Incontinence during pregnancy ups risk of it later

A new study confirms that women who have incontinence during pregnancy are more likely than other women to have the problem after giving birth as well. The good news, researchers say, is that there are ways for women to reduce their risk.

In a study of more than 1,100 first-time mothers, Spanish researchers found that 39 percent reported urinary incontinence, or urine leakage, at some point during pregnancy. Another 10 percent said they had anal incontinence, which included uncontrolled passage of gas or stool.

These women were more likely than those without incontinence during pregnancy to have symptoms seven weeks after giving birth.

Overall, 16 percent of women in the study had urinary incontinence seven weeks after giving birth, while 7 percent had anal incontinence.

The risks for women who’d had those problems during pregnancy were three and six times greater, respectively, compared with women who had remained continent during pregnancy.

The study, reported in the journal Obstetrics & Gynecology, also confirmed that vaginal childbirth carries greater risks compared with cesarean section. Women who had a vaginal delivery were three times more likely than those who had a C-section to have urinary or anal incontinence after childbirth.

Of 692 women who had a vaginal delivery and responded to questionnaires seven weeks after childbirth, 139 reported symptoms of urinary incontinence and 57 reported anal incontinence.

The findings confirm vaginal delivery and incontinence during pregnancy as risk factors for post-childbirth incontinence, lead researcher Maite Solans-Domenech, of the Catalan Agency for Health Technology Assessment and Research in Barcelona, told Reuters Health in an email.

But they also highlight potential ways to reduce the risk, according to Solans-Domenech.

For example, studies have tied excess weight gain to an increased risk of incontinence during pregnancy. (In this study, it was linked to anal incontinence only.) So gaining only the recommended number of pregnancy pounds may help prevent incontinence both during and after pregnancy.

In addition, exercises that strengthen the pelvic floor muscles, known as Kegel exercises, have been shown to lower the risk of pregnancy-related incontinence, Solans-Domenech noted.

As for the mode of delivery, C-sections cannot be considered solely to prevent incontinence, Solans-Domenech said.

However, she added, in cases where a woman already has risk factors for post-childbirth incontinence - such as being older than 35 or having a family history of incontinence - doctors might want to avoid using forceps or other instruments during vaginal delivery, or doing an episiotomy - an incision made to enlarge the vaginal opening during delivery.

Past studies have linked instrument-assisted deliveries, particularly in conjunction with episiotomy, to an increased risk of incontinence, Solans-Domenech and her colleagues point out.

Because the current study followed-up with women only seven weeks after they gave birth, it is unclear how many women had long-term symptoms. Past research has suggested that for most women, incontinence goes away within a few months of giving birth, though for some it may become a persistent problem.

Treatments for persistent incontinence include Kegel exercises, behavioral changes (like scheduled bathroom trips), medications and, in more severe cases, surgery.

SOURCE: Obstetrics & Gynecology, March 2010.

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