Prevalence and predictors of urinary/anal incontinence after vaginal delivery: prospective study of Nigerian women

Abstract

Introduction and hypothesis

Urinary and anal incontinence are major public health problems impacting on the quality of life of affected women, with resultant loss of self-esteem. Despite the anticipated magnitude of this public health problem in sub-Saharan Africa, there is paucity of data on the prevalence of urinary and/or anal incontinence after childbirth in the region. This study determined the prevalence and predictors of urinary and anal incontinence after vaginal delivery among women in Enugu, southeastern Nigeria.

Methods

This was a longitudinal study of 230 consecutive parturients at the University of Nigeria Teaching Hospital, Enugu, Nigeria. Eligible women were followed up immediately, 6 weeks, and 3 months postpartum to assess the development of urinary and/or anal incontinence using validated questionnaires.

Results

Overall, 28 women had urinary incontinence, giving a cumulative prevalence rate of 12.2 %. The cumulative prevalence rate was 13.5 % for anal incontinence and 3 % for combined urinary and anal incontinence. Age, social class, parity, prolonged second stage of labor, and neonatal birth weight were significantly associated with postpartum urinary incontinence (P < 0.05). On the other hand, age, parity, prolonged second stage of labor, episiotomy, and instrumental vaginal delivery were significantly associated with postpartum anal incontinence (P < 0.05).

Conclusion

Urinary and anal incontinence are common after vaginal delivery in Enugu, Nigeria. Modification of obstetric care and discouraging preventable predisposing factors for incontinence, such as prolonged second stage of labor and vaginal delivery of macrosomic babies, are measures that may reduce the prevalence of postpartum incontinence in our population.

Appendices

Appendix 1

International Consultation on Incontinence Questionnaire on Urinary Incontinence–Short Form (ICIQ-UI-SF):

1. How often do you leak urine (tick one box)?

0 □ Never

1 □ About once a week or less often

2 □ Two or three times a week

3 □ About once a day

4 □ Several times a day

5 □ All the time

II. We would like to know how much urine you think leaks. How much urine do you usually leak (whether you wear protection or not)? (Tick one box)

0 □ None

2 □ A small amount

4 □ A moderate amount

6 □ A large amount

III. Overall, how much does leaking urine interfere with your everyday life? Please circle a number between 0 (not at all) and 10 (a great deal). 0 1 2 3 4 5 6 7 8 9 10

ICIQ-UI-SF score = sum I+II+III.

ICIQ-UI-SF Score > 0 = urinary incontinence

ICIQ-UI-SF Score 1–6 = mild urinary incontinence

ICIQ-UI-SF Score >6 = moderate/severe urinary incontinence

IV. When does urine leak? (Please tick all that applies to you.)

1 □ Never—urine does not leak

2 □ Leaks before you can get to the toilet

3 □ Leaks when you cough or sneeze

4 □ Leaks when you are asleep

5 □ Leaks when you are physically active or exercising

6 □ Leaks when you have finished urinating and are dressed

7 □ Leaks for no obvious reason

8 □ Leaks all the time

The unscored self-diagnostic item IV helps indicate the patient’s perception of the cause of her incontinence.

Appendix 2

Anal Incontinence Questionnaire

• 1) Are you having uncontrolled (involuntary) leakage of feces or flatus? [ ]YES, [ ]NO

• 2) If yes which one? [ ]Faeces, [ ]Flatus, [ ]Both

• 3) Does it soil your pants? [ ]YES, [ ]NO

• 4) Does it soil your bed? [ ]YES, [ ]NO

• 5) Do you wear diapers (such as Pampers) to prevent soiling of yourself/bed? [ ]YES, [ ]NO

• 6) Does the leakage hamper your relationship with your husband? [ ]YES, [ ]NO

• 7) Does the leakage hamper sexual intercourse with your husband? [ ]YES, [ ]NO

• 8) Does the leakage cause people to avoid/isolate you? [ ]YES, [ ]NO