title: Frequency, severity and risk factors for urinary and faecal incontinence at 4 years postpartum: a prospective cohort.
abstract: OBJECTIVE
  To investigate frequency, severity and risk factors for urinary incontinence and faecal incontinence 4 years after a first birth.
  
  
  METHODS
  Prospective pregnancy cohort study.
  
  
  METHODS
  Melbourne, Australia.
  
  
  METHODS
  A total of 1011 nulliparous women recruited in early pregnancy.
  
  
  METHODS
  Participants were followed up at 32 weeks of gestation; then at 3, 6, 9 and 12 months and 4 years postpartum.
  
  
  METHODS
  Frequency and severity of urinary and faecal incontinence.
  
  
  RESULTS
  At 4 years, 29.6% of women reported urinary incontinence and 7.1% reported faecal incontinence. Compared with women having only spontaneous vaginal births, women who delivered exclusively by caesarean section were less likely to have urinary incontinence at 4 years postpartum (adjusted odds ratio 0.4, 95% confidence interval 0.3-0.6). Women who reported urinary incontinence before or during the index pregnancy, and those experiencing symptoms in the first year postpartum had increased odds of incontinence at 4 years, with the highest odds (6-12 times higher) among women who had previously reported moderate or severe symptoms. The odds of reporting faecal incontinence at 4 years were two to six times higher for women experiencing symptoms in pregnancy, and around four to eight times higher for those with symptoms in the first year postpartum.
  
  
  CONCLUSIONS
  Urinary and faecal incontinence are prevalent conditions 4 years after a first birth. Women reporting urinary or faecal incontinence during pregnancy had markedly higher odds of reporting symptoms at 4 years postpartum, suggesting a need for further investigation and elucidation of aetiological pathways involving nonbirth-related risk factors.
  
  
  CONCLUSIONS
  Moderate/severe incontinence prevalent 4 years after first birth in population cohort. Prior symptoms are biggest predictor.
authors.affiliation: Healthy Mothers Healthy Families Research Group, Murdoch Children's Research Institute, Melbourne, Vic., Australia.
authors.forename: D
authors.initials: D
authors.lastname: Gartland
authors.affiliation: Public Health, Epidemiology and Biostatistics, School of Health and Population Sciences, University of Birmingham, Birmingham, UK.
authors.forename: C
authors.initials: C
authors.lastname: MacArthur
authors.affiliation: Healthy Mothers Healthy Families Research Group, Murdoch Children's Research Institute, Melbourne, Vic., Australia.
authors.forename: H
authors.initials: H
authors.lastname: Woolhouse
authors.affiliation: Healthy Mothers Healthy Families Research Group, Murdoch Children's Research Institute, Melbourne, Vic., Australia.
authors.forename: E
authors.initials: E
authors.lastname: McDonald
authors.affiliation: Healthy Mothers Healthy Families Research Group, Murdoch Children's Research Institute, Melbourne, Vic., Australia.|General Practice and Primary Health Care Academic Centre, The University of Melbourne, Melbourne, Vic., Australia.
authors.forename: S J
authors.initials: SJ
authors.lastname: Brown
mesh_terms: D000328:Adult; D015992:Body Mass Index; D002585:Cesarean Section / Q000009:adverse effects / Q000706:statistics & numerical data; D005242:Fecal Incontinence / Q000453:epidemiology*; D005260:Female; D006801:Humans; D008875:Middle Aged; D009772:Obstetrical Forceps / Q000009:adverse effects / Q000706:statistics & numerical data; D011247:Pregnancy; D011248:Pregnancy Complications / Q000453:epidemiology*; D015995:Prevalence; D011446:Prospective Studies; D012307:Risk Factors; D013997:Time Factors; D014549:Urinary Incontinence / Q000453:epidemiology*; D014620:Vacuum Extraction, Obstetrical / Q000009:adverse effects / Q000706:statistics & numerical data; D014739:Victoria / Q000453:epidemiology; D055815:Young Adult
keywords: Faecal incontinence; maternal health; mode of birth; pregnancy cohort; urinary incontinence