title: Double incontinence in a cohort of nulliparous pregnant women.
abstract: OBJECTIVE
  To estimate the frequency of double incontinence, and to identify associated risk factors during pregnancy and postpartum in previously continent nulliparous women.
  
  
  METHODS
  A cohort study in healthy, nulliparous, continent pregnant women, attending the public healthcare system of Catalonia (Spain) was designed. The field work was conducted during the control visits of pregnancy, at the time of delivery, and in the postpartum. Double incontinence was defined as a situation in which participants reported simultaneously urinary incontinence (UI) and anal incontinence with the help of a self-administered questionnaire. Prevalence rates, and their corresponding confidence intervals (95% CI), were calculated, as well as the impact on daily life. Multivariable logistic regressions in pregnancy and postpartum were estimated to assess the association of potential risk factors.
  
  
  RESULTS
  The prevalence rate of double incontinence during pregnancy was 8.6% (95% CI: 7.0-10.3). Age over 35 years, and family history of UI were associated to a higher risk of double incontinence. After delivery, the prevalence rate decreased to 3.5% (95% CI: 2.4-4.6); only 6.7% of women with double incontinence in pregnancy had a persistency of their symptoms in early postpartum. Instrumental vaginal deliveries carried 2.2 times more risk of double incontinence than spontaneous ones. Episiotomy implied a higher risk for double incontinence.
  
  
  CONCLUSIONS
  Symptoms of double incontinence are prevalent during first pregnancy; age and other intrinsic factors may favor the occurrence of double incontinence throughout gestation, while instrumental delivery and episiotomy increase the risk of double incontinence in the postpartum period.
authors.affiliation: Clinical Institute of Gynaecology, Obstetrics and Neonatology, Hospital Clínic i Provincial, University of Barcelona, Barcelona, Spain. 12922mep@comb.es
authors.forename: Montserrat
authors.initials: M
authors.lastname: Espuña-Pons
authors.forename: Maite
authors.initials: M
authors.lastname: Solans-Domènech
authors.forename: Emília
authors.initials: E
authors.lastname: Sánchez
mesh_terms: D000203:Activities of Daily Living; D000328:Adult; D000367:Age Factors; D015331:Cohort Studies; D017281:Cost of Illness; D004841:Episiotomy / Q000009:adverse effects; D005113:Extraction, Obstetrical / Q000009:adverse effects; D005242:Fecal Incontinence / Q000453:epidemiology* / Q000523:psychology; D005260:Female; D006801:Humans; D016015:Logistic Models; D015999:Multivariate Analysis; D016017:Odds Ratio; D010298:Parity; D049590:Postpartum Period; D011247:Pregnancy; D015995:Prevalence; D011788:Quality of Life; D018570:Risk Assessment; D012307:Risk Factors; D013030:Spain / Q000453:epidemiology; D011795:Surveys and Questionnaires; D013997:Time Factors; D014549:Urinary Incontinence / Q000453:epidemiology* / Q000523:psychology