Urinary incontinence during pregnancy and postpartum pelvic floor muscle exercise: a prospective study

Siu Chung Wong; Yun Ting Lee; Lai Fong Ho

doi:10.12809/hkjgom.24.2.367

Authors

Siu Chung Wong Princess Margaret Hospital
Yun Ting Lee
Lai Fong Ho

DOI:

https://doi.org/10.12809/hkjgom.24.2.367

Keywords:

Pelvic floor, Pregnant women, Urinary incontinence

Abstract

Objectives: To investigate the incidence of urinary incontinence (UI) during pregnancy and after delivery, perceptions of UI, effectiveness of pelvic floor muscle exercise (PFME) on UI, and risk factors for UI among pregnant women.

Methods: Chinese women aged ≥18 years at 35 to 37 weeks of gestation were invited to participate. Perceptions of UI were assessed using a questionnaire that comprises seven statements. Urinary symptoms were assessed using the self-report six-item Urogenital Distress Inventory (UDI-6). Women were considered to have UI when they had positive scores on any of the incontinence items (items 2 to 4). Women who reported to have UI symptoms were assessed by a physiotherapist in the postnatal ward and were taught PFME. UI impact on QoL was assessed using the self-report seven-item Incontinence Impact Questionnaire (IIQ-7). Participants with UI during pregnancy who delivered in our hospital were followed up at 6 weeks postnatally through telephone. Their adherence to PFME was assessed in terms of the mean number of contractions performed per day.

Results: Of 1134 participants, the incidence of UI was 73.0% during pregnancy and 21.9% after delivery. Predictors for UI during pregnancy were a history of UI before pregnancy (odds ratio [OR]=14.40, p<0.001), higher pre-pregnancy body mass index (OR=1.04, p=0.034), and previous vaginal delivery (OR=2.06, p=0.001), whereas predictors for UI after delivery were vaginal delivery in the index pregnancy (OR=3.86, p<0.001), older age (OR=1.12, p<0.001), a history of UI before pregnancy (OR=1.86, p=0.028), and total score of items 2 to 4 on the UDI-6 during pregnancy (OR=1.20, p=0.015). 86.4% of participants reported poor or no adherence to PFME. Adherence to postnatal PFME was not associated with UI after delivery (p=0.477). Women with higher education levels adhered more to PFME (p=0.008). Perceptions of UI were not associated with adherence to postnatal PFME.

Conclusion: A history of pre-pregnancy UI is the main predictor for UI during pregnancy, whereas vaginal delivery is the main predictor for UI after delivery. The effect of postpartum PFME on UI after delivery is not significant, probably owing to the low rate of adherence to PFME.

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