A RECENT LITERATURE REVIEW SUGGESTS THAT VAGINAL DELIVERY INCREASES RISK OF URINARY INCONTINENCE
Incontinence is common among women and has been previously related to method of childbirth delivery. Stress urinary incontinence (SUI) is the leakage of urine with physical exertion and can also occur during sneezing or coughing. In contrast, urgency urinary incontinence (UUI) is the leakage of urine that is associated with the urge of urinating. Caesarean delivery is thought to have protective effects for the pelvic floor due to the bladder neck support being uncompromised and its integrity maintained.
According to a recent literature review of 23 studies, 15 studies revealed the risk of developing long-term SUI doubled with vaginal delivery when compared to caesarean section. Furthermore, SUI risk was 3 times higher for elective caesarean section. This relationship was age dependent as it was not as strong in older women suggesting that as a woman ages, mode of delivery is one of many causes of incontinence. There was also no difference in SUI risk between women who had assisted (the use of forceps and vacuum) versus spontaneous vaginal delivery. The remaining 8 studies demonstrate a weaker but still positive link between vaginal delivery and UII risk. It appears that women who have had vaginal deliveries have an increased risk of developing both SUI and UUI.
The authors state that their findings are in agreement with a Swedish study that reported vaginal deliveries are related to surgical treatment for incontinence and that this increased risk was longstanding (more than 3 decades). The current literature suggests that increasing the use of the caesarean section could lead to decreased surgical treatment for incontinence resulting in improved pelvic floor health and ultimately public health. However, caesarean sections are also related to other risks including intensive care admissions, longer hospital stays and medical risks for future pregnancies. The benefits of caesarean section relating to incontinence could add yet another dimension when women and their physicians are making decisions regarding method of delivery.
Tahtinen RM, Cartwright R, Tsui JF, Aaltonen RL, Aoki Y, Cardenas JL, El Dib R, Joronen KM, Al Juaid S, Kalantan S, Kochana M, Kopec M, Lopes LC, Mirza E, Oksjoki SM, Pesonen JS, Valpas A, Wang L, Zhang Y, Heels-Ansdell D, Guyatt GH, Tikkinen KAO. Long-term Impact of Mode of Delivery on Stress Urinary Incontinence and Urgency Urinary Incontinence: A Systematic Review and Meta-analysis. Eur Urol (2016)
Written by Aurelie Hartawidjojo BSc, BScPT