title: Factors associated with postpartum urinary/anal incontinence in primiparous women in Quebec.
abstract: OBJECTIVE
  To identify the factors associated with urinary incontinence (UI), anal incontinence (AI), and combined UI and AI (UI/AI) in primiparous women in Quebec at six months postpartum.
  
  
  METHODS
  A questionnaire was mailed to 2492 primiparous women at six months postpartum to collect data on incontinence status, sociodemographic characteristics, elimination habits, lifestyle, and severity index scales. Obstetric characteristics were obtained via Quebec's Med-Echo databank. Pearson chi-square, t test, analysis of variance, univariate regression, and stepwise modelling techniques were used for data analysis.
  
  
  RESULTS
  The prevalence of UI in responders was 29.6%, of AI, 20.6%, and of combined UI/AI, 10.4%. Significant adjusted odds ratios were (1) for UI, English spoken (2.04 [95% confidence intervals 1.13-3.69]) and shoulder dystocia (2.90 [1.09-7.69]); (2) for AI, age > 35 years (2.13 [1.12-4.03]), duration of second stage of labour (1.67 [1.11-2.51]), and third or fourth degree tears (4.00 [2.32-6.89]); and (3) for UI and AI, age (2.00 [1.04-3.83]), English spoken (2.55 [1.25-5.19]), shoulder dystocia (4.91 [1.76-13.71]), instrumental delivery (2.28 [1.30-3.99]), third or fourth degree tears (3.58 [1.95-6.57]), and episiotomy (2.24 [1.162-4.33]). Caesarean section was associated with less UI (0.45 [0.28-0.72]), and smoking was associated with less AI (0.38 [0.19-0.76]).
  
  
  CONCLUSIONS
  Combined UI/AI is associated with several obstetrical factors. The association of UI and AI is observed more frequently after complicated delivery (requiring the application of forceps) or involving perineal damage and episiotomy. As most of the identified factors are modifiable, a preventive treatment policy is advisable.
authors.affiliation: Département de médecine sociale et préventive-Faculté de médecine, Université de Montréal, Montréal, Québec; Centre de recherche de l'Hôpital Ste-Justine (HSJ), Québec.
authors.forename: Marie
authors.initials: M
authors.lastname: Hatem
authors.affiliation: Département d'obstétrique et de gynécologie, Faculté de médecine, Université de Sherbrooke, Sherbrooke, Québec.
authors.forename: Jean-Charles
authors.initials: JC
authors.lastname: Pasquier
authors.affiliation: Centre de recherche de l'Hôpital Ste-Justine (HSJ), Québec; Département d'obstétrique et de gynécologie, Faculté de médecine, Université de Montréal, Montréal, Québec.
authors.forename: William
authors.initials: W
authors.lastname: Fraser
authors.affiliation: Faculté des sciences infirmières, Université de Montréal, Montréal, Québec; Faculté de médecine, Université Laval, Québec City, Québec.
authors.forename: Edith
authors.initials: E
authors.lastname: Lepire
mesh_terms: D000328:Adult; D036861:Delivery, Obstetric / Q000706:statistics & numerical data; D004841:Episiotomy / Q000009:adverse effects; D005242:Fecal Incontinence / Q000453:epidemiology* / Q000209:etiology / Q000517:prevention & control; D005260:Female; D006801:Humans; D010298:Parity; D011247:Pregnancy; D015995:Prevalence; D011644:Puerperal Disorders / Q000453:epidemiology* / Q000209:etiology / Q000517:prevention & control; D011792:Quebec / Q000453:epidemiology; D012307:Risk Factors; D011795:Surveys and Questionnaires; D014549:Urinary Incontinence / Q000453:epidemiology* / Q000209:etiology / Q000517:prevention & control