Background It is uncertain whether women who deliver by cesareansection have an increased risk of urinary incontinence as comparedwith nulliparous women and whether women who deliver vaginallyhave an even higher risk.
Methods We studied 15,307 women enrolled in the Epidemiologyof Incontinence in the County of Nord-Trøndelag (EPINCONT)study, which involved a community-based cohort. The data basefor this study was linked to data from the Medical Birth Registryof Norway. We included women who answered questions relatedto urinary incontinence, were younger than 65 years of age,and had had no deliveries, cesarean sections only, or vaginaldeliveries only.
Results The prevalence of any incontinence was 10.1 percentin the nulliparous group; age-standardized prevalences were15.9 percent in the cesarean-section group and 21.0 percentin the vaginal-delivery group. Corresponding figures for moderateor severe incontinence were 3.7 percent, 6.2 percent, and 8.7percent, respectively; figures for stress incontinence were4.7 percent, 6.9 percent, and 12.2 percent, respectively; figuresfor urge incontinence were 1.6 percent, 2.2 percent, and 1.8percent, respectively; and figures for mixed-type incontinencewere 3.1 percent, 5.3 percent, and 6.1 percent, respectively.As compared with nulliparous women, women who had cesarean sectionshad an adjusted odds ratio for any incontinence of 1.5 (95 percentconfidence interval, 1.2 to 1.9) and an adjusted odds ratiofor moderate or severe incontinence of 1.4 (95 percent confidenceinterval, 1.0 to 2.1). Only stress and mixed-type incontinencewere significantly associated with cesarean sections. The adjustedodds ratio for any incontinence associated with vaginal deliveriesas compared with cesarean sections was 1.7 (95 percent confidenceinterval, 1.3 to 2.1), and the adjusted odds ratio for moderateor severe incontinence was 2.2 (95 percent confidence interval,1.5 to 3.1). Only stress incontinence (adjusted odds ratio,2.4; 95 percent confidence interval, 1.7 to 3.2) was associatedwith the mode of delivery.
Conclusions The risk of urinary incontinence is higher amongwomen who have had cesarean sections than among nulliparouswomen and is even higher among women who have had vaginal deliveries.However, these findings should not be used to justify an increasein the use of cesarean sections.
Source Information
From the Epidemiology of Incontinence in the County of Nord-Trøndelag (EPINCONT) study (G.R., A.K.D, Y.S.H., S.H.); the Section for General Practice (G.R., Y.S.H., S.H.) and the Section for Preventive Medicine (A.K.D.), Department of Public Health and Primary Health Care, University of Bergen; and the Medical Birth Registry of Norway (A.K.D.) — all in Bergen, Norway.
Address reprint requests to Dr. Rortveit at the Section for General Practice, University of Bergen, Ulriksdal 8c, N-5009 Bergen, Norway, or at guri.rortveit{at}isf.uib.no.
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