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International Urogynecology Journal

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01-03-2018 | Original Article

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

Authors: Deirdre Daly, Mike Clarke, Cecily Begley

Published in: International Urogynecology Journal | Issue 3/2018

Abstract

Introduction

While many women report urinary incontinence (UI) during pregnancy, associations with pre-pregnancy urinary leakage remain under-explained.

Methods

We performed a multi-strand prospective cohort study with 860 nulliparous women recruited during pregnancy.

Results

Prevalence of any urinary leakage was 34.8% before and 38.7% during pregnancy. Prevalence of UI, leaking urine at least once per month, was 7.2% and 17.7% respectively. Mixed urinary incontinence (MUI) was reported by 59.7% of women before and 58.8% during pregnancy, stress urinary incontinence (SUI) by 22.6% and 37.2%, and urge urinary incontinence (UUI) by 17.7% and 4.0%, respectively. SUI accounted for half (50.0%), MUI for less than half (44.2%), and UUI for 5.8% of new-onset UI in pregnancy. Pre-pregnancy UI was significantly associated with childhood enuresis [adjusted odds ratio (AOR) 2.9, 95% confidence interval (CI) 1.5–5.6, p = 0.001) and a body mass index (BMI) ≥30 kg/m² (AOR 4.2, 95% CI 1.9–9.4, p <0.001). Women aged ≥35 years (AOR 2.8, 95% CI 1.4–5.9, p = 0.005), women whose pre-pregnancy BMI was 25–29.99 kg/m² (AOR 2.0, 95% CI 1.2–3.5, p = 0.01), and women who leaked urine less than once per month (AOR 2.6, 95% CI 1.6–4.1, p <0.005) were significantly more likely to report new-onset UI in pregnancy.

Conclusion

Considerable proportions of nulliparous women leak urine before and during pregnancy, and most ignore symptoms. Healthcare professionals have several opportunities for promoting continence in all pregnant women, particularly in women with identifiable risk factors. If enquiry about UI, and offering advice on effective preventative and curative treatments, became routine in clinical practice, it is likely that some of these women could become or stay continent.

Brown S, Donath S, MacArthur C, McDonald E, Krastev A. Urinary incontinence in nulliparous women before and during pregnancy: prevalence, incidence, and associated risk factors. Int Urogynecol J. 2010;21(2):193–202. https://doi.org/10.1007/s00192-009-1011-x.CrossRefPubMed

Wesnes SL, Rortveit G, Bo K, Hunskaar S. Urinary incontinence during pregnancy. Obstet Gynecol. 2007;109(4):922–8. https://doi.org/10.1097/01.aog.0000257120.23260.00.CrossRefPubMed

Eliasson K, Nordlander I, Larson B, Hammarstrom M, Mattsson E. Influence of physical activity on urinary leakage in primiparous women. Scand J Med Sci Sports. 2005;15(2):87–94. https://doi.org/10.1111/j.1600-0838.2004.407.x.CrossRefPubMed

Solans-Domenech M, Sanchez E, Espuna-Pons M. Urinary and anal incontinence during pregnancy and postpartum: incidence, severity, and risk factors. Obstet Gynecol. 2010;115(3):618–28. https://doi.org/10.1097/AOG.0b013e3181d04dff.CrossRefPubMed

Sottner O, Zahumensky J, Krcmar M, Brtnicka H, Kolarik D, Driak D, et al. Urinary incontinence in a group of primiparous women in the Czech Republic. Gynecol Obstet Investig. 2006;62(1):33–7. https://doi.org/10.1159/000091820.

Boyles SH, Li H, Mori T, Osterweil P, Guise JM. Effect of mode of delivery on the incidence of urinary incontinence in primiparous women. Obstet Gynecol. 2009;113(1):134–41. https://doi.org/10.1097/AOG.0b013e318191bb37.CrossRefPubMed

Chan SS, Cheung RY, Yiu KW, Lee LL, Chung TK. Prevalence of urinary and fecal incontinence in Chinese women during and after their first pregnancy. Int Urogynecol J. 2012; https://doi.org/10.1007/s00192-012-2004-8.

Hermansen IL, O’Connell BO, Gaskin CJ. Women’s explanations for urinary incontinence, their management strategies, and their quality of life during the postpartum period. J Wound Ostomy Continence Nurs. 2010;37(2):187–92. https://doi.org/10.1097/WON.0b013e3181cf7946.CrossRefPubMed

Economic and Social Research Institute (ESRI) (2013) Perinatal Statistics Report 2012. ERSI, Dublin. Available at: http://www.hpo.ie/latest_hipe_nprs_reports/NPRS_2012/Perinatal_Statistics_Report_2012.pdf

10.

Coulter-Smith S. The Rotunda Hospital Dublin clinical report 2012. Dublin: Rotunda Hospital; 2013. Available at: https://rotunda.ie/rotunda-pdfs/Clinical%20Reports/Annual%20Clinical%20Report%202012.pdf

11.

Brown S, Lumley J, McDonald E, Krastev A, collaboration with the Maternal Health Study collaborative group (2006) Maternal health study: a prospective cohort study of nulliparous women recruited in early pregnancy. BMC Pregnancy Childbirth 6 (1):12. https://doi.org/10.1186/1471-2393-6-12.

12.

Brown S, Lumley J. Maternal health after childbirth: results of an Australian population based survey. BJOG. 1998;105(2):156–61. https://doi.org/10.1111/j.1471-0528.1998.tb10045.x.CrossRef

13.

Glazener CMA, Herbison GP, MacArthur C, Lancashire R, McGee MA, Grant AM, et al. New postnatal urinary incontinence: obstetric and other risk factors in primiparae. BJOG. 2006;113(2):208–17. https://doi.org/10.1111/j.1471-0528.2005.00840.x.

14.

Wesnes SL, Hunskaar S, Bo K, Rortveit G. The effect of urinary incontinence status during pregnancy and delivery mode on incontinence postpartum. A cohort study. BJOG. 2009;116(5):700–7. https://doi.org/10.1111/j.1471-0528.2008.02107.x.CrossRefPubMedPubMedCentral

15.

Haylen B, de Ridder D, Freeman R, Swift S, Berghmans B, Lee J, et al. An international Urogynecological association (IUGA)/international continence society (ICS) joint report on the terminology for female pelvic floor dysfunction. Int Urogynecol J. 2010;21(1):5–26. https://doi.org/10.1007/s00192-009-0976-9.

16.

Sandvik H, Seim A, Vanvik A, Hunksaar S. A severity index for epidemiological surveys of female urinary incontinence: comparison with 48-hour pad-weighing test. Neurourol Urodyn. 2000;19:137–45. https://doi.org/10.1002/(SICI)1520-6777(2000)19:2<137::AID-NAU4>3.0.CO;2-G.CrossRefPubMed

17.

Central Statistics Office. Women and men in Ireland. Cork: Central Statistics Office; 2011. Available at: http://www.cso.ie/en/releasesandpublications/ep/p-wamii/womenandmeninireland2013/educationlist/education/

18.

Hunskaar S, Arnold EP, Burgio K, Diokno AC, Herzog AR, Mallett VT. Epidemiology and natural history of urinary incontinence. Int Urogynecol J Pelvic Floor Dysfunct. 2000;11(5):301–19. https://doi.org/10.1007/s001920070021.CrossRefPubMed

19.

Hunskaar S. A systematic review of overweight and obesity as risk factors and targets for clinical intervention for urinary incontinence in women. Neurourol Urodyn. 2008;27(8):749–57. https://doi.org/10.1002/nau.20635.CrossRefPubMed

20.

Wesnes SL, Lose G. Preventing urinary incontinence during pregnancy and postpartum: a review. Int Urogynecol J. 2013;24(6):889–99. https://doi.org/10.1007/s00192-012-2017-3.CrossRefPubMed

21.

Wesnes SL. Weight and urinary incontinence: the missing links. Int Urogynecol J. 2014;25(6):725–9. https://doi.org/10.1007/s00192-013-2268-7.CrossRefPubMed

22.

D’Ancona CAL, Lopes MH, Faleiros-Martins AC, Lúcio AC, Campos RM, Costa JV. Childhood enuresis is a risk factor for bladder dysfunction in adult life? Neurourol Urodyn. 2012;31(5):634–6. https://doi.org/10.1002/nau.21195.CrossRefPubMed

23.

Akashi S, Tomita K. The impact of a history of childhood nocturnal enuresis on adult nocturia and urgency. Acta Paediatr. 2014;103(9):e410–5. https://doi.org/10.1111/apa.12694.CrossRefPubMed

24.

Peschers UM, DeLancey JOL. Anatomy. In: Haslam J, Laycock J, editors. Therapeutic Management of Incontinence and Pelvic Pain. Second ed. London: Springer; 2008. p. 2–20.

25.

Milsom I, Altman D, Lapitan M, Nelson R, Sillen U, Thom D. Epidemiology of urinary (UI) and Faecal (FI) incontinence and pelvic organ Prolapse (POP). In: Abrams P, Cardozo L, HKhoury S, Wein A, editors. Incontinence. 4th ed. Paris: Health Publications Ltd.; 2009.

26.

Nygaard I, Girts T, Fultz N, Kinchen K, Pohl G, Sternfeld B. Is urinary incontinence a barrier to exercise in women? Obstet Gynecol. 2005;106(2):307–14. https://doi.org/10.1097/01.AOG.0000168455.39156.0f.CrossRefPubMed

27.

Corcos J, Mattiasson A. Female stress urinary incontinence. In: Bo K, Berghmans B, Morkved S, Van Kampen M, editors. Evidenced-based physical therapy for the pelvic floor. Croyden: Churchill Livingstone; 2007. p. 164–71.

28.

Brubaker L, Lukacz ES, Burgio K, Zimmern P, Norton P, Leng W, et al. Mixed incontinence: comparing definitions in non-surgical patients. Neurourol Urodyn. 2011;30(1):47–51. https://doi.org/10.1002/nau.20922.

29.

Sandvik H, Hunskaar S, Vanvik A, Bratt H, Seim A, Hermstad R. Diagnostic classification of female urinary incontinence: an epidemiological survey corrected for validity. J Clin Epidemiol. 1995;48(3):339–43. https://doi.org/10.1016/0895-4356(94)00147-I.

Title: Urinary incontinence in nulliparous women before and during pregnancy: prevalence, incidence, type, and risk factors
Authors: Deirdre Daly
Mike Clarke
Cecily Begley
Publication date: 01-03-2018
Publisher: Springer London
Published in: International Urogynecology Journal / Issue 3/2018
Print ISSN: 0937-3462
Electronic ISSN: 1433-3023
DOI: https://doi.org/10.1007/s00192-018-3554-1

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

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

Abstract

Introduction

Methods

Results

Conclusion

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Introduction

Methods

Results

Conclusion

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