Urinary incontinence, faecal incontinence and pelvic organ prolapse symptoms 20–26 years after childbirth: a longitudinal cohort study

Objective

To investigate pelvic floor dysfunction (PFD; urinary incontinence (UI), faecal incontinence (FI) and prolapse) ≥20 years after childbirth and their association with delivery mode history and demographic characteristics.

Design

Cohort study with long-term follow-up.

Setting

Maternity units in Aberdeen and Birmingham (UK) and Dunedin (NZ).

Population

Women giving birth in 1993/1994.

Methods

Postal questionnaires at 20 (New Zealand) or 26 (United Kingdom) years after index birth (n = 6195). Regression analyses investigated associations between risk factors and UI, FI and prolapse symptoms.

Main Outcome Measures

Prevalence of self-reported UI, FI, ‘something coming down’ from or in the vagina (SCD), and the Pelvic Organ Prolapse-Symptom Score, and relationships with delivery method.

Results

Thirty-seven per cent (n = 2270) responded at 20/26 years, of whom 61% reported UI (59% of whom reported more severe UI), 22% FI and 17% prolapse symptoms. Having only caesarean section (CS) was associated with a significantly lower risk of UI (OR 0.63, 95% CI 0.46–0.85), FI (OR 0.63, 95% CI 0.42–0.96) and SCD (OR 0.44, 95% CI 0.27–0.74) compared to only spontaneous vaginal deliveries (SVDs). Having any forceps delivery was associated with reporting FI compared to only SVDs (OR 1.29, 95% CI 1.00–1.66), but there was no association for UI (OR 0.95, 95% CI 0.76–1.19) or SCD (OR 1.05, 95% CI 0.80–1.38). Higher current BMI was associated with all PFD outcomes.

Conclusions

Prevalence of PFD continues to increase up to 26 years following index birth, and differences were observed according to delivery mode history. Exclusive CS was associated with less risk of UI, FI and any prolapse symptoms.