Tag: Incontinence

Vaginal Delivery Tied to Higher Urinary Incontinence Risk

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Credit Stuart Bradford

Having a child through vaginal delivery increases the risk for long-term urinary incontinence compared to having a cesarean delivery, researchers report.

Scientists pooled data from 16 studies of women in nine countries. Some of the studies examined the effect of delivery mode on stress urinary incontinence, or the involuntary loss of urine that can occur on physical exertion or as a result of sneezing or coughing. Others looked at urge incontinence, marked by a sudden urgent desire to urinate. The analysis is in European Urology.

Tested at age 30, the risk for stress urinary incontinence was more than two and a half times as high for vaginal delivery as for cesarean section. The risk declined with age, and by age 60, the risk was 29 percent higher. Whether the vaginal delivery was spontaneous or assisted with instruments made no difference. The risk for urge incontinence was also slightly increased.

The pooled data has weaknesses. Only one of the studies, for example, was a randomized trial. And none of the studies distinguished between planned cesareans and cesareans that were performed after labor began.

“We are not advocating C-sections to prevent incontinence,” said the senior author, Dr. Kari A.O. Tikkinen, a urologist at Helsinki University Central Hospital. “The absolute risk is quite small. But women should know about this, and discuss the issue with their physicians.”

Treating Incontinence in Women with Osteoporosis

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Many women with osteoporosis also suffer from incontinence. Now a Canadian clinical trial has found that simple pelvic floor muscle training can significantly reduce leakage episodes.

Women with osteoporosis are at risk for incontinence because fractures of the lumbar spine can make them slump, putting more pressure on the pelvic floor, said Chantale Dumoulin, a professor in the faculty of medicine at the University of Montreal and senior author of the study, published online earlier this month in Menopause: The Journal of the North American Menopause Society.

In the study, 46 post-menopausal women with osteoporosis or low bone density and occasional incontinence reduced their leakage episodes by 75 percent after just 12 weekly sessions of physical therapy. A comparison group of similar women who did not get physical therapy saw no improvement, the study found. A year later, the 23 women who had three months of physical therapy maintained their improvement, while the incontinence of the 23 women in the control group, who received only education about osteoporosis, had worsened, researchers found.

The findings are important because exercise helps in the treatment of osteoporosis, but those with incontinence are prone to leaking urine when they’re physically active, deterring them from exercising.

The physical therapy regimen used in the clinical trial involved one hour-long session of physical therapy including pelvic floor muscle-training, followed by 30-minute weekly sessions for 11 weeks. Although pelvic floor muscle training is widely prescribed for the prevention of urinary incontinence in women, researchers said this was the first study to evaluate its use in older women with both osteoporosis and either stress incontinence or urge incontinence.

“The main message for women who have osteoporosis is that they should do pelvic floor exercises even if they don’t have incontinence, because fractures of the lumbar spine cause them to be slumped, and that puts more pressure on the pelvic floor,” said Dr. Dumoulin.