consultation on Incontinence-Short Form (ICIQ-SF), for the characteristics of UI and Wagner’s Quality of Life scale to assess impact on QoL. p < 0.05 was set significant.

Results.Urinary incontinence was present in 56 out of 132 pregnant women (42.4%, UI-present group): mean age, 26.7 ± 5.4y(p = 0.780); median height, 160 cm (min–max: 153–176, p = 0.037); median BMI, 28.7 kg/m²(min–max: 22.4–50.0, p = 0.881); urine leakage occurred per week once (n = 18, 32.1%), twice or thrice (n = 8, 14.3%); per day few times (n = 14, 25%), once (n = 5, 8.9%) and always (n = 8, 14.3%) with mainly a small amount of urine leakage (n = 33, 58.9%) or a moderate (n = 4, 7.1%). There were statistically significant relationships between QoL scores and frequency of UI (p = 0.002) or amount of leakage (p = 0.002). Impact on QoL scores ranged from mild (n = 33, 58.9%), moderate (n = 4, 7.1%) to severe (n = 4, 7.1%) levels in daily life. UI impacted the daily life activities of women by making them less likely to undertake activities outside their homes (23.2%), by affecting their working performance and friendships (8.9%), their daily home activities (7.1%), their general health status (12.5%), their sexual relations (12.5%), by making them more nervous or anxious (10.7%) and by the need to wear pads or protectors (25%). ANOVA, Tukey, and Tamhane tests as the minimal important difference model yielded significant relevance between statistical analyses and clinical outcomes by using standard deviations (p = 0.001, 0.001 and 0.005 respectively). The following features favored the occurence of UI: Age (OR = 0.845, 95% CI [0.268–2.669]), being a housewife (OR = 1.800, 95% CI [0.850–3.810]), anemia (OR = 0.939, 95% CI [0.464–1.901]), parity (OR = 0.519, 95% CI [0.325–0.829]), miscarriage (OR = 1.219, 95% CI [0.588–2.825]) and living in rural areas (OR = 1.800, 95% CI [0.887–3.653]). Height (p = 0, 037), educational status (0.016), miscarriage (0.002), parity (0.006) and place of living (0.020) were significant factors.

Conclusions.Many pregnant women are suffering from UI, which warrants a significant public health consideration in the region. Age, height, being a housewife or graduation level higher than primary school, living in rural, parity, miscarriage, and anemia were the factors in favor of the onset of UI. The authors plan a health promotion program in the region according to the results in order to provide information to health caregivers, especially family physicians, and to educate women about the predictors of UI and pelvic floor exercises for primary prevention and secondary relief of UI during and after pregnancy and provide some hygienic supplies to the poor in this aspect.

Developing strategies to be added to the protocol for antenatal care: an exercise and birth preparation program

OBJECTIVES

To describe the implementation process of a birth preparation program, the activities in the protocol for physical and birth preparation exercises, and the educational activities that have been evaluated regarding effectiveness and women's satisfaction. The birth preparation program described was developed with the following objectives: to prevent lumbopelvic pain, urinary incontinence and anxiety; to encourage the practice of physical activity during pregnancy and of positions and exercises for non-pharmacological pain relief during labor; and to discuss information that would help women to have autonomy during labor.

METHODS

The program comprised the following activities: supervised physical exercise, relaxation exercises, and educational activities (explanations of lumbopelvic pain prevention, pelvic floor function, labor and delivery, and which non-pharmacological pain relief to use during labor) provided regularly after prenatal consultations. These activities were held monthly, starting when the women joined the program at 18-24 weeks of pregnancy and continuing until 30 weeks of pregnancy, fortnightly thereafter from 31 to 36 weeks of pregnancy, and then weekly from the 37th week until delivery. Information and printed materials regarding the physical exercises to be performed at home were provided. Clinicaltrials.gov: NCT01155804.

RESULTS

The program was an innovative type of intervention that systematized birth preparation activities that were organized to encompass aspects related both to pregnancy and to labor and that included physical, educational and home-based activities.

CONCLUSIONS

The detailed description of the protocol used may serve as a basis for further studies and also for the implementation of birth preparation programs within the healthcare system in different settings.

Comparison of low urinary tract symptoms during pregnancy between primiparous and multiparous women

BACKGROUND AND PURPOSE

Low urinary tract symptoms (LUTS) are a common problem during pregnancy. This study aimed to compare changes in the prevalence of LUTS during pregnancy between primiparous and multiparous women.

METHODS

A chart review of consecutive pregnant women who attended our antenatal clinic from March 2002 to January 2006 was performed. All of the women were asked to respond to a LUTS questionnaire in either of the three trimesters.

RESULTS

Of the 270 women included, 164 were nullipara and 106 were multipara. The most common LUTS during pregnancy were frequency (77%), followed by nocturia (75.6%), stress urinary incontinence (SUI) (51.1%), incomplete emptying (43.7%), dysuria (17.8%), and urgency incontinence (10.4%). There was a significantly higher prevalence of SUI (P<0.001) and urgency incontinence (P=0.005) in the multiparous compared to the nulliparous women. Increasing prevalence rates of frequency, nocturia, SUI, and incomplete emptying were reported with gestational age in both the nulliparous and multiparous women.

CONCLUSIONS

Frequency and nocturia were the two most common LUTS during pregnancy. The prevalence rates of all LUTS increased with increasing gestational age except for frequency in the nulliparous women during the second trimester. In addition, multipara was a predictor of SUI during pregnancy.

Incontinência urinária na gestação: implicações na qualidade de vida

Objetivos: comparar a qualidade de vida de gestantes com e sem perda urinaria, identificando os principais fatores que interferem negativamente na qualidade de vida durante essa fase de vida da mulher. Métodos: foram incluídas 15 gestantes com queixa de perda urinaria e presença de sintomas miccionais e 25 gestantes sem queixa miccional, avaliadas em dois momentos, na 24-28" e 34-36" semana gestacional. As avaliações consistiram na aplicação de dois questionários de qualidade de vida (King Health Questionnaire e o World Health Organization Quality of Life). Os dados foram tabulados no Excel e analisados estatisticamente no programa Statistica. Adotou-se um nível de significância de 5%. Resultados: as gestantes sem sintomas miccionais apresentaram melhor qualidade de vida em relação àquelas com sintomas miccionais nos domínios físico, social e ambiental. Para as gestantes com sintomas miccionais ocorreu piora dos escores dos domínios percepção geral de saúde e impacto da incontinência entre a 1" e 2" avaliação. Conclusões: a perda urinária reduz a qualidade de vida das gestantes. Outros fatores como o suporte social e emoções também podem ter impactos negativos na qualidade de vida durante a gestação.

Lower urinary tract symptoms in primiparous women before and during pregnancy

OBJECTIVE

Lower urinary tract symptoms (LUTS), in particular urinary incontinence (UI), commonly develops during pregnancy or following delivery. This study was conducted to investigate the prevalence of the LUTS before and during pregnancy, and to demonstrate the relationships between various obstetric parameters and UI.

METHODS

For this observational study, 1,501 consecutive primiparae who delivered at ≥ 36 gestational weeks were recruited in a tertiary hospital. A urogynecological questionnaire was used to assess the prevalence of LUTS before and during pregnancy. The relationships between various obstetric parameters and UI were analyzed.

RESULTS

Prevalence of LUTS increased over the course of pregnancy. The most commonly reported LUTS symptoms, regardless of pregnancy trimester, were nocturia (51.1%) and frequency (40.3%), UI (37.5%), urgency (31.1%), incomplete bladder emptying (26.3%), straining (15.3%), and voiding difficulty (14.5%). Stress UI (SUI) (26.7%) was more common during pregnancy than mixed UI (6.1%) or urge UI (4.7%). Women with a prepregnancy BMI >30 were at increased risk of developing de novo SUI during pregnancy. Urge incontinence during pregnancy was associated with smoking.

CONCLUSIONS

The prevalence of LUTS generally increased with gestational age. UI during pregnancy was associated with prepregnancy BMI and smoking.

Urinary incontinence in pregnant women and their quality of life

AIMS AND OBJECTIVES

The aim was to investigate the prevalence of urinary incontinence during pregnancy and the related risk factors as well as to assess its influence on the quality of life.

BACKGROUND

Although urinary incontinence is common during pregnancy and can have a substantial impact on quality of life, women rarely seek help for this symptom.

DESIGN

This study was designed as a cross-sectional and descriptive survey.

METHODS

A total of 393 pregnant women participated in the study between March and June 2007. The data was collected using the International Consultation on Incontinence Questionnaire Short Form and Wagner's quality of life scale. Potential risk factors were investigated through logistic regression analysis.

RESULTS

The prevalence of urinary incontinence was 27% (106/393). Factors significantly associated with urinary incontinence included age group, parity, previous urinary incontinence, constipation, urinary incontinence in mother and sister, previous urinary incontinence during pregnancy and postpartum.

CONCLUSION

According to the results of our study, urinary incontinence is common in women during pregnancy. The quality of life of pregnant women was found to be either unaffected or affected very little by urinary incontinence.

RELEVANCE TO CLINICAL PRACTICE

This study reveals that the prevalence of urinary incontinence during pregnancy is very high. The findings will help increase the awareness of health care workers involved in the care of pregnant women about urinary incontinence and aid the design of more intensive education programmes directed towards the prevention of urinary incontinence during pregnancy.

Prevalence and risk factors for urinary incontinence in healthy pregnant Brazilian women

INTRODUCTION AND HYPOTHESIS

Physiological and anatomical changes of pregnancy are risk factors for lower urinary tract symptoms (LUTS). This study aimed to evaluate the prevalence and risk factors for urinary incontinence (UI) in healthy pregnant women.

METHODS

A cross-sectional study was conducted in pregnant Brazilian women who enrolled in the primary health-care system in Sao Jose do Rio Preto, Brazil. Face-to-face interview and completion of two-part questionnaire were administered and done which evaluated the presence of LUTS pre- and during pregnancy. The data were analyzed by logistic regression.

RESULTS

Five hundred pregnant women were enrolled ranging from first to third trimester. LUTS present in 63.8% in these women; the main associated risk factors were multiparity and prepregnancy LUTS as well as smoking, constipation, and daily coffee intake.

CONCLUSIONS

The prevalence of UI during pregnancy is high, highlighting the presence of the risk factors associated with UI during pregnancy.

Suffering in silence: pregnant women's experience of urinary incontinence in Zaria, Nigeria

OBJECTIVE

To determine the prevalence and severity of urinary incontinence during pregnancy in Zaria, Nigeria.

STUDY DESIGN

This was a descriptive, cross-sectional study in which 204 apparently healthy pregnant women attending routine antenatal care (ANC) at the Ahmadu Bello University (ABU) Teaching Hospital in Zaria, Nigeria were screened for urinary incontinence using the International Consultation on Incontinence Questionnaire on Urinary Incontinence (ICIQ-UI Short Form) UK English Version. Nurses working in the antenatal clinic were trained on how to help respondents (most of whom were not literate) to respond to the questions. Uni- and bivariate analysis was performed on the data using SPSS version 15 for Windows.

RESULTS

The prevalence rate of all types of urinary incontinence during pregnancy was 21.1% in the study population. Stress urinary incontinence was the most common type accounting for 60.5%. The majority of the expectant mothers (74.4%) reported leaking no more than once a week; in 90% of them the volume was small in amount. The modal ICIQ score for urinary incontinence was 3 for the study population. The majority (83.4%) of the incontinent women felt their symptom did not interfere with their daily routines.

CONCLUSIONS

About one-fifth of pregnant women in this setting experienced urinary incontinence which they did not report to their primary care providers. Awareness needs to be created for antenatal clients and providers on how to recognize symptoms and manage them. The ICIQ questionnaire has simplified this process.

Urinary incontinence in nulliparous women before and during pregnancy: prevalence, incidence, and associated risk factors

INTRODUCTION

Few studies have examined associations of prepregnancy urinary incontinence (UI).

METHODS

Multicentre prospective pregnancy cohort study (n = 1,507) using standardised measures to assess frequency and severity of UI.

RESULTS

Prevalence of UI increased from 10.8% in the 12 months before the index pregnancy to 55.9% in the third trimester. Stress incontinence (36.9%) and mixed incontinence (13.1%) were more common during pregnancy than urge incontinence alone (5.9%). UI before pregnancy was associated with childhood enuresis (adjusted odds ratio (AdjOR) = 2.4, 95% confidence interval (CI) 1.6-3.4), higher maternal body mass index (AdjOR = 2.3, 95% CI 1.4-3.8), and previous miscarriages or terminations (AdjOR = 1.6, 95% CI 1.1-2.3). The strongest predictor of incident UI in pregnancy was occasional leakage (less than once a month) before pregnancy (AdjOR = 3.6, 95% CI 2.8-4.7).

CONCLUSIONS

Further research is needed to elucidate the complex interplay of prepregnancy and pregnancy-related factors in the aetiology of UI in nulliparous women.

Influence of maternal weight on the new onset of stress urinary incontinence in pregnant women

INTRODUCTION AND HYPOTHESIS

The aim of the study was to investigate the incidence and severity of stress urinary incontinence (SUI) in primigravid women at term and its association with maternal body weight.

METHODS

This was an observational study of 458 primigravid women who came to give birth at Donostia Hospital during 2007. Urinary symptoms were investigated (2002 ICS definitions), and a physical examination including height, weight, pelvic floor muscle strength, and fetal presentation was performed. We calculated the incontinence severity index (ISI) and the women answered the International Consultation on Incontinence short form questionnaire.

RESULTS

SUI affected 139 (30.3%) primigravid women. The ISI distribution was 40.3% slight, 54.7% moderate, 4.3% severe, and 0.7% very severe. Pregnant women at term with body weight >or=75 kg appear to have more than doubled the risk of presenting SUI.

CONCLUSIONS

The incidence of SUI is high in pregnancy. Increased maternal body weight at term is an independent risk factor for incontinence.

Stress urinary incontinence 3 years after pregnancy: correlation to mode of delivery and parity

The aim was to estimate the incidence of stress urinary incontinence 3 years after delivery and its correlation to mode of delivery and parity. A longitudinal cohort study was conducted with 120 women at the Antenatal Clinic at the State University of Campinas. There was a significant difference in the incidence of postpartum stress urinary incontinence (SUI) among patients with SUI during pregnancy (p > 0.0001). Women that were asymptomatic during pregnancy and had vaginal delivery developed SUI 2.4 times more frequently than after c-section (19.2% and 8.0%, respectively). The incidence of SUI after delivery dropped significantly in the primiparous (p = 0.0073) and multiparous 2-3 (p < 0.0001), but not in the multiparous with four or more deliveries (66.7% to 60.0%) (p = 0.5637). A significant correlation has been observed between parity and SUI (p = 0.0299). Pregnancy possibly predisposes to SUI 3 years after delivery as well as parity. No significant correlation has been demonstrated between mode of delivery and SUI.

Prevalence and frequency of severity of urinary incontinence symptoms in late pregnancy: a prospective study in the north of Jordan

OBJECTIVE

To determine the frequency of urinary urge, stress incontinence and bothersome urinary symptoms in late pregnancy in Jordan.

METHOD

Women admitted in spontaneous labor to labor suite at three covering hospitals in the north of Jordan and at least 36 weeks gestational age were eligible for survey to ascertain data on current pregnancies and past pregnancy. Data analyzed for 181 women.

RESULT

Mean gestational age was 39.5 weeks. 85% had normal vaginal delivery. 35% of women reported symptoms of urgency, 30% of whom described symptoms frequency as moderate or severe, and 45% reported stress incontinence, 29% of whom described symptoms frequency as moderate or severe during the current pregnancy. Symptoms in previous pregnancies were reported by 20 and 30% of women for urge and stress incontinence, respectively. Urgency and urge incontinence increased in relation to parity.

CONCLUSION

The frequency of urinary incontinence and bothersome symptoms was relatively similar compared to other countries.

Urinary incontinence during pregnancy

OBJECTIVE

To investigate incidence and prevalence of urinary incontinence during pregnancy and associated risk factors.

METHODS

The data collection was conducted as part of the Norwegian Mother and Child Cohort Study at the Norwegian Institute of Public Health. We present questionnaire data about urinary incontinence obtained from 43,279 women (response rate 45%) by week 30. We report data on any incontinence, in addition to type, frequency, and amount of incontinence. Potential risk factors were investigated by logistic regression analyses.

RESULTS

The prevalence of incontinence increased from 26% before pregnancy to 58% in week 30. The corresponding figures for nulliparous women were 15% and 48%, and for parous women 35% and 67%. The cumulative incidence was 46%. Stress urinary incontinence was the most common type of incontinence in week 30 of pregnancy, experienced by 31% of nulliparous and 42% of parous women. The majority of pregnant women had leakage less than once per week and droplets only, both before and during pregnancy. Parity was a strong and significant risk factor for incontinence in adjusted analyses both before pregnancy (odds ratio [OR] 2.5, 95% confidence interval [CI] 2.4-2.7 for primiparous and OR 3.3, 95% CI 3.1-3.5 for multiparous women) and during pregnancy (ORs 2.0, 95% CI 1.9-2.1 and 2.1, 95% CI 2.0-2.2, respectively). Age and body mass index were weaker, but still statistically significant, risk factors.

CONCLUSION

The prevalence of urinary incontinence increases substantially during pregnancy. Incontinence both before and during pregnancy seems to be associated with parity, age, and body mass index.

LEVEL OF EVIDENCE

II.

The effect of mode of delivery, parity, and birth weight on risk of urinary incontinence

To examine the relationship between symptoms of urinary incontinence (UI) and mode of delivery, parity, and birth weight, data were obtained from a population-based random sample of 3,205 black, Hispanic, and white women age 30-79 in the Boston Area Community Health Survey. Measures include UI symptoms [>or=3 (moderate/severe) Sandvik's severity index]; reproductive history [live birth(s), no live births, never pregnant]; mode of delivery for live births (>or=1 vaginal birth, cesarean delivery only); parity (1, 2, >or=3); and maximum birth weight of live births (<4,000 g, >or=4,000 g). Using logistic regression, women having >or=1 vaginal delivery had twice the odds of UI compared to women with no pregnancies (P = 0.002) or only cesarean deliveries (P = 0.032). There was no difference in odds of UI between cesarean delivery only and never pregnant, by parity or birth weight. Vaginal delivery contributes to risk of UI for black, Hispanic, and white women.