Incidence of urinary and anal incontinence six-month postpartum: a cross-sectional study based on pelvic floor risks

Lleberia Juanós J1, Donoso Dorado L1, Zamora Lapiedra M1, Mestre Costa M1, Pubill Soler J1

Research Type

Clinical

Abstract Category

Health Services Delivery

Abstract 755
Non Discussion Abstract
Scientific Non Discussion Abstract Session 37
Incontinence Mathematical or statistical modelling Pelvic Floor Female
1.Pelvic Floor Unit, Department of Obstetrics and Gynecology, Parc Taulí Hospital Universitari, Institut d'Investigació i Innovació Parc Taulí, I3PT, Universitat Autònoma de Barcelona, Sabadell, Barcelona, Spain
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Abstract

Hypothesis / aims of study
Parity and vaginal delivery are established risk factors for urinary (UI) and fecal incontinence (FI) among women (1). 
Moreover, other factors have been described, such as maternal obesity, operative vaginal delivery, obstetric anal sphincter injuries (OASIS), levator ani lesions or high birth weight that could be related to an increased risk of presenting UI or FI (2). 
The aim of study was to identify which factors regarding women features and their delivery  are associated to having UI or FI at six-month postpartum.
Study design, materials and methods
This cross-sectional study included 6-month postpartum women with a single birth in our hospital between May-June 2018, without neurological or muscular systemic disorders. In January 2019,  validated questionnaires (ICIQ-SF for UI and Wexner Faecal Continence Grading Scale for FI) were performed to our women. 
Our data was collected from the official obstetric data record of the hospital and risk factor for pelvic floor disorders (PFD) register and completed by 2 validated questionnaires through telephone queries. 
The main endpoint is incidence of  UI and FI at 6 months postpartum based on the ICS (International Continence Society) definitions. 
Add, other variables were collected: Age at delivery, body mass index (BMI), maternal diabetes, onset of labour, birth lenght (hours), type of delivery, type of anesthesia, episiotomy, perineal tear, birth weight and shoulder dystocia.
First, a descriptive analysis was done: mean and standard deviation for continuous variable and number -  percentage for categoric variables. 
Secondly, we proceed with comparative bivarible analysis to detect statistic associations to detect IU or IF.
Finally, risk factors were analyzed by logistic regression analyses and adjusted for confounding factors when appropriate. Stata 14.0© was used to conduct statistical analyses.
Results
A total of 280 women were included in our study. 
Descriptive analysis is exposed at table 1. In summary, mean age was 32,4 years (+/-5,4), with mean BMI of 26,8 kg/m2 (+/- 7,2). Type of delivery was eutocic in 213 cases (76.3%), with a mean of birth length of 7.1h (+/-4.9), 60 episiotomies (21.5%), 5 OASIS (1.8%) and mean birth weight 3215,9g (+/-584,6).
Results of main endpoint was: mean of ICIQ-SF (points) 1,2+/- 3.5, with a incidence of urine incontinence of 11,8% (33 cases) and fecal incontinence 0.4% (1 case).

We considered that one case of fecal incontinence was insuficient to look for risk factors, and  we decided not to continue with the search for associations to fecal incontinence.

Comparative analysis
In the bivariant analysis , we compared differences in age, parity,  type of anesthesia, type of delivery, perineal tear, BMI, birth weight, episiotomy and onset of labour on patients with and without UI at 6 month-postpartum. Of those, age (p=0,0049) and type of anesthesia (p=0,016) were stadistically related to UI.
In the multivariant analysis the model which the best AUC was the one that includes age, parity, type of anesthesia, type of delivery, perineal tear and BMI. However, according to our bivariant results, a multivariate logistic regression was performed taking age and type of anesthesia into account. Predictive model resulting was shown in figure 2.
Interpretation of results
According to the results of our descriptive analysis, pregnancy and delivery are factors involved in the developement of UI. This is shown in the fact that in a sample of women with a mean age of 32,4 years, we have obtained a rate of 11,8% of UI postpartum, which is a high value taking into account the young age of these women. 
However, in this study we could not prove the association of some factors related to UI as they are described in the literature. Not differences are shown regarding parity, type of delivery, perineal tear, BMI, birth weight or episiotomy. In addition, the most predictive model to identify those patients with risk factors to developing UI postpartum only includes age and type of anesthesia, which could not be much changeable with measures taken in clinical practice.
Concluding message
Although parity could be related to increasing the rate of young women having UI, we still do not have a good predicting model that could help us identify which factors are more related to this problem. More studies with larger samples should be performed in order to identify which women are at more risk of developing UI postpartum, so we could take preventing measures in our clinical practice
Figure 1 Table 1
Figure 2 Figure 2
References
  1. Gyhagen M, Åkervall S, Milsom I. Int Urogynecol J. 2015;26(8): 1115-21.
  2. Milsom I, Altman D, Cartwright R, et al. Epidemiology of urinary incontinence (UI) and other lower urinary tract symptoms (LUTS), pelvic organ prolapse (POP) and anal incontinence (AI). In: Abrams P, Cardozo L, Wagg A, Wein A, eds. 6th International Consultation on Incontinence. Paris: Health Publications, Ltd; 2014:4-141.
Disclosures
Funding None Clinical Trial No Subjects Human Ethics Committee Comitè Ètica i Investigació Clínica Helsinki Yes Informed Consent Yes