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Antenatal Prediction of Postpartum Urinary and Fecal Incontinence

CHALIHA, CHARLOTTE MA, MBBChir; KALIA, VEENA PhD; STANTON, STUART L. FRCS, FRCOG; MONGA, ASH MRCOG; SULTAN, ABDUL H. MD, MRCOG

Original Research

Objective To investigate the effect of pregnancy and delivery on continence and to assess whether physical markers of collagen weakness can predict postpartum urinary and fecal incontinence (including incontinence of flatus).

Methods In a prospective, longitudinal study in a London teaching hospital, 549 nulliparas were interviewed after 34 weeks' gestation and again 3 months postpartum regarding urinary and fecal symptoms before and during pregnancy and after delivery. Family histories of incontinence, prolapse, and collagen abnormalities were recorded also. Physical examination was done to assess markers of collagen weakness such as striae, hernia, varicose veins, and joint mobility.

Results The prevalence of urinary incontinence before, during, and after pregnancy was 3.6%, 43.7%, and 14.6%, and rates of fecal incontinence were 0.7%, 6.0%, and 5.5%, respectively. Fecal urgency was more common in women who had spontaneous and instrument-assisted vaginal deliveries (n = 413) compared with cesareans (n = 131) (7.3% versus 3.1%; P = .046). Postnatal urinary or fecal dysfunction was not related to antenatal body mass index, smoking, race, striae, varicose veins, hemorrhoids, or family history of incontinence. Higher joint-mobility scores were associated with incontinence of flatus (P = .021) but not with other urinary or fecal symptoms.

Conclusion Although collagen weakness was previously implicated in the pathogenesis of incontinence, physical markers in this study could not predict postpartum urinary and fecal incontinence. Either those markers were not representative of collagen weakness, or a larger study with longer follow-up is necessary.

Clinical markers of collagen weakness such as striae, hernia, joint hypermobility, and varicose veins do not predict postpartum incontinence.

Urogynecology Unit, St. George's Hospital, London; Princess Anne Hospital, Southampton; and Mayday University Hospital, Surrey, United Kingdom.

Address reprint requests to: Charlotte Chaliha, MA, MBBChir, Urogynecology Unit, Department of Obstetrics and Gynecology, St. George's Hospital, Cranmer Terrace, Blackshaw Road, London SW17 0RE, United Kingdom

Supported by the South Thames Project Grant Scheme.

The authors thank Professor Martin Bland for advice regarding statistical analysis of the data.

Received August 27, 1998. Received in revised form April 2, 1999. Accepted April 8, 1999.

© 1999 The American College of Obstetricians and Gynecologists