Urinary Incontinence in the 12-Month Postpartum Period

Abstract

The etiology of postpartum urinary incontinence (UI) appears to be multifactorial. A large number of potential risk factors have been investigated. The aim of this study was to describe the prevalence and severity of UI in the 12-month postpartum period and determine the role of several potential risk factors in its development. Potential predisposing risk factors examined included body mass index, smoking, oral contraceptives, breast-feeding, and pelvic floor muscle exercise. The role of these and other potential factors associated with UI were studied over 4 time points within the postpartum year. Participants were a sample of 523 women at a mean age of 28.6 (range, 14–42 years) who had obstetrical deliveries between February 26, 1990, and March 1, 1991. Women were interviewed on postpartum day 2 or 3 in their rooms. Follow-up telephone interviews to assess outcomes were conducted at 6 weeks, 3 months, 6 months, and 12 months postpartum. Obstetrical data from the index delivery were obtained by chart review and abstracted. Generalized estimating equation (GEE) analysis was used to assess associations between UI and predictor variables. The proportion of women reporting incontinence at 6 weeks after the index delivery was 11.4% and did not change significantly over the postpartum period. Frequency of accidents decreased over the year from a mean 15.9 per week at 6 weeks to about half this amount at the 3- and 6-month follow-up and to about 5 per week at the 12-month follow-up. In the multivariable GEE model equation, postpartum incontinence over the 4 time points was significantly associated with the following 7 variables: baseline report of smoking (odds ratio [OR], 2.934; P = 0.002), incontinence during pregnancy (OR, 2.002; P = 0.007), length of breast-feeding (OR, 1.169; P = 0.023), 2 obstetrical factors (vaginal delivery [OR, 2.360; P = 0.002], and use of forceps [OR, 1.870; P = 0.024]), and 2 time varying covariates (frequency of urination [OR, 1.123; P < 0.001] and body mass index [OR, 1.055; P = 0.005]). Several potential risk factors were not associated with postpartum incontinence. These included educational level, episiotomy, number of vaginal deliveries, attendance at childbirth preparation classes, and performing pelvic floor muscle exercises during the postpartum period. This study identified a number of risk factors associated with incontinence in the postpartum period. Some of these factors are potentially modifiable, and others may help target at-risk women for early intervention.