IS GENITAL TRAUMA ASSOCIATED WITH URINARY INCONTINENCE AT 6 WEEKS AND 3 MONTHS POSTPARTUM?

R. Rogers, L. Leeman, S. Kleyboecker, L. Albers

University of New Mexico, Albuquerque, NM

OBJECTIVE: To evaluate whether genital trauma is associated with urinary incontinence at 6 weeks and 3 months postpartum in low risk healthy women following spontaneous vaginal birth.

MATERIALS AND METHODS: A prospective cohort study of midwifery patients who consented to mapping of genital trauma at birth and assessment of perineal anatomy and urinary continence postpartum was conducted. Women who underwent episiotomy and/or operative delivery were excluded from analysis.  Trauma was categorized into intact (no trauma), anterior (only periurethral, clitoral or labial), posterior (only perineal) or both anterior and posterior.  Incontinence was defined as a positive answer to the question “Have you leaked urine when you did not mean to?”.  To assess the impact of incontinence on social functioning, women completed the Incontinence Impact questionnaire –7(IIQ-7), with scores greater than 0 considered positive.  At 6 weeks, perineal body and genital hiatus measurements and assessment of pelvic floor muscle strength were performed.    Descriptive statistics (means, proportions) were used to describe the study population.  Statistical significance for differences in demographic and clinical variables across trauma and urinary incontinence variables was assessed by t test and one-way analysis of variance for continuous variables and by chi-squared analysis for categorical variables.

RESULTS:  Of 455 eligible women, 363(80%) provided follow-up data at either 6 weeks, 3 months or both; 40% nulliparous, 40% non-Hispanic white, 41% used epidural analgesia and 33% oxytocin augmentation.  Trauma was common, with 91(20%) women intact, 160(35%) with anterior, 115(25%) with anterior and posterior and 80(18%) with posterior trauma.  Nulliparas were less likely than multiparas to deliver intact. (X2 (1) = 34.9, p<. 001).  At 6 weeks, 75/281(27%) and at three months, 75/259(29%) women complained of incontinence.  Number of women with IIQ-7 scores >0 were lower, 45/281(16%) and 3/259(13%), respectively.  At three months, incontinence was not associated with age, pre partum body mass index, maternal weight gain, length of active pushing, fetal weight (all t(df > 2622) < 1.9, p = NS) or race, parity, oxytocin use, epidural, maternal position and postpartum pelvic floor muscle strength, (all (X2 (1) < 2.9, p = NS).  Postpartum perineal body or genital hiatus measurements did not differ with presence or site of trauma (ANOVA all F(3,243) < 1.3, p = NS) or predict urinary incontinence (all t(df> 249)< 1.2, p = NS).  At 3 months, women with anterior trauma were less likely to complain of incontinence18/92(19%) than all others 57/167(34%) (X2 (1) = 6.1, p=. 01).

CONCLUSIONS:  Urinary incontinence is common after birth.  Anterior trauma is not associated with increased complaints of urinary incontinence.  

KEY WORDS:  urinary incontinence, genital trauma

Disclosure – Grant/Research: R. Rogers, Pfizer, Wyeth-Ayerst; Educational Support: R. Rogers, Yamanouchi Pharma America, Proctor & Gamble.