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The effect of epidural analgesia on postpartum urinary incontinence: a systematic review

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Abstract

Introduction and hypothesis

Urinary incontinence (UI) is common during pregnancy and in the postpartum period. Some women appear to recover their usual urinary function but in others UI persists, playing an important role in women’s quality of life. Even though postpartum UI seems to have a multifactorial etiology, pregnancy, vaginal delivery, birth weight and parity are recognized as risk factors. This systematic review aims to evaluate the effect of one particular potential risk factor, epidural analgesia, on the development of postpartum UI in women with vaginal delivery.

Methods

PubMed, Cochrane and Scopus were searched for “epidural analgesia,” “epidural anesthesia” or “epidural” and “urinary incontinence.” All studies published until 31 July 2020 were considered. A total of 393 studies were identified, and 23 studies were included in the systematic review.

Results

From the total 23 articles included in this review, 21 showed a non-significant association between epidural analgesia and postpartum UI. One study found that the risk of postpartum SUI and any type of UI was significantly, but only slightly, increased in women with epidural analgesia. Another study showed a protective effect but was lacking control for important confounders.

Conclusion

There appears to be no association between epidural analgesia and postpartum UI. Therefore, pregnant women should not fear epidural analgesia because of a possible increased risk of UI.

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Abbreviations

UI:

Urinary incontinence

SUI:

Stress urinary incontinence

UUI:

Urge urinary incontinence

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Acknowledgements

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Authors and Affiliations

  1. Faculty of Medicine of the University of Porto, Alameda Prof. Hernâni Monteiro, 4200-319, Porto, Portugal

    Mafalda S. Cardoso

  2. Department of Anesthesiology, Centro Hospitalar Universitário São João, Porto, Portugal

    Miguel F. Valente

  3. Centre for Health Technology and Services Research & Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine of the University of Porto, Porto, Portugal

    Miguel F. Valente

  4. Department of Gynecology and Obstetrics, Centro Hospitalar Universitário São João, Porto, Portugal

    Teresa Rodrigues

  5. Department of Public Health and Forensic Sciences, and Medical Education, Faculty of Medicine of the University of Porto, Porto, Portugal

    Teresa Rodrigues

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  1. Mafalda S. Cardoso
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  2. Miguel F. Valente
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  3. Teresa Rodrigues
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MS Cardoso: Project development, Data collection, Data analysis, Manuscript writing and editing.

T Rodrigues: Project development, Data collection, Data analysis, Manuscript writing and editing.

MF Valente: Manuscript writing, Anesthesiology counseling.

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Correspondence to Mafalda S. Cardoso.

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Cardoso, M.S., Valente, M.F. & Rodrigues, T. The effect of epidural analgesia on postpartum urinary incontinence: a systematic review. Int Urogynecol J 33, 1421–1434 (2022). https://doi.org/10.1007/s00192-021-04988-4

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