Study On Epidemiologic Feature And Risk Factors Of Postpartum Urinary Incontinence

Objective: To investigate the morbidity of postpartum urinary incontinence in primiparae by means of questionnaire and to evaluate the effect of different delivery modes and the risk factors in pregnancy and delivery to the prevalence of postpartum urinary incontinence, providing basis to the prevention and treatment of such a desease.Methods: Seven hundred and eighty-nine primipara, delivered from March to October 2007 in our hospital and were followed up 42 days after delivery, were telephone recruited and their symptoms of urinary incontinence before, after and during pregnancy, along with lower urinary tract symptoms after delivery were investigated. The questionnaire was designed according to International Consultant Incontinence and Bristol female lower urinary tract symptom questionnaires. The incidence and degrees of different kinds of postpartum urinary incontinence in connection with difierent ways of delivery and the associated factors were evaluated.Results:(1) 60 of 775 (7.74 %) women complained of urinary leakage at least once after delivery.(2) According to logistic regression, cesarean section and the occurrence of urinary incontinence during pregnancy were associated factors with postpartum urinary incontinence.(3) The incidence of urinary incontinence in spontaneous vaginal and cesarean section delivery was 12.10%(45/372), 3.72%(15/403), and the incidence of postpartum urinary incontinence in spontaneous vaginal delivery was also higher than that of the cesarean section group (P< 0.05).(4) The incidences of stress urinary incontinence, urgent urinary incontinence and mixed urinary incontinence were 10.20%, 0.30% and 1.60% respectively in spontaneous vaginal delivery and 2.73%, 0.25% and 0.74% in cesarean section. The incidence of stress urinary incontinence was higher in vaginal delivery women than in cesarean section women (P<0.05). Severe cases of stress urinary incontinence were more in spontaneous vaginal delivery than in cesarean section(P<0.05). Mild cases of urinary incontinence was higher than severe cases of urinary incontinence women (P<0.05), from the degrees of postpartum urinary incontinence.(5) 3.33% (2/60) women reported urinary inconfinence before pregnancy; 61.67% (37/60) during pregnancy; 38.33%(23/60) after delivery.(6) The risk factor to postpartum urinary incontinence in vaginal delivery was the occurrence of urinary incontinence during pregnancy and urinary incontinence before pregnancy. But the other events, such as pudendal tears, episiotomy, the duration of the first or second period of delivery,fetal weight, increaseing abdominal pressure, lower urinary tract symptoms after delivery andlactation ,were not correlated.(7) The factor that associated with postpartum urinary incontinence in cesarean section was theurinary incontinence during pregnancy and BMI before pregnancy, but not the weight ofnewborn, the cesarean section itself and lactation.Conclusion:(1) Cesarean section is obviously protective to postpartum urinary incontinence than vaginal delivery and can significant decrease the incidence of postpartum urinary incontinence in 6-8 week.(2) The incidence of stress urinary incontinence was higher in vaginal delivery women than in cesarean section women.(3) Occurrence of urinary incontinence before and during pregnancy are significant risk factors of postpartum urinary incontinence in spontaneous vaginal and the urinary incontinence during pregnancy and BMI before pregnancy are significant risk factors of postpartum urinary incontinence in Cesarean section.(4) The symptoms of the most women with postpartum urinary incontinence are mild, Pelvic floor exercise during pregnancy and after delivery is valid to prevent postpartum urinary incontinence.