New postnatal urinary incontinence: obstetric and other risk factors in primiparae

OBJECTIVE: To identify obstetric and other risk factors for urinary incontinence that occurs during pregnancy or after childbirth. DESIGN: Questionnaire survey of women. SETTING: Maternity units in Aberdeen (Scotland), Birmingham (England) and Dunedin (New Zealand). POPULATION: A total of 3405 primiparous women with singleton births delivered during 1 year. METHODS: Questionnaire responses and obstetric case note data were analysed using multivariate analysis to identify associations with urinary incontinence. MAIN OUTCOME MEASURES: Urinary incontinence at 3 months after delivery first starting in pregnancy or after birth. RESULTS: The prevalence of urinary incontinence was 29%. New incontinence first beginning after delivery was associated with older maternal age (oldest versus youngest group, OR 2.02, 95% CI 1.35-3.02) and method of delivery (caesarean section versus spontaneous vaginal delivery, OR 0.28, 95% CI 0.19-0.41). There were no significant associations with forceps delivery (OR 1.18, 95% CI 0.92-1.51) or vacuum delivery (OR 1.16, 95% CI 0.83-1.63). Incontinence first occurring during pregnancy and still present at 3 months was associated with higher maternal body mass index (BMI>25, OR 1.68, 95% CI 1.16-2.43) and heavier babies (birthweight in top quartile, OR 1.56, 95% CI 1.12-2.19). In these women, caesarean section was associated with less incontinence (OR 0.39, 95% CI 0.27-0.58) but incontinence was not associated with age. CONCLUSIONS: Women have less urinary incontinence after a first delivery by caesarean section whether or not that first starts during pregnancy. Older maternal age was associated with new postnatal incontinence, and higher BMI and heavier babies with incontinence first starting during pregnancy. The effect of further deliveries may modify these findings.     

Risk factors for female anal incontinence: new insight through the Evanston-Northwestern twin sisters study

OBJECTIVE: To evaluate risk factors for anal incontinence using an identical twin sisters study design to provide control over genetic variance. METHODS: A total of 271 identical twin sister pairs (mean age 47 years) completed the validated Colorectal Anal Distress Inventory questionnaire detailing the presence and severity of anal incontinence. Data were analyzed using a stepwise logistic regression with repeated binary measures to account for correlated data within twin pairs. Three different statistical models were used to analyze nonobstetric as well as obstetric risk factors separately. RESULTS: Significant risk factors for anal incontinence and higher Colorectal Anal Distress Inventory anal incontinence subscale scores included age 40 years or older (fecal: odds ratio [OR] 2.82, 95% confidence interval [CI] 1.21-6.0; flatal: OR 1.90, 95% CI 1.11-3.24), menopause (fecal: OR 2.10, 95% CI 1.15-3.8; flatal: OR 2.11, 95% CI 1.43-3.13), increasing parity (parity > or = 2; fecal: OR 3.09, 95% CI 1.25-7.65; flatal: OR 2.72, 95% CI 1.65-4.51), and the presence of stress urinary incontinence (fecal: OR 2.11, 95% CI 1.12-3.98; flatal: OR 1.72, 95% CI 1.14-2.59). Obesity was associated with significantly higher Colorectal Anal Distress Inventory anal incontinence subscale scores (mean difference 5.18, P = .007). Cesarean delivery after initiation of labor was associated with a lower prevalence of anal incontinence than vaginal birth; however, this difference was not statistically significant (17% compared with 4%, P = .11). No anal incontinence was noted in women who had only elective cesarean deliveries. CONCLUSION: Age, menopause, obesity, parity, and stress urinary incontinence are the major risk factors for female anal incontinence.     

女性压力性尿失禁发生的危险因素分析

目的 调查城市社区女性压力性尿失禁发生的危险因素。方法 按照1：8随机抽样的方法,抽取福州市鼓楼区6066例妇女。调查项目包括：年龄、职业、文化程度、体重、血压、月经史、孕产史、分娩方式、新生儿体重、慢性疾病(高血压、糖尿病、慢性咳嗽、习惯性便秘)、腹腔或盆腔手术史、生活习惯(吸烟、酗酒、体育锻炼方式等)、尿失禁症状和发生频率、就医情况等。数据采用多因素回归分析。结果 问卷回收率为92．1％(5587／6066)。尿失禁发生率为18．1％,其中压力性尿失禁占8．8％。调查显示,诸因素中年龄[OR：1．010;95％可信限(CI)：1．001—1．025]、高体重指数(OR：1．092;95％CI：1．054—1．132)、高血压(OR：2．342;95％CI：1．026～5．349)、便秘(OR：1．448;95％CI：1．216—1．725)、多次流产(OR：1．306;95％,CI：1．113～1．533)、多次阴道分娩(OR：1．205;95％CI：1．009—1．440)、加腹压助产(OR．1．684;95％CI:1．140—2．489)、会阴直切(OR：2．244;95% CI：1．162～4．334)、会阴裂伤(OR：2．576;95％CI：1．724～3．851)、会阴切口感染(OR：5．988;95％CI：1．936—18．616)是尿失禁发生的危险因素。结论 压力性尿失禁的发生与多种因素有关,尤其与年龄和妊娠、分娩等产科因素关系密切。     

Symptoms of stress incontinence 1 year after childbirth: prevalence and predictors in a national Swedish sample

BACKGROUND: The aims of the present study were to describe the prevalence of stress incontinence, as described by women themselves, 1 year after childbirth in a national sample of Swedish-speaking women, and to identify possible predictors. METHODS: A cohort study, including 2390 women recruited from 593 antenatal clinics in Sweden during three 1-week periods evenly spread over 1 year (1999-2000), representing 53% of women eligible for the study and 75% of those who consented to participate. Data were collected by means of questionnaires in early pregnancy, 2 months and 1 year after the birth, and from the Swedish Medical Birth Register. RESULTS: One year after the birth, 22% of the women had symptoms of stress incontinence but only 2% said it caused them major problems. The strongest predictor was urinary incontinence (overall leakage) 4-8 weeks after a vaginal delivery (OR 5.5, CI 95% 4.1-7.4) as well as after a cesarean section (OR 11.9, CI 95% 2.9-48.1). Other predictors in women with a vaginal delivery were: multiparity (OR 1.4; CI 95% 1.1-1.8), obesity (OR 1.6; CI 95% 1.1-2.4) and constipation 4-8 weeks postpartum (OR 1.4; CI 95% 1.1-1.9). CONCLUSION: Stress incontinence 1 year after childbirth is a common symptom, which could possibly be reduced by identifying women with urinary leakage at the postnatal check-up.     

Risk of stress urinary incontinence twelve years after the first pregnancy and delivery

OBJECTIVE: To estimate the impact of onset of stress urinary incontinence in first pregnancy or postpartum period, for the risk of symptoms 12 years after the first delivery. METHODS: In a longitudinal cohort study, 241 women answered validated questions about stress urinary incontinence after first delivery and 12 years later. RESULTS: Twelve years after first delivery the prevalence of stress urinary incontinence was 42% (102 of 241). The 12-year incidence was 30% (44 of 146). The prevalence of stress urinary incontinence 12 years after first pregnancy and delivery was significantly higher (P<.01) in women with onset during first pregnancy (56%, 37 of 66) and in women with onset shortly after delivery (78%, 14 of 18) compared with those without initial symptoms (30%, 44 of 146). In 70 women who had onset of symptoms during first pregnancy or shortly after the delivery but remission 3 months postpartum, a total of 40 (57%) had stress urinary incontinence 12 years later. In 11 women with onset of symptoms during the first pregnancy or shortly after delivery but no remission 3 months postpartum, a total of 10 (91%) had stress urinary incontinence 12 years later. Cesarean during first delivery was significantly associated with a lower risk of incontinence. Other obstetric factors were not significantly associated with the risk of incontinence 12 years later. Patients who were overweight before their first pregnancy were at increased risk. CONCLUSION: Onset of stress urinary incontinence during first pregnancy or puerperal period carries an increased risk of long-lasting symptoms.     

Anal incontinence after vaginal delivery: a five-year prospective cohort study

OBJECTIVE: The long-term prevalence of anal incontinence after vaginal delivery is unknown. The aim of the present study was to evaluate the prevalence of anal incontinence in primiparous women 5 years after their first delivery and to evaluate the influence of subsequent childbirth. METHODS: A total of 349 nulliparous women were prospectively followed up with questionnaires before pregnancy, at 5 and 9 months, and 5 years after delivery. A total of 242 women completed all questionnaires. Women with sphincter tear at their first delivery were compared with women without such injury. Risk factors for development of anal incontinence were also analyzed. RESULTS: Anal incontinence increased significantly during the study period. Among women with sphincter tears, 44% reported anal incontinence at 9 months and 53% at 5 years (P = .002). Twenty-five percent of women without a sphincter tear reported anal incontinence at 9 months and 32% had symptoms at 5 years (P < .001). Risk factors for anal incontinence at 5 years were age (odds ratio [OR] 1.1; 95% confidence interval [CI] 1.0-1.2), sphincter tear (OR 2.3; 95% CI 1.1-5.0), and subsequent childbirth (OR 2.4; 95% CI 1.1-5.6). As a predictor of anal incontinence at 5 years after the first delivery, anal incontinence at both 5 months (OR 3.8; 95% CI 2.0-7.3) and 9 months (OR 4.3; 95% CI 2.2-8.2) was identified. Among women with symptoms, the majority had infrequent incontinence to flatus, whereas fecal incontinence was rare. CONCLUSION: Anal incontinence among primiparous women increases over time and is affected by further childbirth. Anal incontinence at 9 months postpartum is an important predictor of persisting symptoms.     

Persistent urinary incontinence and delivery mode history: a six-year longitudinal study

OBJECTIVE: To investigate the prevalence of persistent and long term postpartum urinary incontinence and associations with mode of first and subsequent delivery. DESIGN: Longitudinal study. SETTING: Maternity units in Aberdeen (Scotland), Birmingham (England) and Dunedin (New Zealand). POPULATION: Women (4214) who returned postal questionnaires three months and six years after the index birth. METHODS: Symptom data were obtained from both questionnaires and obstetric data from case-notes for the index birth and the second questionnaire for subsequent births. Logistic regression investigated the independent effects of mode of first delivery and delivery mode history. MAIN OUTCOME MEASURES: Urinary incontinence-persistent (at three months and six years after index birth) and long term (at six years after index birth). RESULTS: The prevalence of persistent urinary incontinence was 24%. Delivering exclusively by caesarean section was associated with both less persistent (OR=0.46, 95% CI 0.32-0.68) and long term urinary incontinence (OR=0.50, 95% CI 0.40-0.63). Caesarean section birth in addition to vaginal delivery, however, was not associated with significantly less persistent incontinence (OR 0.93, 95% CI 0.67-1.29). There were no significant associations between persistent or long term urinary incontinence and forceps or vacuum extraction delivery. Other significantly associated factors were increasing number of births and older maternal age. CONCLUSIONS: The risk of persistent and long term urinary incontinence is significantly lower following caesarean section deliveries but not if there is another vaginal birth. Even when delivering exclusively by caesarean section, the prevalence of persistent symptoms (14%) is still high.     

Urinary incontinence during pregnancy

OBJECTIVE: To investigate incidence and prevalence of urinary incontinence during pregnancy and associated risk factors. METHODS: The data collection was conducted as part of the Norwegian Mother and Child Cohort Study at the Norwegian Institute of Public Health. We present questionnaire data about urinary incontinence obtained from 43,279 women (response rate 45%) by week 30. We report data on any incontinence, in addition to type, frequency, and amount of incontinence. Potential risk factors were investigated by logistic regression analyses. RESULTS: The prevalence of incontinence increased from 26% before pregnancy to 58% in week 30. The corresponding figures for nulliparous women were 15% and 48%, and for parous women 35% and 67%. The cumulative incidence was 46%. Stress urinary incontinence was the most common type of incontinence in week 30 of pregnancy, experienced by 31% of nulliparous and 42% of parous women. The majority of pregnant women had leakage less than once per week and droplets only, both before and during pregnancy. Parity was a strong and significant risk factor for incontinence in adjusted analyses both before pregnancy (odds ratio [OR] 2.5, 95% confidence interval [CI] 2.4-2.7 for primiparous and OR 3.3, 95% CI 3.1-3.5 for multiparous women) and during pregnancy (ORs 2.0, 95% CI 1.9-2.1 and 2.1, 95% CI 2.0-2.2, respectively). Age and body mass index were weaker, but still statistically significant, risk factors. CONCLUSION: The prevalence of urinary incontinence increases substantially during pregnancy. Incontinence both before and during pregnancy seems to be associated with parity, age, and body mass index. LEVEL OF EVIDENCE: II.     

分娩方式对产妇盆底支持组织功能的近期影响

目的 探讨不同分娩方式及产科相关因素对盆底支持组织功能的近期影响.方法 选取健康初产妇120例,其中阴道分娩72例(阴道分娩组),选择性剖宫产48例(剖宫产组),于分娩后6至8周间进行尿失禁问卷调查、盆底肌电图测定盆底肌肉收缩及舒张功能,并行相关性分析.结果 阴道分娩组与剖宫产组产妇分娩后SUI的发生率分别为21%(15/72)、10%(5/48).阴道分娩组盆底肌电图右侧活力值、功值分别为12.9±0.8和59±5,左右两侧平均功值为78±5;剖宫产组右侧活力值、功值分别为17.3±1.7和95±17,左右两侧平均功值109±15,两组各项值比较,差异均有统计学意义(P＜0.05).产妇的年龄(P＜0.01)、分娩前体重指数(P＜0.01)、新生儿出生体重(P＜0.01)及第二产程时间(P=0.003)是产后发生SUI的高危因素;年龄、分娩前后体重指数差、第一产程时间、会阴侧切口长度和角度对盆底肌电图的部分测量值有影响.结论 阴道分娩后SUI发生率与选择性剖宫产相似;产科相关因素可以影响产后尿失禁的发生率及盆底肌肉收缩及舒张功能.     

Urinary incontinence: prevalence and risk factors at 16 weeks of gestation.

OBJECTIVE: To evaluate the prevalence of urinary incontinence at 16 weeks of gestation and to identify possible maternal and obstetric risk factors. DESIGN: Cross-sectional study and cohort study. SETTING: Department of Obstetrics and Gynaecology, Aarhus University Hospital, Denmark. POPULATION: Cross-sectional study: 7795 women attending antenatal care. Cohort study: a sub-group of 1781 pregnant women with one previous delivery at our department. RESULTS: Prevalence and maternal risk factors: the prevalence of urinary incontinence within the preceding year was 8.9% among women at 16 weeks of gestation (nulliparae, 3.9%, para 1, 13.8%, para 2+, 16.2%). Stress or mixed incontinence occurred at least weekly in 3% of all the women. After adjusting for age, parity, body mass index, smoking, previous abortions, and previous lower abdominal or urological surgery in a logistic regression model, primiparous women who had delivered vaginally had higher risk of stress or mixed urinary incontinence than nulliparous women (OR 5.7; 95% CI 3.9-8.3). Subsequent vaginal deliveries did not increase the risk significantly. Young age, body mass index > 30, and smoking were possible risk factors for developing urinary incontinence. Obstetric factors: weight of the newborn > 4000 g (OR 1.9; 95% CI 1.0-3.6) increased the risk of urinary incontinence; mediolateral episiotomy in combination with birthweight > 4000 g also increased the risk (OR 3.5; 95% CI 1.2-10.2); a number of other intrapartum factors did not increase the risk of urinary incontinence. CONCLUSIONS: The first vaginal delivery was a major risk factor for developing urinary incontinence; subsequent vaginal deliveries did not increase the risk significantly. Birthweight > 4000 g increased the risk; episiotomy in combination with birthweight > 4000 g also increased the risk.     

Leaking urine prior to pregnancy: a risk factor for postnatal incontinence

BACKGROUND: The prevalence of 30% for postnatal urinary incontinence is a major women's health issue. The majority of studies to date are retrospective, and evidence about contributing factors is inconsistent. AIMS: To identify women at risk for postnatal urinary incontinence following the first pregnancy and birth. STUDY POPULATION AND METHODS: One hundred and twenty four women participated in a longitudinal study. Questionnaires and interviews were conducted at 14, 24 and 38 weeks' gestation and 24-72 h, 6-8 weeks and 6-18 months postnatal. These, along with chart audits for pregnancy, labour and delivery factors and demographics, formed the database for logistic regression. RESULTS: The only variable to emerge as a key indicator for predicting those women most at risk for developing postnatal urine leakage was a history of urinary leaking prior to the first pregnancy. Women with this history were 4.14 times more at risk of leaking urine 1 year after giving birth than women without previous urine leakage (P = 0.02). There was a pattern of leaking urine across the childbearing experience that suggests some resolution by 12 months regardless of parity. Length of second stage labour and method of delivery were the only labour and delivery variables to show significant differences between leaking and not leaking urine at 12 months postnatal. CONCLUSION: Women who leak urine before their first pregnancy can be identified during early antenatal care as those at risk for postnatal urinary incontinence. Further research to test preventive measures is needed.     

Prevalence of urinary incontinence and associated risk factors in postmenopausal women. Heart & Estrogen/Progestin Replacement Study (HERS) Research Group.

OBJECTIVE: To determine the prevalence of stress, urge, and mixed urinary incontinence and associated risk factors in postmenopausal women. METHODS: Before enrollment in a 4-year, randomized trial of combination hormone therapy to prevent coronary heart disease, 2763 participants completed questionnaires on prevalence and type of incontinence. We measured factors potentially associated with incontinence including demographics, reproductive and medical histories, height, weight, and waist-to-hip circumference ratio. We used multivariate logistic models to determine independent associations between those factors and weekly incontinence by type. RESULTS: The mean (+/- standard deviation [SD]) age of the participants was 67+/-7 years; 89% were white and 8% were black. Fifty-six percent reported weekly incontinence. In multivariate analyses, the prevalence of weekly stress incontinence was higher in white than black women (odds ratio [OR] 2.8, 95% confidence interval [CI] 1.6, 5.1), in women with higher body-mass index (BMI) (OR 1.1 per 5 units, 95% CI 1.0, 1.3), and higher waist-to-hip ratio (OR 1.2 per 0.1 unit, 95% CI 1.0, 1.4). The prevalence of weekly urge incontinence was higher in older women (OR 1.2 per 5 years, 95% CI 1.1, 1.3), diabetic women (OR 1.5, 95% CI 1.1, 2.0) and women who had reported two or more urinary tract infections in the prior year (OR 2.0, 95% CI 1.1, 3.6). CONCLUSION: Stress and urge incontinence are common in postmenopausal women and have different risk factors, suggesting that approaches to risk-factor modification and prevention also might differ and should be specific to types of incontinence.     

Urinary incontinence: prevalence and risk factors at 16 weeks of gestation

Objective To evaluate the prevalence of urinary incontinence at 16 weeks of gestation and to identify possible maternal and obstetric risk factors.
Design Cross-sectional study and cohort study.
Setting Department of Obstetrics and Gynaecology, Aarhus University Hospital, Denmark.
Population Cross-sectional study: 7795 women attending antenatal care. Cohort study: a sub-group of 1781 pregnant women with one previous delivery at our department.
Results Prevalence and maternal risk factors: the prevalence of urinary incontinence within the preceding year was 8.9% among women at 16 weeks of gestation (nulliparae, 3.9%. para 1, 13.8%, para 2+, 16.2%). Stress or mixed incontinence occurred at least weekly in 3% of all the women. After adjusting for age, parity, body mass index, smoking, previous abortions, and previous lower abdominal or urological surgery in a logistic regression model, primiparous women who had delivered vaginally had higher risk of stress or mixed urinary incontinence than nulliparous women (OR 5.7; 95% CI 3.9–8.3). Subsequent vaginal deliveries did not increase the risk significantly. Young age, body mass index > 30, and smoking were possible risk factors for developing urinary incontinence. Obstetric factors: weight of the newborn > 4000 g (OR 1.9; 95% CI 14–3.6) increased the risk of urinary incontinence; mediolateral episiotomy in combination with birthweight > 4000 g also increased the risk (OR 3–5; 95% CI 1.2–10.2); a number of other intrapartum factors did not increase the risk of urinary incontinence.
Conclusions The first vaginal delivery was a major risk factor for developing urinary incontinence; subsequent vaginal deliveries did not increase the risk significantly. Birthweight > 4000 g increased the risk; episiotomy in combination with birthweight > 4000 g also increased the risk.     

Urinary and anal incontinence in morbidly obese women considering weight loss surgery

OBJECTIVE: To estimate prevalence and correlates of urinary and anal incontinence in morbidly obese women undergoing evaluation for laparoscopic weight loss surgery. METHODS: From October 2003 to February 2005, 180 women with body mass index (BMI) of 40 or greater underwent evaluation for laparoscopic weight loss surgery. Using an established Web site, questionnaires were completed to assess symptoms of urinary incontinence, including the Medical, Epidemiological, and Social Aspects of Aging Questionnaire (MESA). Anal incontinence was assessed by asking, "Do you have any uncontrolled anal leakage?" A number of clinical and demographic variables were examined as potential risk factors for urinary incontinence and anal incontinence. RESULTS: Mean age was 39.8 years (range 16-55). Body mass index ranged from 40 to 81 (mean 49.5). Prevalence of urinary incontinence was 66.9% and anal incontinence was 32.0% (45.6% loss of gas only, 21.1% liquid stool only, 24.6% gas and liquid stool only, 8.8% solid stool). In simple logistic regression, presence of urinary incontinence was associated with age (odds ratio [OR] 1.05, 95% confidence interval [CI] 1.01-1.09), number of children (OR 1.54, 95% CI 1.15-2.07), anal incontinence (OR 6.34, 95% CI 2.52-15.93), arthritis (OR 6.04, 95% CI 1.76-20.78), and sleep apnea (OR 2.30, 95% CI 1.21-4.37). Multivariable logistic regression identified 3 factors independently associated with urinary incontinence: number of children (OR 1.55, 95% CI 1.12-2.12), arthritis (OR 5.46, 95% CI 1.51-19.73), and anal incontinence (OR 6.27, 95% CI 2.42-16.26). Presence of anal incontinence was associated only with the presence of urinary incontinence (OR 6.34, 95% CI 2.52-15.93). CONCLUSION: Prevalence of urinary and anal incontinence is high in this group of morbidly obese women as compared with the general population. Studies are needed to determine the effect of weight loss on urinary and anal incontinence symptoms in the morbidly obese woman.     

Faecal incontinence and mode of first and subsequent delivery: a six-year longitudinal study

OBJECTIVE: To investigate the prevalence of persistent and long term postpartum faecal incontinence and associations with mode of first and subsequent deliveries. DESIGN: Longitudinal study. SETTING: Maternity units in Aberdeen, Birmingham and Dunedin. POPULATION: Four thousand two hundred and fourteen women who returned postal questionnaires three months and six years postpartum. METHODS: Symptom data were obtained from both questionnaires and obstetric data from case-notes for the index birth and the second questionnaire for subsequent births. Logistic regression investigated the independent effects of mode of first delivery and delivery history. MAIN OUTCOME MEASURES: Incontinence to bowel motions three months and six years after index birth. For delivery history, the outcome was incontinence only at six years. RESULTS: The prevalence of persistent faecal incontinence was 3.6%. Almost 90% of these women reported no symptoms before their first birth. The forceps delivery of a first baby was independently predictive of persistent symptoms (OR 2.06, 95% CI 1.40-3.04). A caesarean section first birth was not significantly associated with persistent symptoms (OR 1.07, 95% CI 0.64-1.81). Delivering exclusively by caesarean section also showed no association with subsequent symptoms (OR 1.04, 95% CI 0.72-1.50) but ever having forceps was significantly predictive (OR 1.48, 95% CI 1.18-1.87). Other factors independently associated with persistent faecal incontinence were older maternal age, increasing number of births and Asian ethnic group. Birthweight and long second stage were not significantly associated. CONCLUSIONS: The risk of persistent faecal incontinence is significantly higher after a first delivery by forceps. We found no evidence of a lower risk of subsequent faecal incontinence for exclusive caesarean section deliveries.     

Risk factors for forceps delivery in nulliparous patients

OBJECTIVE: To identify risk factors for forceps delivery during first pregnancy. MATERIALS AND METHODS: A retrospective case-control study was carried out in a tertiary maternity ward between January 2001 and December 2003. A total of 582 nulliparous women, with full-term (>37 weeks gestation), singleton, cephalic pregnancies, who delivered by the vaginal route with or without instrumental assistance were evaluated. RESULTS: The strongest risk factors for forceps delivery were birth weight greater than 4000 g (OR: 6.5; 95% CI: 1.6, 26.9), the occiput posterior position of the fetal head (OR: 5.8; 95% CI: 2.5, 13.8), and epidural analgesia (OR: 7.7; 95% CI: 4.1, 14.7). Other significant risk factors for forceps delivery were age over 35 years (OR: 2.4; 95% CI: 1.1, 5.1), induction of labor (OR: 2.1; 95% CI: 1.4, 3.1), first stage of labor longer than 420 min (OR: 2.3, 95% CI: 1.3,4.2), and a prolonged second stage of labor (OR: 1.6, 95% CI: 1.1, 2.4). CONCLUSION: Age over 35 years and induction of labor are risk factors for forceps delivery at admission. Epidural use, fetal head in occiput posterior position, and birth weight >4000 g are strong intrapartum risk factors for instrumental delivery in nulliparous women.     

Incontinence severity and major depression in incontinent women

OBJECTIVE: Research has shown an association between urinary incontinence and depression. Studies that use community-based samples and major depressive disorder diagnostic criteria are needed. The objective of this study was to estimate the prevalence of and factors associated with major depression in women with urinary incontinence. METHODS: We conducted an age-stratified postal survey of 6,000 women aged 30-90 years. Subjects were randomly selected from enrollees in a large health maintenance organization in Washington state. Main outcome measures were prevalence of current major depression and adjusted odds ratios for factors associated with major depression in women with urinary incontinence. RESULTS: The response rate was 64% (n = 3,536) after applying exclusion criteria. The prevalence of urinary incontinence was 42% (n = 1,458). The prevalence of major depression was 3.7% (n = 129), with 2.2% in those without incontinence versus 6.1% in those with incontinence. Among women with incontinence, major depression prevalence rates differed by incontinence severity (2.1% in mild, 5.7% in moderate, and 8.3% in severe) and incontinence type (4.7% in stress, 6.6% in urge/mixed). Obesity (odds ratio [OR] 2.3, 95% confidence interval [CI] 1.3-4.0), current smoking (OR 2.7, 95% CI 1.5-4.9), lower educational attainment (OR 2.0, 95% CI 1.2-3.3), moderate incontinence (OR 2.7, 95% CI 1.1-6.6), and severe incontinence (OR 3.8, 95% CI 1.6-9.1) were each associated with increased odds of major depression in women with urinary incontinence, controlling for age and medical comorbidity. Compared with women with incontinence alone, women with comorbid incontinence and major depression had significantly greater decrements in quality of life and functional status and increased incontinence symptom burden. CONCLUSION: Women with moderate-to-severe urinary incontinence should be screened for comorbid major depression and offered treatment if depression is present. LEVEL OF EVIDENCE: II-2.     

北京市成年女性粪失禁患病率调查

目的 调查北京市成年女性粪失禁(FI)的患病率,分析FI患病的影响因素.方法 采用分层多阶段系统抽样的方法,应用自填式问卷,对北京市6个区(县)20岁及以上成年女性进行问卷调查.结果 本研究符合条件的调查对象共3058例,年龄在20～79岁之间,平均(48±16)岁.北京市成年女性FI患病率为1.28%(39/3058),FI患病率随年龄增加而升高(P＜0.01).多因素非条件logistic回归分析显示,5个因素进入回归方程,分别为:年龄≥40岁(OR值为3.3,95%CI:1.7～6.8)、患尿失禁(OR值为3.0,95%CI:1.5～6.1)、自然分娩(OR值为2.4,95%CI:1.2～4.9)、家庭人均月收入≤2000元(OR值为3.3,95%CI:1.6～6.5)、经常感到疲劳(OR值为3.0,95%CI:1.5～5.8).结论 北京市成年女性FI患病率不高,但影响因素复杂,应该进一步开展相关研究.     

分娩方式对产后妇女粪失禁及尿失禁的影响

目的 调查女性产后粪失禁和尿失禁的发生率及其相关因素.方法 电话随访2006年10月1日至2007年9月30日在北京大学第一医院妇产科分娩的产妇,共纳入2012例妇女,收集其产后6个月内粪失禁和尿失禁的症状.采用Logistic回归法分析分娩方式与尿失禁和粪失禁的关系.结果 (1)参与调查的2012例产后妇女,14例(0.70％)有粪失禁症状.Logistic回归分析显示,粪失禁与阴道产钳助产(OR=20.09,95％ CI:3.64～110.90,P=0.000)和会阴侧切术分娩相关(OR=6.11,95％ CI:1.29～28.80,P=0.024).(2)2012例妇女中产后尿失禁、压力性尿失禁(stress urinary incontinence,SUI)、急迫性尿失禁(urge urinary incontinence,UUI)、混合性尿失禁(mixed urinary incontinence,MUI)的发病率分别为10.04％(202例)、8.15％ (164例)、0.94％(19例)和0.94％(19例).Logistic回归分析显示,与SUI相关的因素有:母亲年龄(OR=1.07,95％ CI:1.04～1.11,P=0.000)、母亲分娩前体重(OR=1.04,95％CI:1.02～1.06,P=0.001)、新生儿头围(OR=1.20,95％ CI:1.05～1.39,P=0.010)、会阴侧切术分娩(OR=4.96,95％ CI:3.05～8.07,P=0.0005)、阴道自然分娩(OR=5.22,95％ CI:2.53～10.76,P=0.000)和阴道产钳助产(OR=9.20,95％ CI:4.07～20.79,P=0.000).与UUI相关的因素有:产妇分娩前体重(OR=1.51,95％CI:1.12～2.05,P=0.008).与MUI相关的因素有:产妇分娩前体重(OR=1.06,95％ CI:1.00～1.11,P=0.049)、第二产程时限(OR=1.01,95％ CI:1.00～1.03,P=0.010)、会阴侧切术分娩(OR=7.76,95％ CI:1.42～42.52,P=0.017)和阴道产钳助产(OR=15.21,95％ CI:1.61～143.44,P=0.018).(3)产后4d和产后42 d SUI的发病率较高分别为7.95％和9.10％.结论 (1)本院产后妇女粪失禁和尿失禁的发病率较先前报道的其他地区的发病率低.(2)阴道分娩是妇女产后粪失禁和尿失禁发生的高危因素,特别是阴道产钳助产和会阴侧切术分娩.(3)母亲的年龄、分娩前体重、新生儿出生时头围、阴道自然分娩、产钳助产、会阴侧切术是发生尿失禁的高危因素.     

The risk of stress incontinence 5 years after first delivery

OBJECTIVES: We aimed to evaluate the impact of a first pregnancy and delivery on the prevalence of stress incontinence 5 years afterward. STUDY DESIGN: This longitudinal cohort study included 278 women who were questioned after their first delivery and again 5 years later. RESULTS: The prevalence of stress incontinence 5 years after a first delivery was 30%, and the 5-year incidence was 19%. The risk of stress incontinence 5 years after a first delivery was related to the onset and duration of symptoms after the first pregnancy and delivery in a "dose-response-like" manner. The use of vacuum extraction or episiotomy during the first delivery increased the risk. CONCLUSIONS: First pregnancy and delivery may result in stress incontinence 5 years later. Women with incontinence 3 months after a first delivery have a particularly high risk of long-lasting symptoms. Obstetric risk factors are vacuum extraction and episiotomy.