Risk factors for the development of postpartum urinary incontinence in primiparous women

Abstract

Urinary incontinence (UI), the complaint of involuntary loss of urine, is a common condition during the immediate postpartum period after a woman’s first pregnancy. The prevalence of UI is high and approximately 18.96% to 55.9% of all pregnant women develop UI during pregnancy. During the postpartum period, the prevalence of UI ranges from 6.9% to 47.0%, which is lower when compared with the prevalence during the third trimester of pregnancy. However the remission rate of UI at three months after childbirth as high as 86.4%. UI is a serious health problem during the postpartum period that affects the quality of life (QoL) of postpartum women by disrupting the women’s daily activities. Postpartum women who have UI feel frustrated and embarrassed. It is well known that UI is related to the weakening of the pelvic floor muscle (PFM), connective tissue and fascia as well as their supportive and sphincteric function. The pathophysiology of UI is multifactorial but there is a lot of evidence to support the critical role of pregnancy and vaginal delivery in the development of UI. Pregnancy may be associated with a reduction in PFM strength that can develop into UI. In addition to pregnancy itself, the physiological changes associated with the second stage of labor can cause significant stress on the PFM appear to play a role in postpartum UI. However, the exact causes of postpartum UI remain unclear. Several risk factors have been proven to be associated with UI, some of which are potentially modifiable to facilitate early intervention for target at risk women. Aging is an important role in UI development in the form of genetic risk factors. The other significant modifiable risk factors for postpartum UI include high body mass index, obesity, smoking, constipation, multiparity, UI before pregnancy, UI during pregnancy, prolonged second stage of labor, mode of delivery and neonatal birth weight. Antenatal UI increases the risk for postpartum incontinence, which in turn increases the risk for long-term persistent UI. The second stage of labor has modest effects on postpartum PFM function. After their first delivery, women who deliver vaginally have a higher incidence of postpartum SUI than those who deliver by cesarean section (C/S). Postpartum women who have higher BMI and weight retention at six months postpartum are at increased risk for postpartum UI. In decreasing the risk for postpartum UI, pregnant women who perform pelvic floor muscle exercises (PFME) may be able to prevent postpartum UI. Postpartum weight loss by advice about eating and exercise habits to avoid weight retention after delivery can also decrease the risk for UI and restore the continence mechanism at six months postpartum. Moreover, elective cesarean sections in these women also have a preventive effect and lower the risk for developing postpartum UI. The purpose of this review chapter is to identify the risk factors for the development of UI in postpartum women. This understanding can be useful for health professionals in educating and counseling pregnant and postpartum women about preventing and reducing the risk factors contributing to the development of UI during postpartum period. © 2016 Nova Science Publishers, Inc.