Vaginal delivery parameters and urinary incontinence: The Norwegian EPINCONT study

doi:10.1067/S0002-9378(03)00588-X

American Journal of Obstetrics and Gynecology

Volume 189, Issue 5, November 2003, Pages 1268-1274

https://doi.org/10.1067/S0002-9378(03)00588-X Get rights and content

Abstract

Objective

The study was undertaken to investigate the effect of nine delivery parameters on urinary incontinence in later life.

Study design

Incontinence data from the EPINCONT study were linked to the Medical Birth Registry of Norway. Effects of birth weight, gestational age, head circumference, breech delivery, injuries in the delivery channel, functional delivery disorders, forceps delivery, vacuum delivery, and epidural anesthesia were investigated. The study covered women younger than 65 years, who had had vaginal deliveries only (n = 11,397).

Results

Statistically significant associations were observed between any incontinence and birth weight 4000 g or greater (odds ratio [OR] 1.1, 95% CI 1.0-1.2); moderate or severe incontinence and functional delivery disorders (OR 1.3, 95% CI 1.1-1.6); stress incontinence and high birth weight (OR 1.2, 95% CI 1.1-1.3) and epidural anesthesia (OR 1.2, 95% CI 1.0-1.5); and urge incontinence and head circumference 38 cm or larger (OR 1.8, 95% CI 1.0-3.3).

Conclusion

The effects were too weak to explain a substantial part of the association between vaginal delivery and urinary incontinence, and statistically significant results may have incurred by chance.

Section snippets

Participants

The EPINCONT study, which is presented in detail elsewhere,¹² is part of the HUNT 2 survey, which was conducted in the county of Nord-Trøndelag in Norway between 1995 and 1997. All women 20 years and older (n = 47,313) received a mailed invitation to visit a screening station. The source population for the EPINCONT study consisted of the 34,755 community-dwelling women who attended the screening. These women were asked to complete a questionnaire at home, and 27,936 women (80%) answered questions

Results

The crude prevalence of urinary incontinence was 24.2% in this EPINCONT substudy. The prevalence of stress, urge, and mixed incontinence was 14.8%, 1.8%, and 6.8%, respectively, whereas 0.8% were unclassifiable according to type of incontinence. Mild incontinence was the case for 12.2% of the women, whereas 7.2% had moderate and 3.2% severe incontinence, and 1.6% had an unclassifiable degree of severity.

Any incontinence increased with age, body mass index, parity, and years since last delivery (

Comment

We have studied aspects of vaginal birth as a risk factor for urinary incontinence by investigating 9 variables connected with the delivery. The effects found in this study were weak and cannot, even taken together, explain the strong association between vaginal delivery and urinary incontinence previously reported. High birth weight was significantly associated with any incontinence and stress incontinence. Functional delivery disorders were associated with moderate or severe incontinence.

Acknowledgements

The EPINCONT Study was supported by the Research Council of Norway. The Nord-Trøndelag Health Study (the HUNT Study) is a collaboration between the HUNT Research Center, the Faculty of Medicine at the Norwegian University of Science and Technology (NTNU), Verdal, the Norwegian Institute of Public Health, and the Nord-Trøndelag County Council. We acknowledge the services of the Medical Birth Registry of Norway.

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Cited by (112)

Effect of Epidural Analgesia on Pelvic Floor Dysfunction at 6 Months Postpartum in Primiparous Women: A Prospective Cohort Study
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Citation Excerpt :
Postpartum PFD has been confirmed to be correlated with several gestational and intrapartum factors, such as maternal age, BMI, vaginal delivery, parity, and perineal tears.1,28,29 Few studies have investigated the effects of epidural analgesia on postpartum PFD, and most of them focused on urinary incontinence, POP, and pelvic floor anatomic and physiological changes,14,15,30-32 with a weak association found between SUI and epidural analgesia (OR = 1.2, 95% CI = 1.0-1,5)33 which was not significant among primiparous women. Therefore, we believe our study is innovative and provides important information.
Epidural analgesia has become a universal intervention for relieving labor pain, and its effect on the pelvic floor is controversial.
To investigate the effect of epidural analgesia on pelvic floor dysfunction (PFD) in primiparous women at 6 months postpartum.
We performed a prospective cohort study involving 150 primiparous women in preparation for vaginal delivery, with 74 (49.3%) receiving epidural analgesia. Baseline demographic and intrapartum data were collected. At 6 months postpartum, PFD symptoms, including stress urinary incontinence, overactive bladder, defecation disorder, pelvic organ prolapse, and 4 kinds of sexual dysfunction (arousal disorder, low sexual desire, dyspareunia, and orgasm disorder), were evaluated. Pelvic floor muscle (PFM) function and postpartum depression were also assessed. Multivariate logistic regression was applied to identify factors associated with the PFD symptoms affected by epidural analgesia.
PFD symptoms and sexual dysfunction were evaluated through Pelvic Floor Distress Inventory-20 (PFDI-20) and Female Sexual Function Index (FSFI-12). PFM function was examined with palpation and surface electromyography (sEMG). Postpartum depression was assessed using Self-Rating Depression Scale (SDS).
At 6 months postpartum, women who delivered with epidural analgesia had a higher incidence of dyspareunia (43.2% vs 26.3%, P <0.05) and longer first, second, and total stage of labor durations (P <0.01) than those who without. No significant difference in other PFD symptoms or PFM function was found between the 2 groups (P >0.05). Multivariate logistic regression revealed that epidural analgesia (OR = 3.056, 95% CI = 1.217-7.671) and SDS scores (OR = 1.066, 95% CI = 1.009-1.127) were independent risk factors for dyspareunia.
At 6 months postpartum in primiparous women, epidural analgesia was associated with an increased risk of postpartum dyspareunia and longer labor durations, which deserves attention for rehabilitation after delivery. Future studies with a larger sample size are needed to evaluate the impact of epidural analgesia on other PFD symptoms. Du J, Ye J, Fei H, et al. Effect of Epidural Analgesia on Pelvic Floor Dysfunction at 6 Months Postpartum in Primiparous Women: A Prospective Cohort Study. Sex Med 2021;9:100417.
Birthweight and urinary incontinence after childbirth: a systematic review and meta-analysis
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Urinary incontinence (UI) is common after childbirth. Many cohort and cross-sectional studies have reported data on birthweight, but results have not been pooled. It is unclear how birthweight affects UI after childbirth. The objective is to review the effect of birthweight on UI after childbirth through meta-analyses.
Searches were performed in Medline, Embase, Svemed+, ClinicalTrials.gov, Cochrane, and Cinahl in August 2016. Additional reference checking was performed. Included articles evaluated birthweight as a possible risk factor for maternal UI. We included articles that were presented in Norwegian, Danish, Swedish, or English. Two independent reviewers extracted the data and analysed it using Review Manager 5.3 software. Available data from included studies on birthweight (≥4000 g and ≥3500 g, respectively) and UI were combined in meta-analyses. PRISMA and MOOSE guidelines were used.
Eighteen studies (N = 30 070) reported data on birthweight >4000 g vs <4000 g. Birthweight>4000 g compared to weight <4000 g was associated with a significantly increased OR of any UI (OR 1.49, 95% CI 1.24 – 1.80). Five studies (N = 15 066) reported data on birthweight >3500 g vs <3500 g. Birthweight>3500 g was also associated with a significantly increased OR of UI (OR 1.26, 95% CI 1.15 – 1.37).
High birthweight appears to increase OR of UI after childbirth. Preventative strategies should be targeted towards women at particular risk.
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Although operative delivery increases the risk of immediate pelvic floor trauma, no previous studies have adequately compared directly the effects of different kinds of instrumental vaginal deliveries on stress urinary incontinence and/or urgency urinary incontinence.
The objectives of the study were to estimate and compare the impact of different kinds of vaginal deliveries, including spontaneous, vacuum, and forceps, on stress and urgency urinary incontinence.
All women aged 20 years or older, living in 1 county in Norway were invited to participate in 2 surveys addressing stress and urgency urinary incontinence using validated questions, “Do you leak urine when you cough, sneeze, laugh, or lift something heavy?” and “Do you have involuntary loss of urine in connection with sudden and strong urge to void?” with response options yes or no. Incontinence data were linked to the Medical Birth Registry of Norway. For this study, we included only women who had a history of vaginal birth(s). Case definitions for stress and urgency urinary incontinence were moderate to severe based on Sandvik Severity Index (slight, moderate, severe). We adjusted analyses for age, parity, body mass index, and time since last delivery and addressed effect modification, including an age threshold of 50 years.
The final analysis included 13,694 women of whom 12.7% reported stress urinary incontinence and 8.4% urgency urinary incontinence. Among women aged younger than 50 years, there was a statistically significant difference in the risk of stress urinary incontinence for forceps delivery (odds ratio, 1.42, 95% confidence interval, 1.09–1.86, absolute difference 5.0%) but not for vacuum (odds ratio, 0.80, 95% confidence interval, 0.59–1.09) when compared with spontaneous vaginal delivery. Among women aged younger than 50 years, forceps also had increased risk for stress urinary incontinence (odds ratio, 1.76, 95% confidence interval, 1.20–2.60) when compared with vacuum. There was no association of stress or urgency urinary incontinence with mode of delivery in women aged 50 years or older.
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^☆: The EPINCONT Study was supported by the Research Council of Norway.

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Vaginal delivery parameters and urinary incontinence: The Norwegian EPINCONT study☆

Abstract

Objective

Study design

Results

Conclusion

Section snippets

Participants

Results

Comment

Acknowledgements

Obstet Gynecol

Obstet Gynecol

J Clin Epidemiol

J Clin Epidemiol

Obstet Gynecol

J Am Assoc Gynecol Laparosc

Reproductive and hormonal risk factors for urinary incontinence in later life: a review of the clinical and epidemiologic literature

J Am Geriatr Soc

Epidemiology and natural history of urinary incontinence

Int Urogynecol J Pelvic Floor Dysfunct

Urinary incontinence after vaginal delivery or cesarean section

N Engl J Med

Stress urinary incontinence: prevalence among nulliparous compared with primiparous and grand multiparous premenopausal women

Neurourol Urodyn