Antenatal prediction of postpartum urinary and fecal incontinence.
OBJECTIVE
To investigate the effect of pregnancy and delivery on continence and to assess whether physical markers of collagen weakness can predict postpartum urinary and fecal incontinence (including incontinence of flatus).


METHODS
In a prospective, longitudinal study in a London teaching hospital, 549 nulliparas were interviewed after 34 weeks' gestation and again 3 months postpartum regarding urinary and fecal symptoms before and during pregnancy and after delivery. Family histories of incontinence, prolapse, and collagen abnormalities were recorded also. Physical examination was done to assess markers of collagen weakness such as striae, hernia, varicose veins, and joint mobility.


RESULTS
The prevalence of urinary incontinence before, during, and after pregnancy was 3.6%, 43.7%, and 14.6%, and rates of fecal incontinence were 0.7%, 6.0%, and 5.5%, respectively. Fecal urgency was more common in women who had spontaneous and instrument-assisted vaginal deliveries (n = 413) compared with cesareans (n = 131) (7.3% versus 3.1%; P = .046). Postnatal urinary or fecal dysfunction was not related to antenatal body mass index, smoking, race, striae, varicose veins, hemorrhoids, or family history of incontinence. Higher joint-mobility scores were associated with incontinence of flatus (P = .021) but not with other urinary or fecal symptoms.


CONCLUSIONS
Although collagen weakness was previously implicated in the pathogenesis of incontinence, physical markers in this study could not predict postpartum urinary and fecal incontinence. Either those markers were not representative of collagen weakness, or a larger study with longer follow-up is necessary.
Chaliha
C
C
Urogynecology Unit, St. George's Hospital, London.
Kalia
V
V
Stanton
S L
SL
Monga
A
A
Sultan
A H
AH
D000293:Adolescent; D000328:Adult; D003094:Collagen; D005242:Fecal Incontinence / Q000175:diagnosis / Q000453:epidemiology* / Q000209:etiology; D005260:Female; D006801:Humans; D007593:Joint Instability / Q000150:complications; D008875:Middle Aged; D011237:Predictive Value of Tests; D011247:Pregnancy; D011248:Pregnancy Complications; D015995:Prevalence; D011446:Prospective Studies; D011644:Puerperal Disorders / Q000175:diagnosis / Q000453:epidemiology* / Q000209:etiology; D012307:Risk Factors; D012867:Skin; D014549:Urinary Incontinence / Q000175:diagnosis / Q000453:epidemiology* / Q000209:etiology; D014648:Varicose Veins / Q000150:complications
D003094:Collagen