Exclusive caesarean section delivery and subsequent urinary and faecal incontinence: a 12-year longitudinal study
Article first published online: 8 APR 2011
© 2011 The Authors BJOG An International Journal of Obstetrics and Gynaecology © 2011 RCOG
BJOG: An International Journal of Obstetrics & Gynaecology
Volume 118, Issue 8, pages 1001–1007, July 2011
How to Cite
MacArthur, C., Glazener, C., Lancashire, R., Herbison, P., Wilson, D. and on behalf of the ProLong study group (2011), Exclusive caesarean section delivery and subsequent urinary and faecal incontinence: a 12-year longitudinal study. BJOG: An International Journal of Obstetrics & Gynaecology, 118: 1001–1007. doi: 10.1111/j.1471-0528.2011.02964.x
- Issue published online: 10 JUN 2011
- Article first published online: 8 APR 2011
- Accepted 23 February 2011. Published Online 8 April 2011.
- Exclusive caesarean delivery;
- faecal incontinence;
- urinary incontinence
Please cite this paper as: MacArthur C, Glazener C, Lancashire R, Herbison P, Wilson D, on behalf of the ProLong study group. Exclusive caesarean section delivery and subsequent urinary and faecal incontinence: a 12-year longitudinal study. BJOG 2011;118:1001–1007.
Objectives To investigate the association between delivery mode history and urinary and faecal incontinence, specifically a history of exclusive caesarean section deliveries.
Design Twelve-year longitudinal study.
Setting Maternity units in Aberdeen, Birmingham and Dunedin.
Population Women who returned postal questionnaires 3 months and 12 years after index birth.
Methods Data on all births over a 12-month period were obtained from units and women were followed 3 months, 6 years and 12 years after the birth.
Main outcome measures Urinary incontinence (UI) and faecal incontinence (FI) 12 years after index birth.
Results Of the 7883 women recruited at 3 months, 3763 were followed up at 12 years: nonresponders were similar in their obstetric factors. After adjustment for parity, body mass index and age at first birth, women who delivered exclusively by caesarean section were less likely to have UI than those who only had spontaneous vaginal births (odds ratio [OR] 0.46, 95% confidence interval [CI] 0.37–0.58), but not if they had a combination of caesarean and spontaneous vaginal births (OR 1.14, 95% CI 0.89–1.47). There was no difference in FI among women who had exclusive caesarean births (OR 0.94, 95% CI 0.66–1.33) or mixed caesarean and spontaneous vaginal births (OR 1.06, 95% CI 0.73–1.54).
Conclusions Unless women are resolved to have all their deliveries by the abdominal route (and their medical advisors agree), caesarean section does not protect from subsequent UI. Even among those who do deliver exclusively by caesarean section, 40% still report UI; and this strategy confers no benefit for subsequent FI.