Risk factors for postpartum urinary incontinence

This was a case-control study with 344 puerperal women (77 cases and 267 controls) with up to 90 days postpartum. In a single session, participants were given a questionnaire with sociodemographic and clinical data and two others that assessed urine leakage, leakage situations, and type of UI.

RESULTS:

Stress UI was present in 45.5% of the women, incidents of urine leakage several times a day in 44.2%, of which 71.4% were in small amounts and 57.1% when coughing or sneezing. In 70.1% of cases, UI began during pregnancy and remained through the postpartum period. After running a binary logistic regression model, the following factors remained in the final model: UI during pregnancy (OR 12.82, CI 95% 6.94 - 23.81, p<0.0001), multiparity (OR 2.26, CI 95% 1.22 - 4.19, p=0.009), gestational age at birth greater or equal to 37 weeks (OR 2.52, CI 95% 1.16 - 5.46, p=0.02) and constipation (OR 1.94, CI 95% 1.05 - 5.46, p=0.035).

CONCLUSION:

Most often, UI first appeared during pregnancy and remained through the postpartum period. Urinary incontinence during pregnancy, multiparity, gestational age at birth greater or equal to 37 weeks, and constipation were presented as risk factors. In the studied group, stress UI was more frequent.

Descriptors:
Urinary Incontinence; Urinary Incontinence, Stress; Postpartum Period; Risk Factors; Obstetric Nursing

Case n=77								Control n=267
Variable	mean	standard deviation	median	Q1 (25%)	Q3 (75%)	MIN	MAX	mean	standard deviation	median	Q1 (25%)	Q3 (75%)	MIN	MAX	p-value^† † P-value calculated with the Mann-Whitney test.
Age	26.9	7.6	27.0	20.0	33.0	14.0	45.0	25.6	7.8	26.0	19.0	30.0	13.0	45.0	0.1896
Time postpartum	51.5	10.9	47.0	44.0	59.0	31.0	83.0	52.5	12.3	48.0	44.0	62.0	12.0	87.0	0.7132
Education level	9.8	2.7	10.0	8.0	12.0	5.0	16.0	9.9	2.7	10.0	8.0	12.0	5.0	18.0	0.4968
Family income	1149.6	621.1	1000.0	600.0	1500.0	200.0	3000.0	1230.7	812.3	1000.0	700.0	1500.0	200.0	6000.0	0.6528
Gestational age	38.4	2.6	39.0	37.9	39.9	28.0	42.0	37.6	3.2	38.4	36.7	39.4	24.3	41.4	0.0365
Number of living children	1.90	1.14	1.00	1.00	3.00	1.00	5.00	1.64	1.01	1.00	1.00	2.00	1.00	7.00	0.0661

Risk factors	Puerperal women (n= 344)				P-value ^† † P-value calculated with Pearson's chi-squared test.
	Incontinent (n=77)		Continent (n=267)
	n	%	N	%
Age (years)					0.1399
≤25	36	46.8	132	49.4
26-30	13	16.9	69	25.8
31-35	15	19.5	31	11.6
>35	13	16.9	35	13.1
Color/race					0.3283
White	30	39.0	88	33.0
Nonwhite	47	61.0	179	67.0
UI during pregnancy					<0.0001
No	23	29.9	224	83.9
Yes	54	70.1	43	16.1
Current BMI (kg/m ² )					0.3335
Underweight (<20)	1	1.3	18	6.7
Normal range (20-24.9)	35	45.5	116	43.4
Overweight (25-29.9)	26	33.8	85	31.8
Obese (≥30)	15	19.5	48	18.0
Parity					0.0291
Primiparous	33	42.9	152	56.9
Multiparous	44	57.1	115	43.1
Type of current birth					0.2806
Normal	28	36.4	108	40.4
Forceps	7	9.1	12	4.5
Cesarean	42	54.5	147	55.1
Type(s) of previous birth(s)					0.1446
None (primiparous)	33	42.9	152	56.9
Only vaginal birth (normal or forceps)	15	19.5	37	13.9
Only cesarean section	10	13.0	32	12.0
Mostly vaginal (normal or forceps)	5	6.5	12	4.5
Mostly cesarean	6	7.8	7	2.6
Same number of vaginal and cesarean	8	10.4	27	10.1
Episiotomy					0.6809
No	60	77.9	202	75.7
Yes	17	22.1	65	24.3
Perineal tearing					0.9435
No	64	83.1	221	82.8
Yes	13	16.9	46	17.2
First degree	8	61.5	31	67.4
Second degree	5	38.5	15	32.6
Newborn's head circumference (cm)					0.1315
<34	32	41.6	137	51.3
≥34	45	58.4	130	48.7
Newborn's weight (g)					0.1828
<3000	31	40.3	136	50.9
3000-35000	24	31.2	77	28.8
>3500	22	28.6	54	20.2
Gestational age at birth (weeks)					0.0193
<37	12	15.6	77	28.8
≥37	65	84.4	190	71.2
Smoking					0.1505
Never smoked	61	79.2	196	73.4
Ex-smoker	14	18.2	46	17.2
Smoker	2	2.6	25	9.4
Constipation					0.0557
No	32	41.6	144	53.9
Yes	45	58.4	123	46.1

Universidade de São Paulo, Escola de Enfermagem Av. Dr. Enéas de Carvalho Aguiar, 419 , 05403-000 São Paulo - SP/ Brasil, Tel./Fax: (55 11) 3061-7553, - São Paulo - SP - Brazil
E-mail: reeusp@usp.br

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[1] Corresponding author: Maria Helena Baena de Moraes Lopes. Rua Tessália Vieira de Camargo, 126 - Cidade Universitária Zeferino Vaz. CEP 13083-887 - Campinas, São Paulo, Brazil. mhbaena@unicamp.br

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Risk factors for postpartum urinary incontinence * * Extracted from the dissertation "Incontinência urinária no puerpério: fatores de risco e impacto na qualidade de vida", Faculdade de Enfermagem, Universidade Estadual de Campinas, 2011.

Factores de riesgo para incontinencia urinaria en el puerperio

Abstract

OBJECTIVE:

METHOD:

RESULTS:

CONCLUSION:

Risk factors for postpartum urinary incontinence ^* * Extracted from the dissertation "Incontinência urinária no puerpério: fatores de risco e impacto na qualidade de vida", Faculdade de Enfermagem, Universidade Estadual de Campinas, 2011.