Skip to main content

Advertisement

SpringerLink
Log in

Prevalence and predictors of double incontinence 1 year after first delivery

  • Original Article
  • Published:
International Urogynecology Journal Aims and scope Submit manuscript

Abstract

Introduction and hypothesis

Urinary (UI) and anal incontinence (AI) are common pelvic floor disorders (PFD), and postpartum women experiencing double incontinence (DI), the combination of UI and AI, tend to have more severe symptoms and a greater impact on quality of life. Our objective was to investigate the prevalence and predictors of postpartum DI and UI alone 1 year after first delivery.

Methods

In this prospective cohort study, 976 women reported the prevalence of DI and UI alone 1 year after their first delivery in one of two hospitals in Norway using the St Marks score and the ICI-Q UI SF.

Results

DI was significantly reduced from 13% in late pregnancy to 8% 1 year later, whereas 30% reported UI at both time points. Incontinence in late pregnancy predicted incontinence 1 year after delivery. Higher age was associated with UI alone. Compared with caesarean delivery, normal vaginal or instrumental delivery increased the risk of UI alone more than three and four times respectively. Obstetric anal sphincter injuries showed a four-fold increase in the risk of DI.

Conclusions

Nearly 50% reported incontinence symptoms 1 year after first delivery. Continence status during pregnancy was one of the main predictors of postpartum continence status. Mode of delivery increased the risk of postpartum UI, whereas obstetric anal sphincter injuries increased the risk of postpartum DI.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Nygaard I, Barber MD, Burgio KL, Kenton K, Meikle S, Schaffer J, et al. Prevalence of symptomatic pelvic floor disorders in US women. JAMA. 2008;300(11):1311–6.

    Article  CAS  Google Scholar 

  2. Delancey JO, Kane Low L, Miller JM, Patel DA, Tumbarello JA. Graphic integration of causal factors of pelvic floor disorders: an integrated life span model. Am J Obstet Gynecol. 2008;199(6):610.e1–5. https://doi.org/10.1016/j.ajog.2008.04.001.

    Article  Google Scholar 

  3. Wesnes SL, Lose G. Preventing urinary incontinence during pregnancy and postpartum: a review. Int Urogynecol J. 2013;24(6):889–99.

    Article  Google Scholar 

  4. Brown SJ, Gartland D, Donath S, MacArthur C. Fecal incontinence during the first 12 months postpartum: complex causal pathways and implications for clinical practice. Obstet Gynecol. 2012;119(2 Pt 1):240–9. https://doi.org/10.1097/AOG.0b013e318242b1f7.

    Article  PubMed  Google Scholar 

  5. Guise JM, Morris C, Osterweil P, Li H, Rosenberg D, Greenlick M. Incidence of fecal incontinence after childbirth. Obstet Gynecol. 2007;109(2 Pt 1):281–8. https://doi.org/10.1097/01.AOG.0000254164.67182.78.

    Article  PubMed  Google Scholar 

  6. Geynisman-Tan JM, Taubel D, Asfaw TS. Is something missing from antenatal education: a survey of pregnant women’s knowledge of pelvic floor disorders. Female Pelvic Med Reconstr Surg. 2017; https://doi.org/10.1097/SPV.0000000000000465 .

    Article  PubMed  Google Scholar 

  7. Hill A-M, McPhail SM, Wilson JM, Berlach RG. Pregnant women’s awareness, knowledge and beliefs about pelvic floor muscles: a cross-sectional survey. Int Urogynecol J. 2017;28(10):1557–65.

    Article  Google Scholar 

  8. Tucker J, Grzeskowiak L, Murphy EMA, Wilson A, Clifton VL. Do women of reproductive age presenting with pelvic floor dysfunction have undisclosed anal incontinence: a retrospective cohort study. Women Birth. 2017;30(1):18–22.

    Article  Google Scholar 

  9. Avery KN, Bosch JL, Gotoh M, Naughton M, Jackson S, Radley SC, et al. Questionnaires to assess urinary and anal incontinence: review and recommendations. J Urol. 2007;177(1):39–49. https://doi.org/10.1016/j.juro.2006.08.075.

    Article  CAS  PubMed  Google Scholar 

  10. Espuna-Pons M, Solans-Domenech M, Sanchez E, Pelvic Floor Research Group. Double incontinence in a cohort of nulliparous pregnant women. Neurourol Urodyn. 2012;31(8):1236–41. https://doi.org/10.1002/nau.22249.

    Article  PubMed  Google Scholar 

  11. Fialkow MF, Melville JL, Lentz GM, Miller EA, Miller J, Fenner DE. The functional and psychosocial impact of fecal incontinence on women with urinary incontinence. Am J Obstet Gynecol. 2003;189(1):127–9. https://doi.org/10.1067/mob.2003.548.

    Article  CAS  PubMed  Google Scholar 

  12. Johannessen HH, Wibe A, Stordahl A, Sandvik L, Backe B, Morkved S. Prevalence and predictors of anal incontinence during pregnancy and 1 year after delivery: a prospective cohort study. Br J Obstetr Gynaecol. 2014;121(3):269–79. https://doi.org/10.1111/1471-0528.12438.

    Article  CAS  Google Scholar 

  13. Vaizey CJ, Carapeti E, Cahill JA, Kamm MA. Prospective comparison of faecal incontinence grading systems. Gut. 1999;44(1):77–80.

    Article  CAS  Google Scholar 

  14. Haylen BT, de Ridder D, Freeman RM, Swift SE, Berghmans B, Lee J, et al. An International Urogynecological Association (IUGA)/International Continence Society (ICS) joint report on the terminology for female pelvic floor dysfunction. Neurourol Urodyn. 2010;29(1):4–20. https://doi.org/10.1002/nau.20798.

    Article  PubMed  Google Scholar 

  15. Hatem M, Pasquier J-C, Fraser W, Lepire E. Factors associated with postpartum urinary/anal incontinence in primiparous women in Quebec. J Obstet Gynaecol Can. 2007;29(3):232–9. https://doi.org/10.1016/S1701-2163(16)32402-1.

    Article  PubMed  Google Scholar 

  16. Brown S, Gartland D, Perlen S, McDonald E, MacArthur C. Consultation about urinary and faecal incontinence in the year after childbirth: a cohort study. BJOG. 2015;122(7):954–62.

    Article  CAS  Google Scholar 

  17. Viktrup L, Rortveit G, Lose G. Does the impact of subsequent incontinence risk factors depend on continence status during the first pregnancy or the postpartum period 12 years before? A cohort study in 232 primiparous women. Am J Obstet Gynecol. 2008;199(1):73.e71-73.e74. https://doi.org/10.1016/j.ajog.2007.11.069.

    Article  PubMed  Google Scholar 

  18. Burgio KL, Zyczynski H, Locher JL, Richter HE, Redden DT, Wright KC. Urinary incontinence in the 12-month postpartum period. Obstet Gynecol. 2003;102(6):1291–8.

    PubMed  Google Scholar 

  19. Slieker-ten Hove MCP, Pool-Goudzwaard AL, Eijkemans MJC, Steegers-Theunissen RPM, Burger CW, Vierhout ME. Prevalence of double incontinence, risks and influence on quality of life in a general female population. Neurourol Urodyn. 2010;29(4):545–50. https://doi.org/10.1002/nau.20760.

    Article  PubMed  Google Scholar 

  20. Kapoor DS, Thakar R, Sultan AH. Combined urinary and faecal incontinence. Int Urogynecol J. 2005;16(4):321–8. https://doi.org/10.1007/s00192-004-1283-0.

    Article  Google Scholar 

  21. Lo J, Osterweil P, Li H, Mori T, Eden KB, Guise JM. Quality of life in women with postpartum anal incontinence. Obstet Gynecol. 2010;115(4):809–14. https://doi.org/10.1097/AOG.0b013e3181d4160d.

    Article  PubMed  Google Scholar 

  22. Wei JT, Dunn R, Nygaard I, Burgio K, Lukacz ES, Markland A, et al. Development and validation of a quantitative measure of adaptive behaviors in women with pelvic floor disorders. Female Pelvic Med Reconstr Surg. 2017;23(4):232–7.

    Article  Google Scholar 

  23. Boreham MK, Richter HE, Kenton KS, Nager CW, Gregory WT, Aronson MP, et al. Anal incontinence in women presenting for gynecologic care: prevalence, risk factors, and impact upon quality of life. Am J Obstet Gynecol. 2005;192(5):1637–42. https://doi.org/10.1016/j.ajog.2004.11.030.

    Article  PubMed  Google Scholar 

  24. Johannessen HH, Norderval S, Stordahl A, Falk RS, Wibe A. Interview-based versus self-reported anal incontinence using St Mark’s incontinence score. Int Urogynecol J. 2017; https://doi.org/10.1007/s00192-017-3363-y.

    Article  Google Scholar 

  25. Richter HE, Burgio KL, Clements RH, Goode PS, Redden DT, Varner RE. Urinary and anal incontinence in morbidly obese women considering weight loss surgery. Obstet Gynecol. 2005;106(6):1272–7. https://doi.org/10.1097/01.AOG.0000187299.75024.c4.

    Article  PubMed  Google Scholar 

  26. Wesnes SL, Hunskaar S, Bo K, Rortveit G. Urinary incontinence and weight change during pregnancy and postpartum: a cohort study. Am J Epidemiol. 2010;172(9):1034–44.

    Article  Google Scholar 

  27. American College of Obstetricians and G. ACOG Committee opinion no. 548: weight gain during pregnancy. Obstet Gynecol. 2013;121(1):210–2. https://doi.org/10.1097/01.AOG.0000425668.87506.4c.

    Article  Google Scholar 

  28. The International Weight Management in Pregnancy (i-WIP) Collaborative Group. Effect of diet and physical activity based interventions in pregnancy on gestational weight gain and pregnancy outcomes: meta-analysis of individual participant data from randomised trials. BMJ. 2017;358:j3119. https://doi.org/10.1136/bmj.j3119.

    Article  Google Scholar 

  29. Boyle R, Hay-Smith EJ, Cody JD, Morkved S. Pelvic floor muscle training for prevention and treatment of urinary and faecal incontinence in antenatal and postnatal women. Cochrane Database Syst Rev. 2012;10:CD007471. https://doi.org/10.1002/14651858.CD007471.pub2.

    Article  PubMed  Google Scholar 

  30. Johannessen HH, Wibe A, Stordahl A, Sandvik L, Morkved S. Do pelvic floor muscle exercises reduce postpartum anal incontinence? A randomised controlled trial. BJOG. 2016;124(4):686–94. https://doi.org/10.1111/1471-0528.14145.

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

The authors would like to thank the women who took part in the study, Clara Karoliussen, Janne Hensmo Sjo and Claudia Lindgren for assembling the cohort and data collection, and Negin Sadati and Arne Uleberg for the collection of the background data. We would also like to thank The Norwegian Extrafoundation for Health and Rehabilitation through EXTRA funds, the Norwegian Women’s Public Health Association, Ostfold Hospital Trust, the Norwegian University of Science and Technology and the Central Norway Regional Health Authority for funding this project.

Author information

Authors and Affiliations

  1. Department of Physical Medicine and Rehabilitation, Department of Research, Østfold Hospital Trust, P.O. Box 300, 1714, Grålum, Norway

    Hege Hølmo Johannessen

  2. Department of Public Health and Nursing, Norwegian University of Science and Technology, Trondheim, Norway

    Signe Nilssen Stafne & Siv Mørkved

  3. Department of Physiotherapy, St Olavs Hospital Trondheim University Hospital, Trondheim, Norway

    Signe Nilssen Stafne

  4. Oslo Centre of Biostatistics and Epidemiology, Oslo University Hospital, Oslo, Norway

    Ragnhild Sørum Falk

  5. Department of Surgery, Østfold Hospital Trust, Grålum, Norway

    Arvid Stordahl

  6. Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway

    Arne Wibe

  7. Department of Surgery, St Olavs Hospital, Trondheim University Hospital, Trondheim, Norway

    Arne Wibe

  8. Department of Research and Development, St Olavs Hospital Trondheim University Hospital, Trondheim, Norway

    Siv Mørkved

Authors
  1. Hege Hølmo Johannessen
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Signe Nilssen Stafne
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Ragnhild Sørum Falk
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Arvid Stordahl
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Arne Wibe
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Siv Mørkved
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Hege Hølmo Johannessen.

Ethics declarations

Conflicts of interest

None.

Additional information

Presented as an abstract at the 46th Annual Meeting of the International Continence Society in Tokyo, Japan, on 14 September 2016

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Johannessen, H.H., Stafne, S.N., Falk, R.S. et al. Prevalence and predictors of double incontinence 1 year after first delivery. Int Urogynecol J 29, 1529–1535 (2018). https://doi.org/10.1007/s00192-018-3577-7

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00192-018-3577-7

Keywords

Search

Navigation