title: The effect of vaginal and cesarean delivery on lower urinary tract symptoms: what makes the difference?
abstract: A prospective cohort study was undertaken to evaluate the effect of pregnancy and childbirth in nulliparous pregnant women. The focus of this paper is on the difference in the prevalences and risk factors for lower urinary tract symptoms (LUTS) between woman who delivered vaginally or by cesarean and secondly the effect of LUTS on the quality of life between these two groups was analyzed. Included were 344 nulliparous pregnant women who completed four questionnaires with the Urogenital Distress Inventory and the Incontinence Impact Questionnaire (IIQ). Two groups were formed: vaginal delivery group (VD), which included spontaneous vaginal delivery and an instrumental vaginal delivery and cesarean delivery group (CD). No statistical significant differences were found in the prevalences of LUTS during pregnancy between the two groups. Three months after childbirth, urgency and urge urinary incontinence (UUI) are less prevalent in the CD group, but no statistical difference was found 1 year postpartum. Stress incontinence was significantly more prevalent in the VD group at 3 and 12 months postpartum. The presence of stress urinary incontinence (SUI) in early pregnancy is predictive for SUI both in the VD as in CD group. A woman who underwent a CD and had SUI in early pregnancy had an 18 times higher risk of having SUI in year postpartum. Women were more embarrassed by urinary frequency after a VD. After a CD, 9% experienced urge urinary incontinence. Urge incontinence affected the emotional functioning more after a cesarean, but the domain scores on the IIQ were low, indicating a minor restriction in lifestyle. In conclusion, after childbirth, SUI was significantly more prevalent in the group who delivered vaginally. Besides a vaginal delivery, we found both in the VD and in the CD group that the presence of SUI in early pregnancy increased the risk for SUI 1 year after childbirth. Further research is necessary to evaluate the effect of SUI in early pregnancy on SUI later in life. Women were more embarrassed by urinary frequency after a vaginal delivery. UUI after a CD compared to a vaginal birth limited the women more emotionally; no difference was found for the effect of SUI on the quality of life between the two groups.
authors.affiliation: Department of Perinatology and Gynecology, University Medical Center Utrecht, Room F05.216, Heidelberglaan 100, P.O. Box 85500, Utrecht, 3508 GA, The Netherlands. hbrummen@zonnet.nl
authors.forename: Henriette Jorien
authors.initials: HJ
authors.lastname: van Brummen
authors.forename: Hein W
authors.initials: HW
authors.lastname: Bruinse
authors.forename: Geerte
authors.initials: G
authors.lastname: van de Pol
authors.forename: A Peter M
authors.initials: AP
authors.lastname: Heintz
authors.forename: C Huub
authors.initials: CH
authors.lastname: van der Vaart
mesh_terms: D002585:Cesarean Section / Q000009:adverse effects*; D036861:Delivery, Obstetric / Q000009:adverse effects*; D005260:Female; D006801:Humans; D010298:Parity; D011247:Pregnancy; D011446:Prospective Studies; D011788:Quality of Life; D012307:Risk Factors; D011795:Surveys and Questionnaires; D014550:Urinary Incontinence, Stress / Q000453:epidemiology / Q000209:etiology; D053202:Urinary Incontinence, Urge / Q000453:epidemiology / Q000209:etiology; D014551:Urinary Tract / Q000503:physiopathology; D014555:Urination Disorders / Q000453:epidemiology / Q000209:etiology*