Lifestyle, not childbirth method, affects continence

Montreal-Women who are choosing to have a Caesarean section instead of a vaginal delivery to avoid incontinence later in life should opt for vaginal delivery and should focus on their lifestyle choices, which can influence the likelihood that they will develop incontinence, according to research presented here at the International Continence Society annual meeting.

"There is some increased risk of incontinence if a woman has a vaginal delivery, but it appears that as women age, mode of delivery isn't that important as a risk factor. If they are choosing to have a Caesarean section to avoid incontinence, that's not a good reason."

Researchers looked at a sample of 443 women, 40 to 79 years of age, excluding those who had previous pelvic floor surgery. Pelvic floor function, cardiovascular health, and other outcomes were investigated. Women were grouped by age and childbirth status (no births, Caesarean section, or at least one spontaneous or instrumental delivery). Participants underwent an interview involving validated pelvic floor function questionnaires and clinical examination including ICS pelvic organ prolapse quantification. Pelvic examination and interviews were repeated at year 2.

Incidence was calculated as new cases over one year among women who displayed no symptoms in year 1. Investigators calculated progression as the number of cases with deteriorating symptoms (once or more per week to daily) among women who complained of symptoms less than once a week in year 1.

A statistically significant increase in stress urinary and fecal incontinence was reported from year 1 to year 2. Women with a BMI above 30 were nearly twice as likely to have stress urinary incontinence. The risk was 1.5 times greater when BMI ranged between 25 and 30 or when waist circumference was greater than 88 cm.

Being on hormone replacement therapy increased the risk of women having urge urinary incontinence more than twofold. Women who had a BMI greater than 30 stood nearly three times the risk of having fecal incontinence for loose stool. The risk for the same condition was nearly fourfold in women whose waist circumference exceeded 88 cm.

Smoking drove the risk for fecal incontinence for formed stool to more than three times the average.

No associations between urinary and fecal incontinence prevalence, incidence, and progression were seen with age, mode of delivery, or age at first delivery.

Dr. Baessler emphasized that lifestyle choices have a greater impact on urinary and fecal incontinence than aging itself or the mode of childbirth in later years. Women need to be more watchful of health status as they age, noting the effects of weight gain, smoking, and using hormone replacement therapy.