Pregnancy and post-partum urinary incontinence

Pregnancy and post-partum urinary incontinence – more than an inconvenience

The hormonal and physical effects of pregnancy and childbirth are a major reason why women
are more likely than men to suffer urinary incontinence.The dramatic effect is illustrated in statistics that show women who have given birth to be more than two-and-a-half times more likely to be incontinent than women who haven’t given birth.1

During pregnancy, mechanical and hormonal factors cause changes in renal physiology, most commonly resulting in frequency of voiding and stress incontinence. Other symptoms during pregnancy include urinary urgency, urge incontinence, incomplete emptying and slow stream. 2,3

The increase in stress incontinence during pregnancy is argued to be the result of damage to the fascias, ligaments, pelvic floor muscles and nerves supporting and controlling the bladder neck and urethra. 4

Vaginal delivery is linked to a high rate of incontinence in the post-partum period,5 and women who may have been continent during the pregnancy could find themselves with stress incontinence after the birth. In fact, the reported incidence of de novo incontinence (starting again) after a first vaginal birth is 21% with spontaneous birth and 36% with forceps delivery. 1

Unfortunately, post-partum incontinence increases the likelihood of long-term incontinence – women who have experienced post-partum incontinence are more than three times as likely to have urinary incontinence five years later.6

The link between incontinence and depression

Many women and health care professionals consider urinary incontinence as a mere inconvenience or simply an unavoidable increasingly being recognised that incontinence can have a profound effect on suffering, being linked to depression and reduced quality of life.7

A Melbourne study by Brown & Lumley (2000) found that three physical health factors were
associated with significantly poorer levels of emotional wellbeing in the months after birth: tiredness, having a higher than usual number of minor illnesses, and urinary incontinence.8

The authors say, “The study confirms the link between maternal emotional wellbeing and physical health and recovery in the postnatal period and has important implications for clinical practice.”

They say that all health professionals in contact with mothers in the year following childbirth should make it a high priority to encourage greater disclosure of physical and emotional health problems. However, when it comes to urinary incontinence, many new mothers want health professionals to seek out information about symptoms rather than having to broach the subject themselves (see page 2).

Patient confidence in achieving treatment goals

A review of the impact of urinary in continence on depression7 describes their co-occurrence
in many sufferers. The authors point out that, although it’s unclear whether incontinence leads to depression or whether depression can cause incontinence, it’s clear that a relationship exists. They argue that helping a patient feel able to achieve particular incontinence treatment goals may also improve depression and quality of life. “Self-efficacy and quality of life are positively related while depression and self-efficacy are negatively related. The choices, goals, effort, and persistence of an individual can be impacted by individual self-efficacy.

Interventions that are tailored to increase selfefficacy may improve depression and quality of life,” they say.

Did you know:

•Women are at least twice as likely as men in every age bracket to suffer from urinary incontinence. The main reasons are the hormonal and physical effects of pregnancy and childbirth.1
•Women who have had even one vaginal birth are more than 2.5 times as likely to report incontinence as women who have never given birth.1
• Pregnancy-related urinary incontinence may not be the result of increasing pressure on the bladder caused by the weight of the foetus, but the result of local tissue changes caused by hormones.
• Exposure to oxytocin during labour has been found to increase the chance of urinary incontinence in later life.

References:

1. Sampselle C. Behavioral interventions in young and middle-age women. AJN 2003, 103: 9-19.

2. Stanton S, Kerr-Wilson R & Grant Harris V. The incidence of urological symptoms in normal pregnancy. Br J Obstet Gynaecol. 1980, 87: 897-900.

3. Cutner A et al. Assessment of urinary symptoms in early pregnancy. Br J Obstet Gynaecol. 1991, 98:1283-6.

4. Morkved S et al. Pelvic floor muscle training during pregnancy to prevent urinary incontinence: A single-blind randomized controlled trial. Obstet Gynecol. 2003, 101(2): 313-9.

5. Eason E et al. Effects of carrying a pregnancy and of method of delivery on urinary incontinence: A prospective cohort study. BMC Pregnancy and Childbirth 2004, 4:4.

6. Viktrup L & Lose G.The risk of stress incontinence 5 years after first delivery. Am J Obstet Gynecol 2001, 185: 82-7.

7. Broome B.The impact of urinary incontinence on self-efficacy and quality of life. Health and Quality of Life Outcomes 2003, 1:35.Viewed at http://www.hlqu.com/content/1/1/35 on 7 February 2005.

8. Brown S & Lumley J. Physical health problems after childbirth and maternal depression at six to seven months postpartum. BJOG 2000, 107(10):1194-201.

9. Hvidman L et al. Correlates of urinary incontinence in pregnancy. Int Urogynecol J Pelvid Floor Dysfunct. 2002, 13(5):278-83.

10. Thom D et al. Evaluation of parturition and other reproductive variables as risk factors for urinary incontinence in later life. Obstet Gynecol. 1997, 90(6):983-9.

11. Chiarelli P et al.Women’s knowledge, practises, and intentions regarding correct pelvic floor