Objective: To study the effect of one vaginal delivery (VD) compared with one caesarean section (CS) on the prevalence, severity and bothersomeness of urinary incontinence (UI) subtypes--stress (SUI), urge (UUI) and mixed (MUI)--20 years after delivery.
Design: Registry-based national cohort study.
Setting: Women who returned postal questionnaires (response rate 65.2%) in 2008.
Population: Primiparae with one birth in 1985-88 (n = 5236) and no further births.
Methods: Medical Birth Register data were linked to a questionnaire. Analysis of variance and multivariate analysis were used to obtain adjusted prevalences and odds ratios (adjOR).
Main outcome measures: Prevalence, risk factors, severity, bothersomeness of UI subtypes.
Results: The prevalence of SUI, UUI and MUI was 15.3, 6.1, 14.4%, respectively, and was higher for all subtypes after VD versus CS. Moderate to severe incontinence was more prevalent after VD (21.3%) compared with CS (13.5%; adjOR 1.68, 95% confidence interval [95% CI] 1.40-2.03). Bothersome incontinence differed between MUI (38.9%), UUI (27.1%) and SUI (18.0%). The prevalence of bothersome UI was higher after VD compared with CS (11.2 versus 6.3%; adjOR 1.85, 95% CI 1.42-2.39) and consulting a doctor for UI was reported more often after VD than CS. Bothersome MUI occurred in 40.0% of incontinent women after VD compared with 29.9% after CS (adjOR 1.65, 95% CI 1.07-2.54). Symptomatic pelvic organ prolapse was an important modifier of UI with regard to its prevalence, duration, type and bothersomeness.
Conclusion: The prevalence of SUI, UUI and MUI was higher and moderate to severe UI and bothersome UI were reported more often after VD than CS 20 years after one delivery.
Keywords: Bothersomeness; caesarean section; epidemiology; mixed urinary incontinence; severity; stress urinary incontinence; urge urinary incontinence; vaginal delivery.
© 2013 RCOG.