The prevalence of urinary incontinence 20 years after childbirth: a national cohort study in singleton primiparae after vaginal or caesarean delivery
Article first published online: 14 MAR 2012
© 2012 The Authors BJOG An International Journal of Obstetrics and Gynaecology © 2012 RCOG
BJOG: An International Journal of Obstetrics & Gynaecology
Special Issue: Urogynaecology and female pelvic reconstructive surgery
Volume 120, Issue 2, pages 144–151, January 2013
How to Cite
Gyhagen, M., Bullarbo, M., Nielsen, T. and Milsom, I. (2013), The prevalence of urinary incontinence 20 years after childbirth: a national cohort study in singleton primiparae after vaginal or caesarean delivery. BJOG: An International Journal of Obstetrics & Gynaecology, 120: 144–151. doi: 10.1111/j.1471-0528.2012.03301.x
- Issue published online: 14 DEC 2012
- Article first published online: 14 MAR 2012
- Accepted 21 January 2012. Published Online 14 March 2012.
- Body mass index;
- caesarean section;
- risk factor;
- urinary incontinence;
- vaginal delivery
Objective To investigate the prevalence and risk factors for urinary incontinence (UI) 20 years after one vaginal delivery or one caesarean section.
Design Registry-based national cohort study.
Setting Women who returned postal questionnaires (response rate 65.2%) in 2008.
Population Singleton primiparae who delivered in the period 1985–1988 with no further births (n = 5236).
Methods The Swedish Pregnancy, Obesity and Pelvic Floor (SWEPOP) study linked Medical Birth Register (MBR) data to a questionnaire about UI.
Main outcome measures Prevalence of UI and UI for more than 10 years (UI > 10 years) were assessed 20 years after childbirth.
Results The prevalence of UI (40.3 versus 28.8%; OR 1.67; 95% CI 1.45–1.92) and UI > 10 years (10.1 versus 3.9%; OR 2.75; 95% CI 2.02–3.75) was higher in women after vaginal delivery than after caesarean section. There was no difference in the prevalence of UI or UI > 10 years after an acute caesarean section or an elective caesarean section. We found an 8% increased risk of UI per current body mass index (BMI) unit, and age at delivery increased the UI risk by 3% annually.
Conclusions Two decades after one birth, vaginal delivery was associated with a 67% increased risk of UI, and UI > 10 years increased by 275% compared with caesarean section. Our data indicate that it is necessary to perform eight or nine caesarean sections to avoid one case of UI. Weight control is an important prophylactic measure to reduce UI. Current BMI was the most important BMI-determinant for UI, which is important, as BMI is modifiable.