Urinary incontinence: Prevalence, type and severity from pregnancy to postpartum

Abstract

Urinary incontinence (UI), defined as the complaint of involuntary loss of urine, is a common condition among women during pregnancy and the postpartum period. UI can be divided into several different types, including stress urinary incontinence (SUI), mixed urinary incontinence (MUI), urge urinary incontinence (UUI), overflow incontinence and functional incontinence. However, SUI, MUI and UUI are the most common types of UI among pregnant and postpartum women. The most common type of urinary incontinence (UI) in pregnant women is SUI, followed by MUI and UUI. Pregnancy may also be associated with reduced pelvic floor muscle (PFM) strength, which can cause UI. Both physiological and hormonal changes during pregnancy may lead to disruption in the normal urinary tract function and weaken the supportive and sphincteric function of PFM. Hence, when intra-abdominal pressure increases, the urethral sphincter is not strong enough to close the urethra, thereby resulting in urine leakage. The prevalence of UI varies depending on the use of different populations, study designs, methods for assessing incontinence, definitions of UI, evaluation questionnaires, stage of pregnancy and duration following childbirth. The prevalence of UI during pregnancy is estimated to range from 10.8% to 84.12%. The prevalence of UI also increases with gestational age and peaks during the third trimester of pregnancy. SUI is the most common type of UI during pregnancy, and the overall prevalence rate of SUI (4% to 78.8%) is higher than MUI (13.1% to 24.8%) and UUI (5.9% to 12.9%). The prevalence of UI reaches a maximum during pregnancy and decreases after childbirth. During the postpartum period, the overall prevalence of postpartum UI ranges from 2.7% to 76.4% with a remission rate of three months after childbirth of up to 86.4%. The most common type of UI in postpartum women is SUI (5.0% to 57%), followed by MUI (47.5%) and UUI (5.5% to 44.0%). UI can affect the psychological and social well-being of women. UI can also have long-term effects on quality of life (QOL) and is associated with enormous health-related costs. UI is known to have detrimental effects on QOL in approximately 54.3% of pregnant women. Pregnant women with UI have statistically significant lower QOL during pregnancy than those without UI, and the QOL of incontinent pregnant women worsens with increasing gestational age to term. Moreover, pregnant women with UUI or MUI have worse QOL scores during pregnancy than those with SUI alone. UI not only affects QOL during pregnancy, but also affects QOL during the postpartum period. Therefore, UI is a serious health problem during the postpartum period and affects the QOL of postpartum women by disrupting daily activities. Postpartum women who have UI are associated with feelings of frustration and embarrassment. Approximately three-fourths (74%) of postpartum women with UI report mild UI, and 26% of these report moderate UI, while none report severe UI. The prevalence of depressive symptoms is higher in women with UI than in those without UI. The purpose of this chapter on the presentation of data from several studies of UI in pregnant and postpartum women is to review and discuss the prevalence, types and severity of UI among women from pregnancy to the postpartum period. Understanding these issues can be useful for healthcare professionals in delivering more informed counseling to women to help prevent UI during pregnancy and the postpartum period. © 2016 Nova Science Publishers, Inc.