Effects of pregnancy and childbirth on the incidence of urinary disorders in multiple sclerosis.
OBJECTIVE
Women with multiple sclerosis frequently pose questions to physicians regarding the potential negative impact of pregnancy, especially on urinary disorders. About 50 to 80% of patients suffer from urinary disorders during the course of the disease. Trauma to the pelvic floor and the urethral sphincter during vaginal delivery may lead to the development of stress urinary incontinence. The purpose of this work was to study the consequences of pregnancy and childbirth on urinary problems.


METHODS
An inception cohort of 368 consecutive women suffering from multiple sclerosis (MS), according to the Poser criteria, were included in the study between June 1999 and June 2000. For each patient a full urological and obstetrical record was obtained.


RESULTS
Two hundred and seventy-three women (74%) had had at least one pregnancy. The parous women were older at the time of the study (mean age: 45.5 years vs 35.5 years), and were older at MS onset (mean age: 32.8 years vs 25.7 years). The nulliparous women were more rapidly disabled, with a shorter time to reach an EDSS score of 3 from MS onset (mean time of 5.9 years versus 8.2 years in parous women). In parous women, 259 (95%) had had at least one vaginal delivery and 14 (5%) had had a caesarean only. Delivery modalities had no influence on urinary disorder frequency or the type of problems.


CONCLUSIONS
On the basis of these data, there is actually no clear argument for systematically performing caesarean section in MS women. Urinary disorders in these women were mostly linked to the duration and the severity of the disease but not to pregnancy or delivery modalities. From our point of view, caesarean section must be decided only on classic obstetrical criteria as for healthy women independently of multiple sclerosis. However our data were open and retrospective.
Durufle
A
A
Department of Physical Medicine and Rehabilitation, Centre Hospitalier Universitaire, Rennes, France.
Nicolas
B
B
Petrilli
S
S
Robineau
S
S
Guillé
F
F
Edan
G
G
Gallien
P
P
D000328:Adult; D005260:Female; D006801:Humans; D008875:Middle Aged; D009103:Multiple Sclerosis / Q000150:complications*; D036801:Parturition; D011247:Pregnancy; D011248:Pregnancy Complications; D014555:Urination Disorders / Q000209:etiology*