Urinary Incontinence After Vaginal Delivery or Cesarean Section
Rortveit G, Daltveit AK, Hannestad YS, Hunskaar S, for the Norwegian EPINCONT Study.
N Engl J Med. 2003;348:900–90712621134.
It is widely accepted that traumatic childbirth is a major cause of pelvic floor damage and stress urinary incontinence. Yet, the actual data to support or refute this are not well characterized. In this noteworthy study, Rortveit and colleagues, from Norway, address this important issue.
The investigators studied whether women who deliver by cesarean section have an increased risk of urinary incontinence compared with nulliparous women and whether women who deliver vaginally have an even higher risk. A total of 15,307 women in a community-based cohort were evaluated. Women were included if they answered questions related to urinary incontinence; were younger than 65 years; and had no deliveries, cesarean sections only, or vaginal deliveries only.
The prevalence of any incontinence was 10.1% in the nulliparous women, 15.9% in those who had cesarean sections only, and 21.0% in those who had vaginal delivery only. Compared with nulliparous women, those who had cesarean sections had an adjusted odds ratio (OR) for any incontinence of 1.5. Only stress and mixed-type incontinence were significantly associated with cesarean sections. The adjusted OR for any incontinence associated with vaginal deliveries compared with cesarean sections was 1.7. Only stress incontinence (adjusted OR, 2.4) was associated with the mode of delivery.
Results of this study demonstrated that women who delivered vaginally had a 2- to 3-times higher risk of stress incontinence compared with nulliparous women, whereas those who delivered by cesarian section had a 50% higher risk. Other interesting findings were that urge incontinence is not associated with childbirth and that even nulliparous women can develop stress urinary incontinence. However, urologists should not interpret the study as indicating cesarean sections if one wants to prevent incontinence.