Vaginal Birth Not Linked to Urinary Incontinence

Vaginal Birth Not Linked to Urinary Incontinence

NEW YORK (Reuters Health) Nov 30 - Compared with their nulliparous
sisters, women who have given birth vaginally are not at increased risk
for urinary incontinence, according to a report in the December issue of
Obstetrics and Gynecology. Rather, familial factors seem to play an
important role in determining risk.

Previous reports looking at the association between vaginal birth and
incontinence have been plagued by various methodologic issues, such as
the use of unvalidated self-report survey instruments and making no
distinction between the various types of urinary incontinence or disease
severity.

In the present study, Dr. Gunhilde M. Buchsbaum, from the University of
Rochester Medical Center in New York, and colleagues used a
comprehensive questionnaire to assess pelvic floor disorders in 143
pairs of nulliparous/parous postmenopausal sisters. Clinical evaluation
of urinary incontinence and genital prolapse was conducted in 101 of the
pairs.

The rate of urinary incontinence among the parous women was 49.7%, not
significantly higher than the 47.6% rate seen among the nulliparous
women, the authors state. Moreover, the type of incontinence and disease
severity did not differ significantly between the groups.

The same urinary status seen in one sister was often present in the
other, suggesting that there is an underlying familial disposition
toward urinary incontinence.

"A genetic predisposition for urinary incontinence needs to be explored
further because finding a genetic link to this condition would have
great implications for the direction of basic research, treatment
approaches, risk management, and potential prophylactic interventions,"
the authors state.

Obstet Gynecol 2005;106:1253-1258.

Jo,

Thanks for posting the Reuters report.

I hope the results are reproduced.

The Reuter's article stated:

Clinical evaluation
of urinary incontinence and genital prolapse was conducted in 101 of the
pairs.

I didn't see any genital prolapse results mentioned so I went to PubMed (see
abstract below) and didn't see genital prolapse results mentioned there
either.

Incidentally, Paciornik compared indigenous mothers and daughters years
ago...

I don't have the Paciornik cite - but here is what I wrote back in 2004...

BEGIN excerpt of Better aging - 'ejection' chairs (also: Squatting and
vaginal tone)


The Brazilian obstetrician Moyses Paciornik, MD studied people indigenous to
the forests near Curitiba, Brazil.

He and his team found far less uro-genital morbidity (better vaginal tone,
less uterine prolapse, less urinary incontinence) in indigenous grandmothers
than in their daughters. *He thought squatting childbirth practiced by the
grandmothers was the reason their vaginal tone was much better than in their
daughters who gave birth on their backs under modern medical supervision.

He also thought that use of the squatting position as an activity of daily
living improves vaginal tone.

(Paciornik used the opportunity of a cancer survey to measure vaginal tone
with a Kegelometer and take medical histories. *When he returned to
Curitiba, he and his son Claudio - also an obstetrician - set up a birth
center where they did only squatting births. *Claudio's video, "Birth in the
Squatting Position" is quite well known. *When The Lancet published a letter
suggesting that squatting birth is dangerous and then refused to publish the
Paciorniks' report of 25,000 squatting births, I urged Moyses to submit it
to the journal Birth where it was published with my description of the
grisly biomechanics of semistting delivery. *See Birth 1992;19(4):230-1.)

END excerpt of Better aging - 'ejection' chairs (also: Squatting and vaginal
tone)
http://groups.google.com/group/
sci.med/msg/c5637a6cb4adea17

Here again is the Reuter's report (again, thanks for posting it Jo)...

in article , Jo at
wrote on 12/20/05 3:48 AM:

Vaginal Birth Not Linked to Urinary Incontinence

NEW YORK (Reuters Health) Nov 30 - Compared with their nulliparous
sisters, women who have given birth vaginally are not at increased risk
for urinary incontinence, according to a report in the December issue of
Obstetrics and Gynecology. Rather, familial factors seem to play an
important role in determining risk.

Previous reports looking at the association between vaginal birth and
incontinence have been plagued by various methodologic issues, such as
the use of unvalidated self-report survey instruments and making no
distinction between the various types of urinary incontinence or disease
severity.

In the present study, Dr. Gunhilde M. Buchsbaum, from the University of
Rochester Medical Center in New York, and colleagues used a
comprehensive questionnaire to assess pelvic floor disorders in 143
pairs of nulliparous/parous postmenopausal sisters. Clinical evaluation
of urinary incontinence and genital prolapse was conducted in 101 of the
pairs.

The rate of urinary incontinence among the parous women was 49.7%, not
significantly higher than the 47.6% rate seen among the nulliparous
women, the authors state. Moreover, the type of incontinence and disease
severity did not differ significantly between the groups.

The same urinary status seen in one sister was often present in the
other, suggesting that there is an underlying familial disposition
toward urinary incontinence.

"A genetic predisposition for urinary incontinence needs to be explored
further because finding a genetic link to this condition would have
great implications for the direction of basic research, treatment
approaches, risk management, and potential prophylactic interventions,"
the authors state.

Obstet Gynecol 2005;106:1253-1258.

Here's the PubMed abstract for the Buchsbaum et al. study...

Obstet Gynecol. 2005 Dec;106(6):1253-8. PubMed abstract
*
Urinary incontinence in nulliparous women and their parous sisters.
Buchsbaum GM, Duecy EE, Kerr LA, Huang LS, Guzick DS.
Departments of Obstetrics and Gynecology and Biostatistics and Computational
Biology, University of Rochester Medical Center, Rochester, New York; and
Department of Urology, University of Utah, Salt Lake City, Utah.
OBJECTIVE: To investigate the role of vaginal delivery and familial factors
in the development of urinary incontinence by comparing the prevalence of
this condition in nulliparous women and their parous sisters. METHODS: A
sample of 143 pairs of nulliparous/parous postmenopausal sisters completed a
comprehensive questionnaire regarding symptoms of pelvic floor disorders. Of
these, 101 pairs underwent clinical evaluation of urinary incontinence and
genital prolapse. RESULTS: Among this sample of biological sisters, urinary
incontinence was reported by 47.6% of nulliparous women and by 49.7% of
parous women (P = .782). We found no difference in the severity or type of
urinary incontinence between these 2 groups. There was a high concordance in
continence status, however, within biological sisters. CONCLUSION: Vaginal
birth does not seem to be associated with urinary incontinence in
postmenopausal women. Considering the high concordance in continence status
between sister pairs, and considering that the majority of parous women are
continent, an underlying familial predisposition toward the development of
urinary incontinence may be present. LEVEL OF EVIDENCE: II-2.

END Buchsbaum et al. PubMed abstract

Interestingly, they do not seem to mention the parity of the parous women.

Todd

Doh!

Thanks, Jo.

In misc.kids.breastfeeding Jo wrote:
: Vaginal Birth Not Linked to Urinary Incontinence

: NEW YORK (Reuters Health) Nov 30 - Compared with their nulliparous
: sisters, women who have given birth vaginally are not at increased risk
: for urinary incontinence, according to a report in the December issue of
: Obstetrics and Gynecology. Rather, familial factors seem to play an
: important role in determining risk.

: Previous reports looking at the association between vaginal birth and
: incontinence have been plagued by various methodologic issues, such as
: the use of unvalidated self-report survey instruments and making no
: distinction between the various types of urinary incontinence or disease
: severity.

: In the present study, Dr. Gunhilde M. Buchsbaum, from the University of
: Rochester Medical Center in New York, and colleagues used a
: comprehensive questionnaire to assess pelvic floor disorders in 143
: pairs of nulliparous/parous postmenopausal sisters. Clinical evaluation
: of urinary incontinence and genital prolapse was conducted in 101 of the
: pairs.

: The rate of urinary incontinence among the parous women was 49.7%, not
: significantly higher than the 47.6% rate seen among the nulliparous
: women, the authors state. Moreover, the type of incontinence and disease
: severity did not differ significantly between the groups.

: The same urinary status seen in one sister was often present in the
: other, suggesting that there is an underlying familial disposition
: toward urinary incontinence.

: "A genetic predisposition for urinary incontinence needs to be explored
: further because finding a genetic link to this condition would have
: great implications for the direction of basic research, treatment
: approaches, risk management, and potential prophylactic interventions,"
: the authors state.

: Obstet Gynecol 2005;106:1253-1258.

Jo wrote:
Vaginal Birth Not Linked to Urinary Incontinence

[...]

The rate of urinary incontinence among the parous women was 49.7%, not
significantly higher than the 47.6% rate seen among the nulliparous
women, the authors state. Moreover, the type of incontinence and disease
severity did not differ significantly between the groups.

Yikes! Is that the rate in the general population, or was
this study looking disproportionately at women with urinary
incontinence?

Emily
--
DS1 5/02
DS2 9/05

VAGINAL BIRTH LINKED TO URINARY INCONTINENCE...

Jo posted "Vaginal Birth Not Linked To Urinary Incontinence" a Reuters story
about a December 2005 study of urinary incontinence in twins (Buchsbaum et
al.; PubMed abstract below)...

Another December 2005 study of twins (Goldberg et al.) concluded:

"Vaginal delivery mode represents a potent determinant of stress urinary
incontinence, carrying more than twice the risk of cesarean section."
--Goldberg et al. Am J Obstet Gynecol. 2005 Dec;193(6):2149-53. Pubmed
abstract

Emily wondered about the 49.7% urinary incontinence rate reported in the
other December 2005 study of twins...

Jo wrote:
Vaginal Birth Not Linked to Urinary Incontinence

[...]

The rate of urinary incontinence among the parous women was 49.7%, not
significantly higher than the 47.6% rate seen among the nulliparous
women, the authors state. Moreover, the type of incontinence and disease
severity did not differ significantly between the groups.

Yikes! Is that the rate in the general population, or was
this study looking disproportionately at women with urinary
incontinence?

Emily
--
DS1 5/02
DS2 9/05

Goldberg et al. reported a 51.8% stress urinary incontinence rate, as in,

Am J Obstet Gynecol. 2005 Dec;193(6):2149-53. PubMed abstract
*
Delivery mode is a major environmental determinant of stress urinary
incontinence: results of the Evanston-Northwestern Twin Sisters Study.
Goldberg RP, Abramov Y, Botros S, Miller JJ, Gandhi S, Nickolov A, Sherman
W, Sand PK.
Evanston Continence Center, Northwestern University Medical School,
Evanston, IL 60201, USA.
OBJECTIVE: We studied a large cohort of identical twin sisters, utilizing
the unique properties of a twin research design to explore the relationship
between obstetrical delivery mode and stress urinary incontinence. STUDY
DESIGN: An anonymous 67-item survey was completed by 271 identical twin
pairs (n = 542) at the world's largest annual gathering of twins. Logistic
regression for repeated binary measures was used to evaluate risk factors
and accounting for shared genetics within pairs. RESULTS: The twins had a
mean age of 47.1 years (range 15 to 85 years), and stress urinary
incontinence was reported by 51.8%. Stress urinary incontinence was
associated with age (P = .001), parity (P = .001), obesity (P = .002), and
birth mode, with vaginal delivery conferring a considerable increase in
stress urinary incontinence risk relative to cesarean section (odds ratio
2.28, 95% confidence interval 1.14 to 4.55, P = .019). CONCLUSION: Vaginal
delivery mode represents a potent determinant of stress urinary
incontinence, carrying more than twice the risk of cesarean section. This
study of identical twins provides new insight into the epidemiology of
female incontinence.

I liked that Goldberg et al. specifically mentioned parity.

As I noted in my first post this thread, the other study (Buchsbaum et al.;
see below) did not seem to mention parity...

Obstet Gynecol. 2005 Dec;106(6):1253-8. PubMed abstract
*
Urinary incontinence in nulliparous women and their parous sisters.
Buchsbaum GM, Duecy EE, Kerr LA, Huang LS, Guzick DS.
Departments of Obstetrics and Gynecology and Biostatistics and Computational
Biology, University of Rochester Medical Center, Rochester, New York; and
Department of Urology, University of Utah, Salt Lake City, Utah.
OBJECTIVE: To investigate the role of vaginal delivery and familial factors
in the development of urinary incontinence by comparing the prevalence of
this condition in nulliparous women and their parous sisters. METHODS: A
sample of 143 pairs of nulliparous/parous postmenopausal sisters completed a
comprehensive questionnaire regarding symptoms of pelvic floor disorders. Of
these, 101 pairs underwent clinical evaluation of urinary incontinence and
genital prolapse. RESULTS: Among this sample of biological sisters, urinary
incontinence was reported by 47.6% of nulliparous women and by 49.7% of
parous women (P = .782). We found no difference in the severity or type of
urinary incontinence between these 2 groups. There was a high concordance in
continence status, however, within biological sisters. CONCLUSION: Vaginal
birth does not seem to be associated with urinary incontinence in
postmenopausal women. Considering the high concordance in continence status
between sister pairs, and considering that the majority of parous women are
continent, an underlying familial predisposition toward the development of
urinary incontinence may be present. LEVEL OF EVIDENCE: II-2.

END Buchsbaum et al. PubMed abstract

While Buchsbaum et al. explicitly mention comparing parous vs. non-parous
twins, Goldberg et al. do not explicitly mention this as an aspect of their
study...

I will cc Goldberg et al. via .

Hopefully Dr. Goldberg or one of his colleagues will have the time to
briefly compare and contrast the two December 2005 twins studies in a
reply...

Todd

In article ,
Jo wrote:

Vaginal Birth Not Linked to Urinary Incontinence
snipped

Interesting! I got a special visit from the physio after DS2 was born to tell
me that I was at higher risk of incontinence because DS2 weighed over 4kg.

--
Chookie -- Sydney, Australia
(Replace "foulspambegone" with "optushome" to reply)

"In Melbourne there is plenty of vigour and eagerness, but there is
nothing worth being eager or vigorous about."
Francis Adams, The Australians, 1893.

"Chookie" wrote in message
...
In article ,
Jo wrote:

Vaginal Birth Not Linked to Urinary Incontinence
snipped

Interesting! I got a special visit from the physio after DS2 was born to
tell
me that I was at higher risk of incontinence because DS2 weighed over 4kg.

I was definitely urinary and fecal incontinent right after DS's birth
(episiotomy & 4th degree tear) and still have trouble with it 4 years later.
I'm convinced it was the birth of DS that did it, though some of you may get
technical and blame the episiotomy (which was very necessary, because he was
in distress).

"Chookie" wrote

Interesting! I got a special visit from the physio after DS2 was born to
tell
me that I was at higher risk of incontinence because DS2 weighed over 4kg.


Both my kids were over 4kg - DD was 4.2kg and DS was 4.4kg. I had worse
problems after DD's birth than DS's. She was born by c/s and he was a vbac!

Jean

--
DD - June '02
DS - May '05

"Chookie" wrote in message
...
In article ,
Jo wrote:

Vaginal Birth Not Linked to Urinary Incontinence
snipped

Interesting! I got a special visit from the physio after DS2 was born to
tell
me that I was at higher risk of incontinence because DS2 weighed over 4kg.

I've never had any problems ( H was ~4.5 kgs) but maybe that's down to one
of my good friends' information that she impressed upon me after H was born
(she's a physio who specialises in ante and postnatal "exercises" for women
as well as other maternity related stuff).
She was good with the gentle reminders for the following months too .... the
red spot trick sure helps the memory I had a 2nd degree tear so I had to
"go slow" with the exercises at first, but no problems with incontinence....

I'm pleased to get this ref though ... there's a few people I'd love to pass
it on to....
Amanda

In article ,
"A&G&K&H" wrote:


She was good with the gentle reminders for the following months too .... the
red spot trick sure helps the memory

Do tell. What's the red spot trick?
--
Sara
accompanied by TK, number two, due in April of 2006

Quoting, for users of Google Groups:
http://groups.google.com/support/bin...4213&topic=250