Postpartum stress incontinence

Abstract

Urinary stress incontinence may affect up to 50% of women in their postpartum period. This is often present during pregnancy with 54.3% of sufferers experiencing an impact on quality of life antenatally and 71.1% postnatally. Antenatal stress incontinence is caused by a combination of factors including anatomical factors and connective tissue changes. Changes have been shown in the bladder neck, functional urethral length and intravaginal and intra-anal pressures in relation to pregnancy and childbirth. Postpartum incontinence occurs for these reasons and additionally, delivery-related factors. Whilst vaginal delivery is a risk factor for the subsequent development of postnatal symptoms, the evidence of a protective effect of performing caesarean sections is less compelling. Evidence regarding delivery factors and their influences on the development of stress incontinence varies regarding infant weight, mode of delivery, head position, duration of labour and use of epidural analgesia. Eighty percent of women have partial denervation of their pelvic floor after their first vaginal delivery. The relationship between epidural analgesia and postpartum stress incontinence has become a contentious issue and as anaesthetic techniques have changed, the literature is no longer valid. It is not clear whether pelvic-floor exercises will prevent stress incontinence. There are many barriers to women receiving pelvic-floor education. Specialist physiotherapists are best placed to supervise this. Over 60% of women with leakage do not seek help and healthcare workers must be aware of the significant and common problem of stress incontinence so that they can offer appropriate advice and referral as necessary. Management options also include surgery, drug treatment and containment products. Women having antenatal stress incontinence have double the risk of having stress incontinence 15 years later.